{"id":1010,"date":"2012-02-19T12:09:28","date_gmt":"2012-02-19T11:09:28","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=1010"},"modified":"2015-11-12T15:50:13","modified_gmt":"2015-11-12T14:50:13","slug":"ce-marc-shows-strength-of-perfusion-mri","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2012\/02\/19\/ce-marc-shows-strength-of-perfusion-mri\/","title":{"rendered":"CE-MARC shows strength of perfusion MRI"},"content":{"rendered":"

In recent years it has become clear that treatment of coronary artery disease – and in particular percutaneous coronary intervention (PCI) – must be guided by imaging techniques that give some information on the extent of myocardial ischaemia. \u00a0While nuclear medicine techniques such as SPECT (single-photon emission computed tomography) have become widespread, and have a high negative predictive value, they still expose patients to ionising radiation. \u00a0Furthermore, the sensitivity of SPECT has been noted to vary. \u00a0Cardiac Magnetic Resonance Imaging (MRI), is a potential alternative that uses no ionising radiation, provides high-resolution images, and is capable of assessing various cardiac parameters in one comprehensive examination.<\/p>\n

The CE-MARC study (Clinical Evaluation of MAgnetic Resonance imaging in Coronary heart disease) was designed to provide a real-world comparison of stress perfusion MRI and SPECT, using coronary angiography as the gold standard. \u00a0752 patients with stable angina (not including those who had had previous bypass surgery) were recruited over a three year period. \u00a0Of these, 378 were assigned to CMR then SPECT, while 374 were assigned to SPECT then CMR. \u00a0Overall 39% of patients had significant coronary disease as detected by X-ray angiography. \u00a0For multiparametric CMR the sensitivity was 86\u00b75% (95% CI 81\u00b78\u201490\u00b71), and specificity 83\u00b74% (79\u00b75\u201486\u00b77), compared to the sensitivity of SPECT which was 66\u00b75% (95% CI 60\u00b74\u201472\u00b71), and specificity 82\u00b76% (78\u00b75\u201486\u00b71). \u00a0The sensitivity and negative predictive value of CMR and SPECT differed significantly (p<0\u00b70001 for both) but specificity and positive predictive value did not (p=0\u00b7916 and p=0\u00b7061, respectively).<\/p>\n

Conclusions:<\/strong><\/p>\n

This large, prospective trial of stress perfusion MRI shows its high diagnostic accuracy and superiority over SPECT imaging. \u00a0As such CE-MARC is a landmark trial that is likely to challenge the current dominance of nuclear imaging for the assessment of myocardial perfusion.<\/p>\n