Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease

a systematic review and meta-analysis

Giovanni Di Leo, Erica Fisci, Francesco Secchi, Marco Alì, Federico Ambrogi, Luca Maria Sconfienza, Francesco Sardanelli

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To review the diagnostic performance of MR coronary angiography (MRCA) for coronary artery disease (CAD).

METHODS: Two independent reviewers searched on MEDLINE/EMBASE with the following inclusion criteria: 01/01/2000-03/23/2015 publication date; per-patient sensitivity/specificity for >50 % stenosis confirmed by conventional coronary angiography with raw data provided or retrievable; sample size >10. Quality was appraised using QUADAS2.

RESULTS: Nine hundred eighteen studies were retrieved, 24 of them, including 1,638 patients, were selected. Using a bivariate model, the pooled sensitivity was 89 % (95 % confidence interval 86-92 %), the pooled specificity 72 % (63-79 %). Meta-regression did not show a significant impact on sensitivity/specificity for both year of publication and disease prevalence (p ≥ 0.114). Sensitivity of contrast-enhanced examinations (95 %, 90-97 %) was higher (p = 0.005) than that of unenhanced examinations (87 %, 83-90 %). Specificity of whole-heart acquisition mode (78 %, 72-84 %) was higher (p = 0.006) than that of targeted mode (57 %, 45-69 %). Specificity at 3 T (83 %, 69-92 %) was higher (p = 0.067) than that at 1.5 T (68 %, 60-76 %). Risk of bias and concerns regarding applicability were low.

CONCLUSIONS: Sensitivity and specificity of MRCA for CAD were 89 % and 72 %, respectively. A specificity higher than 80 % may be obtained at 3 T. Whole-heart contrast-enhanced protocols should be preferred for a higher diagnostic performance.

KEY POINTS: • MRCA sensitivity and specificity for CAD are below those of CTA. • Contrast administration increased sensitivity to 95 % (90-97 %), comparable with that of CTA. • Whole-heart mode increased specificity to 78 % (72-84 %), comparable with that of CTA. • Specificity at 3 T was borderline-significantly higher (p = 0.067) than at 1.5 T. • Whole-heart contrast-enhanced protocols are the best approach for MRCA.

Original languageEnglish
Pages (from-to)3706-18
Number of pages13
JournalEuropean Radiology
Volume26
Issue number10
DOIs
Publication statusPublished - Oct 2016

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Magnetic Resonance Angiography
Coronary Angiography
Meta-Analysis
Coronary Artery Disease
Sensitivity and Specificity
Publications
Contrast Sensitivity
MEDLINE
Sample Size
Pathologic Constriction
Confidence Intervals

Keywords

  • Contrast Media
  • Coronary Angiography
  • Coronary Artery Disease
  • Coronary Stenosis
  • Humans
  • Magnetic Resonance Angiography
  • Sensitivity and Specificity
  • Journal Article
  • Meta-Analysis
  • Review

Cite this

@article{ccc6c8690d324f80b929079e4d132bd5,
title = "Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease: a systematic review and meta-analysis",
abstract = "OBJECTIVES: To review the diagnostic performance of MR coronary angiography (MRCA) for coronary artery disease (CAD).METHODS: Two independent reviewers searched on MEDLINE/EMBASE with the following inclusion criteria: 01/01/2000-03/23/2015 publication date; per-patient sensitivity/specificity for >50 {\%} stenosis confirmed by conventional coronary angiography with raw data provided or retrievable; sample size >10. Quality was appraised using QUADAS2.RESULTS: Nine hundred eighteen studies were retrieved, 24 of them, including 1,638 patients, were selected. Using a bivariate model, the pooled sensitivity was 89 {\%} (95 {\%} confidence interval 86-92 {\%}), the pooled specificity 72 {\%} (63-79 {\%}). Meta-regression did not show a significant impact on sensitivity/specificity for both year of publication and disease prevalence (p ≥ 0.114). Sensitivity of contrast-enhanced examinations (95 {\%}, 90-97 {\%}) was higher (p = 0.005) than that of unenhanced examinations (87 {\%}, 83-90 {\%}). Specificity of whole-heart acquisition mode (78 {\%}, 72-84 {\%}) was higher (p = 0.006) than that of targeted mode (57 {\%}, 45-69 {\%}). Specificity at 3 T (83 {\%}, 69-92 {\%}) was higher (p = 0.067) than that at 1.5 T (68 {\%}, 60-76 {\%}). Risk of bias and concerns regarding applicability were low.CONCLUSIONS: Sensitivity and specificity of MRCA for CAD were 89 {\%} and 72 {\%}, respectively. A specificity higher than 80 {\%} may be obtained at 3 T. Whole-heart contrast-enhanced protocols should be preferred for a higher diagnostic performance.KEY POINTS: • MRCA sensitivity and specificity for CAD are below those of CTA. • Contrast administration increased sensitivity to 95 {\%} (90-97 {\%}), comparable with that of CTA. • Whole-heart mode increased specificity to 78 {\%} (72-84 {\%}), comparable with that of CTA. • Specificity at 3 T was borderline-significantly higher (p = 0.067) than at 1.5 T. • Whole-heart contrast-enhanced protocols are the best approach for MRCA.",
keywords = "Contrast Media, Coronary Angiography, Coronary Artery Disease, Coronary Stenosis, Humans, Magnetic Resonance Angiography, Sensitivity and Specificity, Journal Article, Meta-Analysis, Review",
author = "{Di Leo}, Giovanni and Erica Fisci and Francesco Secchi and Marco Al{\`i} and Federico Ambrogi and Sconfienza, {Luca Maria} and Francesco Sardanelli",
year = "2016",
month = "10",
doi = "10.1007/s00330-015-4134-0",
language = "English",
volume = "26",
pages = "3706--18",
journal = "European Radiology",
issn = "0938-7994",
publisher = "Springer Verlag",
number = "10",

}

TY - JOUR

T1 - Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease

T2 - a systematic review and meta-analysis

AU - Di Leo, Giovanni

AU - Fisci, Erica

AU - Secchi, Francesco

AU - Alì, Marco

AU - Ambrogi, Federico

AU - Sconfienza, Luca Maria

AU - Sardanelli, Francesco

PY - 2016/10

Y1 - 2016/10

N2 - OBJECTIVES: To review the diagnostic performance of MR coronary angiography (MRCA) for coronary artery disease (CAD).METHODS: Two independent reviewers searched on MEDLINE/EMBASE with the following inclusion criteria: 01/01/2000-03/23/2015 publication date; per-patient sensitivity/specificity for >50 % stenosis confirmed by conventional coronary angiography with raw data provided or retrievable; sample size >10. Quality was appraised using QUADAS2.RESULTS: Nine hundred eighteen studies were retrieved, 24 of them, including 1,638 patients, were selected. Using a bivariate model, the pooled sensitivity was 89 % (95 % confidence interval 86-92 %), the pooled specificity 72 % (63-79 %). Meta-regression did not show a significant impact on sensitivity/specificity for both year of publication and disease prevalence (p ≥ 0.114). Sensitivity of contrast-enhanced examinations (95 %, 90-97 %) was higher (p = 0.005) than that of unenhanced examinations (87 %, 83-90 %). Specificity of whole-heart acquisition mode (78 %, 72-84 %) was higher (p = 0.006) than that of targeted mode (57 %, 45-69 %). Specificity at 3 T (83 %, 69-92 %) was higher (p = 0.067) than that at 1.5 T (68 %, 60-76 %). Risk of bias and concerns regarding applicability were low.CONCLUSIONS: Sensitivity and specificity of MRCA for CAD were 89 % and 72 %, respectively. A specificity higher than 80 % may be obtained at 3 T. Whole-heart contrast-enhanced protocols should be preferred for a higher diagnostic performance.KEY POINTS: • MRCA sensitivity and specificity for CAD are below those of CTA. • Contrast administration increased sensitivity to 95 % (90-97 %), comparable with that of CTA. • Whole-heart mode increased specificity to 78 % (72-84 %), comparable with that of CTA. • Specificity at 3 T was borderline-significantly higher (p = 0.067) than at 1.5 T. • Whole-heart contrast-enhanced protocols are the best approach for MRCA.

AB - OBJECTIVES: To review the diagnostic performance of MR coronary angiography (MRCA) for coronary artery disease (CAD).METHODS: Two independent reviewers searched on MEDLINE/EMBASE with the following inclusion criteria: 01/01/2000-03/23/2015 publication date; per-patient sensitivity/specificity for >50 % stenosis confirmed by conventional coronary angiography with raw data provided or retrievable; sample size >10. Quality was appraised using QUADAS2.RESULTS: Nine hundred eighteen studies were retrieved, 24 of them, including 1,638 patients, were selected. Using a bivariate model, the pooled sensitivity was 89 % (95 % confidence interval 86-92 %), the pooled specificity 72 % (63-79 %). Meta-regression did not show a significant impact on sensitivity/specificity for both year of publication and disease prevalence (p ≥ 0.114). Sensitivity of contrast-enhanced examinations (95 %, 90-97 %) was higher (p = 0.005) than that of unenhanced examinations (87 %, 83-90 %). Specificity of whole-heart acquisition mode (78 %, 72-84 %) was higher (p = 0.006) than that of targeted mode (57 %, 45-69 %). Specificity at 3 T (83 %, 69-92 %) was higher (p = 0.067) than that at 1.5 T (68 %, 60-76 %). Risk of bias and concerns regarding applicability were low.CONCLUSIONS: Sensitivity and specificity of MRCA for CAD were 89 % and 72 %, respectively. A specificity higher than 80 % may be obtained at 3 T. Whole-heart contrast-enhanced protocols should be preferred for a higher diagnostic performance.KEY POINTS: • MRCA sensitivity and specificity for CAD are below those of CTA. • Contrast administration increased sensitivity to 95 % (90-97 %), comparable with that of CTA. • Whole-heart mode increased specificity to 78 % (72-84 %), comparable with that of CTA. • Specificity at 3 T was borderline-significantly higher (p = 0.067) than at 1.5 T. • Whole-heart contrast-enhanced protocols are the best approach for MRCA.

KW - Contrast Media

KW - Coronary Angiography

KW - Coronary Artery Disease

KW - Coronary Stenosis

KW - Humans

KW - Magnetic Resonance Angiography

KW - Sensitivity and Specificity

KW - Journal Article

KW - Meta-Analysis

KW - Review

U2 - 10.1007/s00330-015-4134-0

DO - 10.1007/s00330-015-4134-0

M3 - Article

VL - 26

SP - 3706

EP - 3718

JO - European Radiology

JF - European Radiology

SN - 0938-7994

IS - 10

ER -