采用磁共振冠状动脉成像评估冠状动脉疾病：一项全国多中心试验。

Assessment of coronary artery disease using magnetic resonance coronary angiography: a national multicenter trial.

机构信息

Department of Radiology, Mie University Hospital, Tsu, Japan.

出版信息

J Am Coll Cardiol. 2010 Sep 14;56(12):983-91. doi: 10.1016/j.jacc.2010.01.071.

DOI:10.1016/j.jacc.2010.01.071

PMID:20828652

Abstract

OBJECTIVES

This national multicenter study determined the diagnostic performance of 1.5-T whole-heart coronary magnetic resonance angiography (MRA) in patients with suspected coronary artery disease (CAD).

BACKGROUND

Whole-heart coronary MRA using steady-state free precession allows noninvasive detection of CAD without the administration of contrast medium. However, the accuracy of this approach has not been determined in a multicenter trial.

METHODS

Using a 1.5-T magnetic resonance imaging unit, free-breathing steady-state free precession whole-heart coronary MRA images were acquired for 138 patients with suspected CAD at 7 hospitals. The accuracy of MRA for detecting a ≥ 50% reduction in diameter was determined using X-ray coronary angiography as the reference method.

RESULTS

Acquisition of whole-heart coronary MRA images was performed in 127 (92%) of 138 patients with an average imaging time of 9.5 ± 3.5 min. The areas under the receiver-operator characteristic curve from MRA images according to vessel- and patient-based analyses were 0.91 (95% confidence interval [CI]: 0.87 to 0.95) and 0.87 (95% CI: 0.81 to 0.93), respectively. The sensitivity, specificity, positive and negative predictive values, and accuracy of MRA according to a patient-based analysis were 88% (49 of 56, 95% CI: 75% to 94%), 72% (51 of 71, 95% CI: 60% to 82%), 71% (49 of 69, 95% CI: 59% to 81%), 88% (51 of 58, 95% CI: 76% to 95%), and 79% (100 of 127, 95% CI: 72% to 86%), respectively.

CONCLUSIONS

Non-contrast-enhanced whole-heart coronary MRA at 1.5-T can noninvasively detect significant CAD with high sensitivity and moderate specificity. A negative predictive value of 88% indicates that whole-heart coronary MRA can rule out CAD.

摘要

目的

本全国多中心研究旨在确定 1.5T 全心脏冠状动脉磁共振血管造影（MRA）在疑似冠状动脉疾病（CAD）患者中的诊断性能。

背景

使用稳态自由进动的全心脏冠状动脉 MRA 可在无需使用造影剂的情况下无创检测 CAD。然而，这种方法的准确性尚未在多中心试验中确定。

方法

在 7 家医院，使用 1.5T 磁共振成像设备对 138 例疑似 CAD 患者进行自由呼吸稳态自由进动全心脏冠状动脉 MRA 图像采集。以 X 射线冠状动脉造影作为参考方法，确定 MRA 检测直径减少≥50%的准确性。

结果

在 138 例患者中，有 127 例（92%）成功获取了全心脏冠状动脉 MRA 图像，平均成像时间为 9.5±3.5 分钟。根据血管和患者的分析，MRA 图像的受试者工作特征曲线下面积分别为 0.91（95%置信区间：0.87 至 0.95）和 0.87（95%置信区间：0.81 至 0.93）。根据患者的分析，MRA 的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 88%（49 例，95%置信区间：75%至 94%）、72%（51 例，95%置信区间：60%至 82%）、71%（49 例，95%置信区间：59%至 81%）、88%（51 例，95%置信区间：76%至 95%）和 79%（100 例，95%置信区间：72%至 86%）。