Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease: a systematic review and meta-analysis.

Abstract

To review the diagnostic performance of MR coronary angiography (MRCA) for coronary artery disease (CAD). Two independent reviewers searched on MEDLINE/EMBASE with the following inclusion criteria: 01/01/2000-03/23/2015 publication date; per-patient sensitivity/specificity for >50% stenosis confirmed by conventional coronary angiography with raw data provided or retrievable; sample size >10. Quality was appraised using QUADAS2. Nine hundred eighteen studies were retrieved, 24 of them, including 1,638 patients, were selected. Using a bivariate model, the pooled sensitivity was 89% (95% confidence interval 86-92%), the pooled specificity 72% (63-79%). Meta-regression did not show a significant impact on sensitivity/specificity for both year of publication and disease prevalence (p ≥ 0.114). Sensitivity of contrast-enhanced examinations (95%, 90-97%) was higher (p = 0.005) than that of unenhanced examinations (87%, 83-90%). Specificity of whole-heart acquisition mode (78%, 72-84%) was higher (p = 0.006) than that of targeted mode (57%, 45-69%). Specificity at 3T (83%, 69-92%) was higher (p = 0.067) than that at 1.5T (68%, 60-76%). Risk of bias and concerns regarding applicability were low. Sensitivity and specificity of MRCA for CAD were 89% and 72%, respectively. A specificity higher than 80% may be obtained at 3T. Whole-heart contrast-enhanced protocols should be preferred for a higher diagnostic performance. • MRCA sensitivity and specificity for CAD are below those of CTA. • Contrast administration increased sensitivity to 95 % (90-97 %), comparable with that of CTA. • Whole-heart mode increased specificity to 78 % (72-84 %), comparable with that of CTA. • Specificity at 3T was borderline-significantly higher (p = 0.067) than at 1.5T. • Whole-heart contrast-enhanced protocols are the best approach for MRCA.