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
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
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DOI：
10.1093/eurheartj/ehm617
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发表时间：
2008-02-01
影响因子：
39.3
通讯作者：
Johansson, Lars
中科院分区：
文献类型：
--
作者：
Schwitter, Juerg;Wacker, Christian M.;Johansson, Lars
方法和结果来自18个中心的2 41例符合条件的患者，随机给予0.0 1、0.025、0.0 5、0.075或0.1mmo1/kg Gd-DTPA-BMA(Omniscan(TM)，GE-Healthcare)，每负荷(0.42 mg/kg)和静息灌注试验。冠状动脉疾病(CAD)在定量CXA上定义为直径狭窄度<50%。5项CMR和8项SPECT研究(在225项完整研究中)由于质量不够高而被排除在分析之外(3名盲人读者对每种方式进行评分)。CMR与SPECT的比较基于受试者工作特征(ROC)分析。如果仅考虑42例患者的SPECT检查，最佳CM剂量(0.1 mmol/kg)的灌注-CMR表现与SPECT相似[ROC曲线下面积(AUC)：0.86+/-0.06 vs 0.75+/-0.09，P=0.12]；结论：在这项多中心、多供应商的试验中，ROC分析表明，灌注CMR是一种有价值的替代SPECT检测冠心病的方法，在头对头的比较中表现出同等的性能。将灌注-CMR与整个SPECT人群进行比较，表明CMR优于SPECT，这值得在更大规模的试验中进一步评估。
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 (Omniscan (TM), 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.