A meta-analysis shows that stress cardiac magnetic resonance imaging (MRI) ""demonstrates overall good sensitivity and specificity for the diagnosis of coronary artery disease"" in high-risk patients. A meta-analysis shows that stress cardiac magnetic resonance imaging (MRI) "demonstrates overall good sensitivity and specificity for the diagnosis of coronary artery disease" in high-risk patients.

Dr. Kiran L. Nandalur, now at the William Beaumont Hospital in Royal Oak, Michigan, and colleagues, analyzed the outcomes of 37 studies conducted between January 1990 and January 2007 comparing the accuracy of stress cardiac MRI with catheter X-ray angiography in detecting coronary artery occlusions of 50 per cent or greater.

The studies included 2191 patients, 754 of whom underwent imaging of stress-induced wall motion abnormalities and 1,516 patients who underwent perfusion imaging.

A disease prevalence of 70.5 per cent was detected in the patients who underwent stress cardiac MRI, with a sensitivity of 83 per cent and a specificity of 86 per cent.

For those who underwent perfusion imaging, a disease prevalence of 57.4 per cent was seen, with a sensitivity of 91 per cent and specificity of 81 per cent.

Dr. Nandalur told Reuters Health that for high-risk patients "stress cardiac MRI is a promising method in the detection of CAD given its excellent accuracy, lack of ionizing radiation, high spatial resolution for the detection of early signs of ischemia, and notably its noninvasive nature."

"Stress MRI appears to be most useful in the patients who would most benefit from noninvasive imaging -- those with intermediate risk -- to determine if they should undergo catheter-based angiography if the test is positive or...observation and medical management if it is negative," Dr. Nandalur said.

"Its use in a low-risk population is not established, as the use of any noninvasive imaging test as a screening tool carries a lot of risks and benefits, especially in terms of costs to the healthcare system."

"The need for noninvasive imaging with stress MRI, nuclear scans or echocardiography may not be as important in high-risk patients for the detection of luminal stenosis, but they are still important in the detection of ischemia and in the prognosis and therapeutic ramifications in these patients," Dr. Nandalur said.

The results of this meta-analysis are published in the October 2nd issue of the Journal of the American College of Cardiology.

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