Abstract
ObjectivesTo determine and compare the diagnostic performance of stress myocardial perfusion imaging (MPI) for the diagnosis of obstructive coronary artery disease (CAD), using conventional coronary angiography (CCA) as the reference standard.MethodsWe searched Medline and Embase for literature that evaluated stress MPI for the diagnosis of obstructive CAD using magnetic resonance imaging (MRI), contrast-enhanced echocardiography (ECHO), single-photon emission computed tomography (SPECT) and positron emission tomography (PET).ResultsAll pooled analyses were based on random effects models. Articles on MRI yielded a total of 2,970 patients from 28 studies, articles on ECHO yielded a sample size of 795 from 10 studies, articles on SPECT yielded 1,323 from 13 studies. For CAD defined as either at least 50 %, at least 70 % or at least 75 % lumen diameter reduction on CCA, the natural logarithms of the diagnostic odds ratio (lnDOR) for MRI (3.63; 95 % CI 3.26–4.00) was significantly higher compared to that of SPECT (2.76; 95 % CI 2.28–3.25; P = 0.006) and that of ECHO (2.83; 95 % CI 2.29–3.37; P = 0.02). There was no significant difference between the lnDOR of SPECT and ECHO (P = 0.52).ConclusionOur results suggest that MRI is superior for the diagnosis of obstructive CAD compared with ECHO and SPECT. ECHO and SPECT demonstrated similar diagnostic performance.Key Points• MRI can assess myocardial perfusion.• MR perfusion diagnoses coronary artery disease better than echocardiography or SPECT.• Echocardiography and SPECT have similar diagnostic performance.• MRI can save coronary artery disease patients from more invasive tests.• MRI and SPECT show evidence of publication bias, implying possible overestimation.Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-012-2434-1) contains supplementary material, which is available to authorized users.
Highlights
Coronary artery disease (CAD) is one of the major causes of mortality and morbidity throughout the world [1]
Our results suggest that magnetic resonance imaging (MRI) is superior for the diagnosis of obstructive CAD compared with ECHO and single-photon emission computed tomography (SPECT)
We searched Medline and Embase for English-language literature published between January 2000 and May 2011 evaluating the presence of obstructive CAD by stress perfusion imaging tests, namely MRI, contrast-enhanced ECHO, SPECT and positron emission tomography (PET)
Summary
Coronary artery disease (CAD) is one of the major causes of mortality and morbidity throughout the world [1]. Systematic reviews and metaanalyses have been published for most of the techniques but none of these reviews compare MPI techniques [6,7,8,9,10]. Studies with verification bias are often included in these reports which may have overestimated the sensitivity and underestimated the specificity of the tests considered. To overcome these problems a systematic review of different MPI techniques is required using the same selection criteria and methods of analysis for all techniques and excluding studies with (potential) verification bias, to make a fair comparison between these imaging tests
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
