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European Heart Journal Advance Access originally published online on January 21, 2008
European Heart Journal 2008 29(4):480-489; doi:10.1093/eurheartj/ehm617
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
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MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial

Juerg Schwitter1,*, Christian M. Wacker2, Albert C. van Rossum3, Massimo Lombardi4, Nidal Al-Saadi5, Hakan Ahlstrom6, Thorsten Dill7, Henrik B.W. Larsson8, Scott D. Flamm9, Moritz Marquardt10 and Lars Johansson6

1 Division of Cardiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
2 University Hospital Wuerzburg, Wuerzburg, Germany
3 VU University Medical Center, Amsterdam, The Netherlands
4 Clinical Physiology Institute, Pisa, Italy
5 Charité, Berlin, Germany
6 University Hospital Uppsala, Uppsala, Sweden
7 Kerckhoff Clinics, Bad Nauheim, Germany
8 St Olaf University Hospital, Trondheim, Norway
9 St Luke’s Episcopal Hospital, Texas Heart Institute, Houston, TX, USA
10 GE Healthcare Buchler GmbH & Co. KG, Munich, Germany

Received 22 April 2007; revised 11 November 2007; accepted 13 December 2007; online publish-ahead-of-print 21 January 2008.

* Corresponding author. Tel: +41 44 255 38 71, Fax: +41 44 255 44 01, Email: juerg.schwitter{at}usz.ch

See page 434 for the editorial comment on this article (doi:10.1093/eurheartj/ehn030)

Aims: To determine in a multicentre, multivendor trial the diagnostic performance for perfusion-cardiac magnetic resonance (perfusion-CMR) in comparison with coronary X-ray angiography (CXA) and single-photon emission computed tomography (SPECT).

Methods and results: Of 241 eligible patients from 18 centres, 234 were randomly dosed with 0.01, 0.025, 0.05, 0.075, or 0.1 mmol/kg Gd-DTPA-BMA (OmniscanTM, GE-Healthcare) per stress (0.42 mg/kg adenosine) and rest perfusion study. Coronary artery disease (CAD) was defined as diameter stenosis ≥50% on quantitative CXA. Five CMR and eight SPECT studies (of 225 complete studies) were excluded from analyses due to inadequate quality (three blinded readers scored per modality). The comparison of CMR vs. SPECT was based on receiver operating characteristic (ROC) analysis. Perfusion-CMR at the optimal CM dose (0.1 mmol/kg) had similar performance as SPECT, if only the SPECT studies of the 42 patients with this dose were considered [area under ROC curve (AUC): 0.86 ± 0.06 vs. 0.75 ± 0.09 for SPECT, P = 0.12]; however, diagnostic performance of perfusion-CMR was better vs. the entire SPECT population (AUC: 0.67 ± 0.05, n = 212, P = 0.013).

Conclusions: In this multicentre, multivendor trial, ROC analyses suggest perfusion-CMR as a valuable alternative to SPECT for CAD detection showing equal performance in the head-to-head comparison. Comparing perfusion-CMR with the entire SPECT population suggests CMR superiority over SPECT, which warrants further evaluation in larger trials.

Key Words: Magnetic resonance imaging • Single-photon emission computed tomography • Coronary artery disease • Contrast medium • Quantitative X-ray coronary angiography • Myocardial perfusion


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