Department of Radiology, Charité Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Ann Intern Med. 2010 Feb 2;152(3):167-77. doi: 10.7326/0003-4819-152-3-201002020-00008.
Two imaging techniques, multislice computed tomography (CT) and magnetic resonance imaging (MRI), have evolved for noninvasive coronary angiography.
To compare CT and MRI for ruling out clinically significant coronary artery disease (CAD) in adults with suspected or known CAD.
MEDLINE, EMBASE, and ISI Web of Science searches from inception through 2 June 2009 and bibliographies of reviews.
Prospective English- or German-language studies that compared CT or MRI with conventional coronary angiography in all patients and included sufficient data for compilation of 2 x 2 tables.
2 investigators independently extracted patient and study characteristics; differences were resolved by consensus.
89 and 20 studies (comprising 7516 and 989 patients) assessed CT and MRI, respectively. Bivariate analysis of data yielded a mean sensitivity and specificity of 97.2% (95% CI, 96.2% to 98.0%) and 87.4% (CI, 84.5% to 89.8%) for CT and 87.1% (CI, 83.0% to 90.3%) and 70.3% (CI, 58.8% to 79.7%) for MRI. In studies that included only patients with suspected CAD, sensitivity and specificity of CT were 97.6% (CI, 96.1% to 98.5%) and 89.2% (CI, 86.0% to 91.8%). Covariate analysis yielded a significantly higher sensitivity for CT scanners with more than 16 rows (98.1% [CI, 97.0% to 99.0%]; P < 0.050) than for older-generation scanners (95.6% [CI, 94.0% to 97.0%]). Heart rates less than 60 beats/min during CT yielded significantly better values for sensitivity than did higher heart rates (P < 0.001).
Few studies investigated coronary angiography with MRI. Only 5 studies were direct head-to-head comparisons of CT and MRI. Covariate analyses explained only part of the observed heterogeneity.
For ruling out CAD, CT is more accurate than MRI. Scanners with more than 16 rows improve sensitivity, as do slowed heart rates.
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两种非侵入性冠状动脉造影成像技术，多层螺旋 CT（CT）和磁共振成像（MRI），已经发展起来。
比较 CT 和 MRI 用于排除疑似或已知冠心病（CAD）成人的临床显著 CAD。
从 2009 年 6 月 2 日起通过 MEDLINE、EMBASE 和 ISI Web of Science 搜索，并查阅综述的参考文献。
前瞻性英语或德语研究，比较 CT 或 MRI 与所有患者的常规冠状动脉造影，并包含足够的数据以编制 2 x 2 表。
2 位研究者独立提取患者和研究特征；差异通过共识解决。
分别评估 89 项和 20 项研究（包括 7516 例和 989 例患者）的 CT 和 MRI。对数据进行双变量分析，得出 CT 的平均敏感性和特异性分别为 97.2%（95% CI，96.2%至 98.0%）和 87.4%（CI，84.5%至 89.8%），MRI 为 87.1%（CI，83.0%至 90.3%）和 70.3%（CI，58.8%至 79.7%）。在仅包括疑似 CAD 患者的研究中，CT 的敏感性和特异性分别为 97.6%（CI，96.1%至 98.5%）和 89.2%（CI，86.0%至 91.8%）。协变量分析表明，具有 16 排以上的 CT 扫描仪的敏感性显著更高（98.1%[CI，97.0%至 99.0%]；P<0.050），而较旧一代的扫描仪敏感性较低（95.6%[CI，94.0%至 97.0%]）。CT 时心率低于 60 次/分钟时，敏感性值明显优于高心率（P<0.001）。
少数研究调查了 MRI 下的冠状动脉造影。只有 5 项研究是 CT 和 MRI 的直接头对头比较。协变量分析仅解释了部分观察到的异质性。
对于排除 CAD，CT 比 MRI 更准确。具有 16 排以上的扫描仪可提高敏感性，减慢心率也可提高敏感性。
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