Comparison of the Diagnostic Accuracies of 1.5T and 3T Stress Myocardial Perfusion Cardiovascular Magnetic Resonance for Detecting Significant Coronary Artery Disease

Abstract

Objective: To compare the diagnostic performance of cardiovascular magnetic resonance (CMR) myocardial perfusion at 1.5- and 3-tesla (T) for detecting significant coronary artery disease (CAD), with invasive coronary angiography (ICA) as the reference method.

Materials and methods: We prospectively enrolled 281 patients (age 62.4 ± 8.3 years, 193 men) with suspected or known CAD who had undergone 1.5T or 3T CMR and ICA. Two independent radiologists interpreted perfusion defects. With ICA as the reference standard, the diagnostic performance of 1.5T and 3T CMR for identifying significant CAD (≥ 50% diameter reduction of the left main and ≥ 70% diameter reduction of other epicardial arteries) was determined.

Results: No differences were observed in baseline characteristics or prevalence of CAD and old myocardial infarction (MI) using 1.5T (n = 135) or 3T (n = 146) systems. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) for detecting significant CAD were similar between the 1.5T (84%, 64%, 74%, 76%, and 0.75 per patient and 68%, 83%, 66%, 84%, and 0.76 per vessel) and 3T (80%, 71%, 71%, 80%, and 0.76 per patient and 75%, 86%, 64%, 91%, and 0.81 per vessel) systems. In patients with multi-vessel CAD without old MI, the sensitivity, specificity, and AUC with 3T were greater than those with 1.5T on a per-vessel basis (71% vs. 36%, 92% vs. 69%, and 0.82 vs. 0.53, respectively).

Conclusion: 3T CMR has similar diagnostic performance to 1.5T CMR in detecting significant CAD, except for higher diagnostic performance in patients with multi-vessel CAD without old MI.

Keywords: Atherosclerosis; Coronary artery disease; Invasive coronary angiography, 3 tesla; Magnetic resonance imaging; Myocardial perfusion.

Fig. 1. AUC for 1.5T and 3T CMR perfusion.

A-D. Patient-based diagnostic performance of 1.5T (A, C) and 3T (B, D) CMR perfusion. E-H. Vessel-based diagnostic performance of 1.5T (E, G) and 3T (F, H) CMR perfusion. AUC of 3T CMR perfusion (H) is significantly greater than AUC of 1.5T CMR perfusion (G) (0.79 vs. 0.67, p = 0.006) on per vessel territory in patients without old MI. AUC = area under receiver operating characteristic curve, CMR = cardiovascular magnetic resonance, MI = myocardial infarction

Fig. 2. AUC for 1.5T and 3T CMR perfusion according to CAD extent.

AUC values of both 1.5T (A, C) and 3T (B, D) CMR perfusion imaging for detecting significant CAD are greater in patients with SVD (A, B) than in those with MVD (C, D). CAD = coronary artery disease, MVD = multi-vessel disease, SVD = single-vessel disease

Fig. 3. AUC for 1.5T and 3T CMR perfusion according to combined CAD extent and presence or absence of old MI.

1.5T CMR perfusion (C, D) had significantly greater AUC values in SVD (C) than in MVD (D) in patients without old MI (p = 0.01) and 3T CMR had significantly larger AUC values in SVD (E) than in MVD (F) in patients with old MI (p = 0.007). AUC values for 3T CMR were greater than those for 1.5T CMR, except in patients with old MI and MVD (p = 0.20) (B, F), but were only significantly greater in patients without old MI and with MVD (p = 0.001) (D, H).

Fig. 4. 1.5T CMR perfusion with false negative result in MVD without MI.

67-year-old female with chest pain; 1.5T CMR stress perfusion (A), rest perfusion (B), and delayed enhancement (C) images show reversible subendocardial perfusion defect at mid-inferior left ventricular wall (arrows). ICA shows severe stenosis at middle segment of right coronary artery (arrow) (D). There was also significant stenosis at large obtuse marginal branch (arrow) (E), but it was not associated with defects in CMR perfusion images. ICA = invasive coronary angiography

Fig. 5. 3T CMR perfusion with true positive result in MVD without MI.

76-year-old male patient with hypertension and diabetes mellitus who had had 2 previous percutaneous coronary interventions; he had resting pain at epigastric area 2 or 3 times a month. 3T CMR stress perfusion (A), rest perfusion (B), and delayed (C) images show reversible perfusion defects at apical to mid-septal, inferior, and lateral and basal anterior, inferolateral, and inferior left ventricular wall (arrows) (A), corresponding to 3 vessel territories. ICA (D) shows multiple significant stenoses at distal LAD (arrowhead) and first (thin arrow), second (thick arrow), and fifth (long arrow) obtuse marginal branches, consistent with 2-vessel disease. However, given left coronary hyperdominance, 3T CMR and ICA coincide. LAD = left anterior descending coronary artery