Diagnostic performance of coronary magnetic resonance anglography as compared against conventional x-ray angiography - A meta-analysis

OBJECTIVES This study was designed to define the current role of coronary magnetic resonance angiography (CMRA) for the diagnosis of coronary artery disease (CAD). BACKGROUND Coronary magnetic resonance angiography has been proposed as a promising noninvasive method for diagnosis of CAD, but individual studies evaluating its clinical value have been of limited sample size. METHODS We identified all studies (MEDLINE and EMBASE) that evaluated CAD by both CMRA and conventional angiography in 10 subjects during the period 1991 to January 2004. We recorded true and false positive and true and false negative CMRA assessments for detection of CAD using X-ray angiography as the reference standard. Analysis was done at segment, vessel, and subject level. RESULTS We analyzed 39 studies (41 separate comparisons). Across 25 studies (27 comparisons) with data on 4,620 segments (993 subjects), sensitivity and specificity for detection of CAD were 73% and 86%, respectively. Vessel-level analyses (16 studies, 2,041 vessels) showed sensitivity 75% and specificity 85%. Subject-level analyses (13 studies, 607 subjects) showed sensitivity 88% and specificity 56%. At the segment level, sensitivity was 69% to 79% for all but the left circumflex (61%) coronary artery; specificity was 82% to 91%. There was considerable between-study heterogeneity, but weighted summary receiver-operating characteristic curves agreed with these estimates. There were no major differences between subgroups based on technical or population characteristics, year of publication, reported blinding, or sample size. CONCLUSIONS In evaluable segments of the native coronary arteries, CMRA has moderately high sensitivity for detecting significant proximal stenoses and may have value for exclusion of significant multivessel CAD in selected subjects considered for diagnostic catheterization. (C) 2004 by the American College of Cardiology Foundation.