Detection of coronary artery stenosis with whole-heart coronary magnetic resonance angiography

OBJECTIVES We sought to determine the diagnostic performance of whole-heart coronary magnetic resonance (MR) angiography for detecting significant coronary artery disease. BACKGROUND The accuracy of whole-heart coronary MR angiography has not been determined in a large number of patients. METHODS Three-dimensional coronary MR angiograms covering the entire heart were obtained during free breathing in 131 patients. Images were acquired during a patient-specific time window in the cardiac cycle with minimal motion of the coronary artery. Significant coronary artery disease was defined on X-ray coronary angiography as a diameter reduction of >= 50% in coronary arteries with a reference diameter of >= 2 mm. RESULTS The acquisition of MR angiography was completed in 113 (86%) of 131 patients, with an imaging time averaged at 12.9 +/- 4.3 min. On a patient-based analysis, the sensitivity, specificity, positive and negative predictive value, and accuracy of MR angiography were 82% (95% confidence interval [CI] 69% to 91%), 90% (95% CI 79% to 96%), 88% (95% CI 74% to 95%), 86% (95% CI 75% to 93%), and 87% (95% CI 79% to 92%), respectively. These values in the individual segments were 78% (95% CI 68% to 85%), 96% (95% Cl 95% to 97%), 69% (95% CI 60% to 77%), 98% (95% CI 96% to 98%), and 94% (95% CI 96% to 96%). CONCLUSIONS Whole-heart coronary MR angiography allows for noninvasive detection of significant narrowing in coronary arterial segments with a diameter of 2 min with moderate sensitivity and high specificity.