Institute of Diagnostic Radiology, University Hospital Zurich, Raemistr 100, 8091, Zurich, Switzerland.
Int J Cardiovasc Imaging. 2010 Jun;26(5):579-90. doi: 10.1007/s10554-010-9595-2. Epub 2010 Feb 10.
To prospectively compare the diagnostic performance of low-dose computed tomography coronary angiography (CTCA) and cardiac magnetic resonance imaging (CMR) and combinations thereof for the diagnosis of significant coronary stenoses. Forty-three consecutive patients with known or suspected coronary artery disease underwent catheter coronary angiography (CA), dual-source CTCA with prospective electrocardiography-gating, and cardiac CMR (1.5 Tesla). The following tests were analyzed: (1) low-dose CTCA, (2) adenosine stress-rest perfusion-CMR, (3) late gadolinium enhancement (LGE), (4) perfusion-CMR and LGE, (5) low-dose CTCA combined with perfusion-CMR, (5) low-dose CTCA combined with late gadolinium-enhancement, (6) low-dose CTCA combined with perfusion-CMR and LGE. CA served as the standard of reference. CA revealed >50% diameter stenoses in 68/129 (57.7%) coronary arteries in 29/43 (70%) patients. In the patient-based analysis, sensitivity, specificity, NPV and PPV of low-dose CTCA for the detection of significant stenoses were 100, 92.9, 100 and 96.7%, respectively. For perfusion-CMR and LGE, sensitivity, specificity, NPV, PPV, and accuracy were 89.7, 100, 82.4, and 100%, respectively. In the artery-based analysis, sensitivity and NPV of low-dose CTCA was significantly (P < 0.05) higher than that of perfusion-CMR and LGE. All combinations of low-dose CTCA and perfusion-CMR and/or LGE did not improve the diagnostic performance when compared to low-dose CTCA alone. Taking CA as standard of reference, low-dose CTCA outperforms CMR with regard to sensitivity and NPV, whereas CMR is more specific and has a higher PPV than low-dose CTCA.
前瞻性比较低剂量 CT 冠状动脉成像（CTCA）和心脏磁共振成像（CMR）及其组合对诊断有意义的冠状动脉狭窄的诊断性能。
连续 43 例已知或疑似冠状动脉疾病的患者接受了导管冠状动脉造影（CA）、前瞻性心电图门控双源 CTCA 和心脏 CMR（1.5T）检查。分析了以下检查：（1）低剂量 CTCA，（2）腺苷负荷-静息灌注-CMR，（3）延迟钆增强（LGE），（4）灌注-CMR 和 LGE，（5）低剂量 CTCA 联合灌注-CMR，（5）低剂量 CTCA 联合延迟钆增强，（6）低剂量 CTCA 联合灌注-CMR 和 LGE。CA 作为参考标准。CA 在 43 例患者中的 29 例（70%）中发现 129 条冠状动脉中有 68 条（57.7%）存在>50%的直径狭窄。在基于患者的分析中，低剂量 CTCA 检测有意义狭窄的敏感性、特异性、NPV 和 PPV 分别为 100%、92.9%、100%和 96.7%。对于灌注-CMR 和 LGE，敏感性、特异性、NPV、PPV 和准确性分别为 89.7%、100%、82.4%、100%和 97.0%。在基于动脉的分析中，低剂量 CTCA 的敏感性和 NPV 明显（P<0.05）高于灌注-CMR 和 LGE。与单独使用低剂量 CTCA 相比，低剂量 CTCA 与灌注-CMR 和/或 LGE 的所有组合并未提高诊断性能。以 CA 为参考标准，低剂量 CTCA 在敏感性和 NPV 方面优于 CMR，而 CMR 在特异性和 PPV 方面优于低剂量 CTCA。
