Clinical comparison of sub-mm high-resolution non-contrast coronary CMR angiography against coronary CT angiography in patients with low-intermediate risk of coronary artery disease: a single center trial

Abstract

Background The widespread clinical application of coronary cardiovascular magnetic resonance (CMR) angiography (CMRA) for the assessment of coronary artery disease (CAD) remains limited due to low scan efficiency leading to prolonged and unpredictable acquisition times; low spatial-resolution; and residual respiratory motion artefacts resulting in limited image quality. To overcome these limitations, we have integrated highly undersampled acquisitions with image-based navigators and non-rigid motion correction to enable high resolution (sub-1 mm3) free-breathing, contrast-free 3D whole-heart coronary CMRA with 100% respiratory scan efficiency in a clinically feasible and predictable acquisition time. Objectives To evaluate the diagnostic performance of this coronary CMRA framework against coronary computed tomography angiography (CTA) in patients with suspected CAD. Methods Consecutive patients (n = 50) with suspected CAD were examined on a 1.5T CMR scanner. We compared the diagnostic accuracy of coronary CMRA against coronary CTA for detecting a ≥ 50% reduction in luminal diameter. Results The 50 recruited patients (55 ± 9 years, 33 male) completed coronary CMRA in 10.7 ± 1.4 min. Twelve (24%) had significant CAD on coronary CTA. Coronary CMRA obtained diagnostic image quality in 95% of all, 97% of proximal, 97% of middle and 90% of distal coronary segments. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were: per patient (100%, 74%, 55%, 100% and 80%), per vessel (81%, 88%, 46%, 97% and 88%) and per segment (76%, 95%, 44%, 99% and 94%) respectively. Conclusions The high diagnostic image quality and diagnostic performance of coronary CMRA compared against coronary CTA demonstrates the potential of coronary CMRA as a robust and safe non-invasive alternative for excluding significant disease in patients at low-intermediate risk of CAD.

High-resolution non-contrast free-breathing coronary cardiovascular magnetic resonance angiography for detection of coronary artery disease: validation against invasive coronary angiography

“…In a preceding study [ 8 ], compared to reference standard of CCTA, there was a high sensitivity, specificity, PPV, NPV and diagnostic accuracy of 100% (95% CI: 76–100%), 74% (95% CI: 58–85%), 55% (95% CI: 35–73%), 100% (95% CI: 88–100%) and 80% (95% CI: 67–89%) respectively, for the detection of CAD. However, that study was performed in a cohort of patients with a lower risk of and prevalence of CAD, and the comparator was CCTA, rather than the invasive gold standard of ICA [ 7 ].…”

“…This consisted of three main steps as previously described [ 8 ], which involves beat-to-beat respiratory binning and intra-bin translational motion correction using 2D iNAV [ 10 ], bin-to-bin 3D non-rigid motion correction [ 11 ] and 3D patch-based low-rank reconstruction [ 7 ].…”

“…More recently, this technique shows good diagnostic accuracy against CCTA [ 8 ], although the prevalence of CAD was relatively low. Thus, the objective of this study was to prospectively determine the diagnostic accuracy of CCMRA against the gold standard of ICA in patients with suspected CAD.…”

Coronary Magnetic Resonance Angiography in Chronic Coronary Syndromes

“…In a single centre study of 50 patients, this CMRA technique obtained diagnostic image quality in 95, 97, 97, and 90% of all, proximal, middle and distal coronary segments, respectively. Furthermore, 100, 97, 96, and 87% of left main stem, right coronary artery, left anterior descending and left circumflex artery segments, respectively on CMRA were of diagnostic image quality (Figure 10) (66). The sensitivity, FIGURE 9 | Reformatted non-contrast whole-heart sub-millimeter isotropic CMRA (left) and CCTA (right) images along the LCX (top) and RCA (bottom) are shown for a 54 year-old male patient.…”

“…specificity, positive predictive value, negative predictive value and diagnostic accuracy were as follows: per patient (100, 74, 55, 100, and 80%), per vessel (81, 88, 46, 97, and 88%) and per segment (76,95,44,99, and 94%), respectively, with an average acquisition time of 10.7 min at 0.9 mm isotropic spatial resolution (66).…”