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Combined Non-Invasive Anatomic and Functional assessment with MSCT and MRI for the Detection of Significant Coronary Artery Disease in Patients with an Intermediate Pre-Test Likelihood
  1. Jacob M Van Werkhoven1,*,
  2. Mark W Heijenbrok2,
  3. Joanne D Schuijf1,
  4. J Wouter Jukema1,
  5. Ernst E Van der Wall1,
  6. Joop HM Schreur2,
  7. Jeroen J Bax1
  1. 1 Leiden University Medical Center, Netherlands;
  2. 2 Medical Center Haaglanden, Netherlands
  1. Correspondence to: Jacob Van Werkhoven, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands; j.m.van_werkhoven{at}lumc.nl

Abstract

Objectives: To compare magnetic resonance myocardial perfusion imaging (MRI) to anatomical assessment with multi-slice computed tomography coronary angiography (MSCT) and conventional coronary angiography.

Design and patients: In this prospective study, 53 patients (60% male, average age 57±9 years, 83% intermediate pre-test likelihood) underwent 1.5 Tesla MRI, 64-slice MSCT, and conventional coronary angiography.

Main outcome measures: The presence of significant stenosis (≥50% luminal narrowing) was determined on MSCT and conventional coronary angiography. Ischemia on MRI was defined as a stress perfusion abnormality in the absence of delayed contrast enhancement.

Results: A significant stenosis was observed on MSCT in 15 (28%) patients, while ischemia on MRI was observed in 19 (36%). In the 38 patients without significant stenosis on MSCT, normal perfusion was observed in 29 (76%). In patients with a significant stenosis on MSCT, ischemia was observed in 10 (67%). In all patients without significant stenosis on MSCT and normal perfusion on MRI (n=29), significant stenosis was absent on conventional coronary angiography. All patients with both MSCT and MRI abnormal (n=10) had significant stenoses on conventional coronary angiography.

Conclusion: The anatomic and functional data obtained with MSCT and MRI is complementary for the assessment of CAD. These findings support the sequential or combined assessment of anatomy and function.

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