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Published on: February 10, 2012
Clinical utility of computed tomography and magnetic resonance techniques for noninvasive coronary angiography
Matthew J Budoff1, Stephan Achenbach, Andre Duerinckx
1Division of Cardiology, Saint John's Cardiovascular Research Center, Harbor-UCLA Medical Center Research and Education Institute, Torrance, California 90502, USA. Budoff@flash.net
Insights
Noninvasive coronary angiography methods like electron beam angiography (EBA) show promise for detecting coronary artery disease (CAD). While not a complete replacement for conventional angiography, these techniques offer safer, cost-effective patient options.
Area of Science:
- Cardiovascular imaging
- Medical diagnostics
- Radiology
Background:
- Conventional coronary angiography (CCA) is invasive and costly.
- Noninvasive coronary angiography (NIC) methods are advancing.
- NIC aims to augment or replace CCA for diagnosing coronary artery disease (CAD).
Purpose of the Study:
- To review literature on noninvasive coronary angiography (NIC).
- Focus on electron beam angiography (EBA), magnetic resonance angiography (MRA), and spiral computed tomography (CT).
- Evaluate these methods for visualizing coronary artery obstructions.
Main Methods:
- Conducted MEDLINE searches for NIC studies.
- Included magnetic resonance imaging (MRI), multi-row detector spiral computed tomography (MDCT), and electron beam tomography (EBT).
- Performed weighted analysis to determine sensitivity and specificity.
Main Results:
- Electron beam angiography (EBA) showed 87% sensitivity and 91% specificity for obstructive CAD.
- Multi-row detector spiral CT (MDCT) had 59% sensitivity and 89% specificity, improving with newer devices.
- Magnetic resonance angiography (MRA) demonstrated 77% sensitivity and 71% specificity.
Conclusions:
- Noninvasive coronary angiography (NIC) is evolving and not yet a universal alternative to CCA.
- EBA, MDCT, and MRA are used clinically at specialized centers.
- Selective NIC use can be cost-effective and safer for patients deciding on treatment.
Objective:
The purpose of this study was to provide a comprehensive review of the literature relating to electron beam angiography (EBA), magnetic resonance angiography, and spiral computed tomography, currently the three most promising noninvasive methods to visualize obstructions in the coronary tree.
Background:
Given the high costs and invasiveness of coronary angiography, there is increased interest in noninvasive coronary angiography, which has made great strides to become a clinically useful tool to augment conventional coronary angiography (CCA).
Methods:
MEDLINE searches were performed to include all articles related to noninvasive angiography utilizing either magnetic resonance imaging (MRI), multi-row detector spiral computed tomography (MDCT), and electron beam tomography (EBT). Weighted analysis was performed to define the published sensitivity and specificity for each technique.
Results:
Electron beam angiography (EBA) provides an overall sensitivity of 87% and specificity of 91% for the detection of obstructive coronary artery disease (CAD). Four-level MDCT data demonstrated an overall sensitivity of 59% and specificity of 89%, with higher accuracy in two recent studies of 16-level detector devices. Magnetic resonance angiography demonstrated sensitivity for detection of obstructive CAD of 77% and specificity of 71%.
Conclusions:
Noninvasive coronary angiography is a rapidly developing technique and currently not an alternative to CCA in all cases. All three methods are currently used clinically in certain centers with appropriate expertise. Selective use should prove both cost-effective and provide a safer, less-invasive method for patients to determine the need for medical versus revascularization therapy.
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