CE-MARC shows strength of perfusion MRI

19 February 2012 by Alistair C Lindsay

In recent years it has become clear that treatment of coronary artery disease—and in particular percutaneous coronary intervention (PCI)—must be guided by imaging techniques that give some information on the extent of myocardial ischaemia. While nuclear medicine techniques such as SPECT (single-photon emission CT) have become widespread, and have a high negative predictive value, they still expose patients to ionising radiation. Furthermore, the sensitivity of SPECT has been noted to vary. Cardiac MRI, is a potential alternative that uses no ionising radiation, provides high-resolution images, and is capable of assessing various cardiac parameters in one comprehensive examination.

The CE-MARC study (Clinical Evaluation of MAgnetic Resonance imaging in Coronary heart disease) was designed to provide a real-world comparison of stress perfusion MRI and SPECT, using coronary angiography as the gold standard. Seven hundred and fifty-two patients with stable angina (not including those who had had previous bypass surgery) were recruited over a 3-year period. Of these, 378 were assigned to CMR then SPECT, while 374 were assigned to SPECT then CMR. Overall 39% of patients had significant coronary disease as detected by x-ray angiography. For multiparametric CMR the sensitivity was 86.5% (95% CI 81.8 to 90.1), and specificity …