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• W43403350 abstract "Non-invasive cardiac imaging with magnetic resonance (CMR) and multi-detector computed tomography (MDCT) has progressed rapidly within the past few years and will most likely become and integral part of the diagnostic work-up of patients with known or suspected coronary artery disease (CAD). In this article, the capabilities, advantages and disadvantages of CMR and MDCT-coronary angiography will be presented and the rationale for their utilisation will be discussed. Therefore, the requirements for a modern management of patients with CAD will be first analysed. Invasive coronary angiography studies in the pre-interventional area showed, that CAD progresses through repeated ruptures of vulnerable plaques. Current imaging techniques are not developed enough for a reliable characterisation of vulnerable plaques in the coronary system. However, vulnerable plaques are defined not only by composition, but also by their stenosis severity, since high-grade stenosis are associated with an increased risk of rupture and occlusion. These severe, haemodynamically significant coronary lesions can be detected by CMR perfusion imaging or by anatomical depiction by MDCT-coronary angiography. In large CMR perfusion multicenter trials, the sensitivity and specificity for detection of ≥50% diameter stenoses by CMR perfusion imaging ranges from 86–91% and 65–84%, respectively. In “MR-IMPACT”, the MR perfusion technique was superior to single photon-emission computed tomography (91% and 67% with CMR versus 74% and 57% with SPECT) with exclusion rates of 2.2% and 3.6%, respectively. Advantages of CMR are: high diagnostic performance as proven in multicenter trials, no harmful radiation exposure, and thus repeatability, and the CMR examination is safe and lasts 1–1.5 hours only. For MDCT-coronary angiography, one multicenter trial is available and reported an exclusion rate of 42% of patients because of inadequate image quality, and thus, could not confirm the single center studies. In single center studies sensitivities and specificities range from 82–95% and 86–98%, respectively. MDCT coronary angiography is relatively easy to apply and lasts about 15 minutes. Due to the radiation exposure, MDCT-coronary angiography seems not ideal for monitoring CAD. In current practice, patients are examined only after symptoms occur (re-active strategy). With this re-active strategy, about every second cardiac death occurs before the patient reaches the hospital or the catheter-lab for invasive treatment (statistics USA 2004). The goal of an active strategy is therefore to detect high-risk patients earlier by modern diagnostic techniques and to perform revascularisations in these patients before potentially deadly infarcts occur. Since CAD is a chronic disease, an active strategy would involve a repeated risk stratification. For such an active strategy, an ideal test should therefore be highly accurate, non-harmful, and thus, repeatable, and unexpensive." @default.
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• W43403350 date "2007-04-27" @default.
• W43403350 modified "2023-10-16" @default.
• W43403350 title "Abklärung der koronaren Herzkrankheit mittels Herz-MR oder Mehrzeilen-CT" @default.
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• W43403350 doi "https://doi.org/10.4414/cvm.2007.01241" @default.
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