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Published in:

01-04-2011

MR and CT: When to Use Each

Authors: Aloha Meave, Moises Jimenez-Santos, Erick Alexanderson

Published in: Current Cardiovascular Imaging Reports | Issue 2/2011

Abstract

Coronary CT angiography (CCTA) and cardiovascular magnetic resonance (CMR) have evolved as quite useful techniques in chronic/acute coronary artery disease evaluation. The calcium score measurement quantifies coronary artery calcium and classifies the patients into low, intermediate, and high risk of major adverse coronary events. The CCTA value resides in the high accuracy to exclude the presence of coronary artery disease. CMR allows the acquisition of images throughout the body in any tomographic plane without limitations imposed by body habitus; also, it allows to characterize cardiovascular anatomy and structure, tissue composition, right and left ventricular function, and visualize and quantify myocardial perfusion along with viability. Since the acquisition is performed with cardiac gating in both methods, the left and right ventricular function can be calculated along with valvular characterization. Both techniques provide high-value anatomical/functional information that finally will impact on the patient’s treatment and survival.

•• Hundley WG, Bluemke DA, Finn PJ, et al. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the american college of cardiology foundation task force on expert consensus documents. J Am Coll Cardiol. 2010;55:2614–62. This manuscript is the most recent clinical document that states the best performance scenario evidence supported in clinical practice of both imaging techniques.PubMedCrossRef

•• Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, Grundy SM, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). J Am Coll Cardiol. 2007;49:378–402. This manuscript is the most recent clinical document that states the best performance scenario evidence supported in clinical practice for calcium scoring.PubMedCrossRef

•• Taylor AJ, Cequeira M, Hodgson JM, Mark D, Min J, O’Gara P, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010;56:xxx–xx. This manuscript is the most recent clinical document that states the best performance scenario evidence supported in clinical practice of both imaging techniques.CrossRef

Mowatt G, Cook JA, Hillis GS, et al. 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart. 2008;94:1386–93.PubMedCrossRef

• Meijboom WB, Meijs MF, Schuijf JD, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective multicenter, multivendor study. J Am Coll Cardiol. 2008;52:2135–44. This article represents one of the most important prospective protocols recently performed to evaluate diagnostic accuracy of 64-MDCT CCTA.PubMedCrossRef

• Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography trial. J Am Coll Cardiol. 2008;52:1724–32. This article represents one of the most important prospective protocols recently performed to evaluate diagnostic accuracy of 64-MDCT CCTA.PubMedCrossRef

• Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–36. This article represents one of the most important prospective protocols recently performed to evaluate diagnostic accuracy of 64-MDCT CCTA.PubMedCrossRef

•• Hendel RC, Patel MR, Kramer CM, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appopriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006;48:1475–97. This paper enlists the proper and, up to now, accepted indications to perform both imaging techniques.PubMedCrossRef

Pennell DJ. Cardiovascular magnetic resonance. Circulation. 2010;121:692–705.PubMedCrossRef

10.

Kilner PJ, Gatehouse PD, Firmin DN. Flow measurement by magnetic resonance: a unique asset worth optimising. J Cardiovasc Magn Reson. 2007;9:723–8.PubMedCrossRef

11.

Sadowski EA, Bennett LK, Chan MR. et al Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology. 2007;243:148–57.PubMedCrossRef

12.

Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990 s. Nature. 1993;362:801–9.PubMedCrossRef

13.

Davies MJ. The composition of coronary artery plaque. N Engl J Med. 1993;69:377–81.

14.

The quest for the vulnerable cardiac patient using computed tomography angiography. A new begining. J Cardiovascular Comput Tomogr. 2008;2:102–4.

15.

Raggi P, Gongora MC, Gopal A, Callister TQ, Budoff M, Shaw LJ. Coronary artery calcium to predict all cause mortality in elderly men and women. J Am Coll Cardiol. 2008;52(1):17–23.PubMedCrossRef

16.

Budoff MJ, Shaw LJ, Liu ST, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25 253 patients. J Am Coll Cardiol. 2007;49(18):1860–70.PubMedCrossRef

17.

Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291(2):210–5.PubMedCrossRef

18.

Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358(13):1336–45.PubMedCrossRef

19.

Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.PubMedCrossRef

20.

Polonsky T, McClelland R, Jorgensen N, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA. 2010;303:1610–6.PubMedCrossRef

21.

Min JK, Wann S. Indications for coronary and cardiac computed tomographic angiography. Cardiol Rev. 2007;15:87–96.PubMedCrossRef

22.

Abdulla J, Abildstrom SZ, Gotzsche O, Christensen E, Kober L, Torp-Pedersen C. 64-Multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis. Eur Heart J. 2007;28:3042–50.PubMedCrossRef

23.

Hamon M, Biondi-Zoccai GG, Malagutti P, et al. Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-analysis. J Am Coll Cardiol. 2006;48:1896–910.PubMedCrossRef

24.

Hamon M, Morello R, Riddell JW, Hamon M. Coronary arteries: diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography—meta-analysis. Radiology. 2007;245:720–31.PubMedCrossRef

25.

Mowatt G, Cummins E, Waugh N, et al. Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Health Technol Assess. 2008;12:iii–143.

26.

27.

•• Min J, Shaw L, Berman D. The present state of coronary computed tomography angiography. J Am Coll Cardiol. 2010;55:957–65. This paper nicely reviews the most actual evidence for the proper usage of CCTA along with a very good comparison with other imaging techniques, such as nuclear.PubMedCrossRef

28.

Sharir T, Germano G, Kang X, et al. Prediction of myocardial infarction versus cardiac death by gated myocardial perfusion SPECT: risk stratification by the amount of stress-induced ischemia and the poststress ejection fraction. J Nucl Med. 2001;42:831–7.PubMed

29.

• Hausleiter J, Meyer T, Hermann F, et al. Estimated radiation dose associated with cardiac CT angiography. JAMA. 2009;301:500–7. This article states the dose radiation in performing a CCTA and also some suggestions to diminish it.PubMedCrossRef

30.

Blankstein R, Shturman L, Rogers I, et al. Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography. Jour Am Coll Cardiol. 2009;54:1072–84.CrossRef

31.

Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol. 1999;83:897–902 [Erratum in AmJ Cardiol 1999; 84:1143].PubMedCrossRef

32.

Feuchtner G, Dichtl W, Mûller S, et al. MDCT for diagnosis of aortic regurgitation in patients referred to CT coronary angiography. AJR. 191;W1-7

33.

Abbara S, Pena A, Maurovich-Horvat P, et al. Feasibility and optimization of aortic valve planimetry with MDCT. AJR. 2007;188:356–60.PubMedCrossRef

34.

Killen R, Arnous S, Martos S, et al. Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular etiologies. Eur Radiol. 2010;20:1886–95.CrossRef

35.

Henneman MM, Schuijf JD, Jukema JW, et al. Assessment of global and regional left ventricular function and volumes with 64-slice MSCT: a comparison with 2D echocardiography. J Nucl Cardiol. 2006;13:480–7.PubMedCrossRef

36.

Juergens K, Fischbach R. Left ventricular function studied with MDCT. Eur Radiol. 2006;16:342–57.PubMedCrossRef

37.

Grothues F, Moon JCC, Bellenger NG, et al. Interstudy reproducibility of right ventricular volumes, function and mass with cardiovascular magnetic resonance. Am Heart J. 2004;147:218–23.PubMedCrossRef

38.

Guerber BL, Raman SV, Nayak K, et al. Myocardial first-pass perfusion cardiovascular magnetic resonance: history, theory and current state of the art. J Cardiovasc Magn Reson. 2008;10:18.CrossRef

39.

Schwitter J, Wacker CM, van Rossum AC, et al. MR-IMPACT: comparison of perfusion-cardiac magnetic resonancece with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J. 2008;29:480–9.PubMedCrossRef

40.

Nandalur KR, Dwamena BA, Choudhri AF, et al. Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis. J Am Coll Cardiol. 2007;50:1343–53.PubMedCrossRef

41.

Nagel E, Lehmkuhl HB, Bocksch W, et al. Noninvasive diagnosis of ischemia induced wall motion abnormalities with the use fo high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation. 1999;99:763–70.PubMed

42.

Fenchel M, Kramer U, Nael K. Cardiac magnetic resonance imaging at 3.0 T. Top Magn Reson Imaging. 2007;18(2):95–104.PubMedCrossRef

43.

Simonetti OP, Kim RJ, Fieno DS, et al. An improved MR imaging technique for the visualization of myocardial infarction. Radiology. 2001;218:215–23.PubMed

44.

Kim RJ, Albert TS, Wible JH. et al Performance of delayed-enhancement magnetic resonance imaging with gadoversetamide contrast for the detection and assessment of myocardial infarction: an international, multicenter, double-blinded, randomized trial. Circulation. 2008;117:629–37.PubMedCrossRef

45.

Kim RJ, Fieno DS, Parrish TB, et al. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation. 1999;100:1992–2002.PubMed

46.

Wu E, Ortiz JT, Tejedor P, et al. Infarct size by contrast enhanced cardiac magnetic resonance is a stronge predictor of outcomes than left ventricular ejection fraction or end-systolic volume index. Prospective cohort study. Heart. 2008;94:730–6.PubMedCrossRef

47.

Choi KM, Kim RJ, Gubernikoff G. et al Transmural extent of acute myocardial infarction predicts long term improvement in contractile function. Circulation. 2001;104:1101–7.PubMedCrossRef

48.

Tarantini G, Razzolini R, Cacciavillani L, et al. Influence of transmurality, infarct size, and severe microvascular obstruction on left ventricle remodeling and function after primary coronary angioplasty. Am J Cardiol. 2006;98:1033–40.PubMedCrossRef

49.

Wagner A, Mahrlholdt H, Holly TA, et al. Contrast-enhanced MRI and routine single-photon emisiion computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet. 2003;361:374–9.PubMedCrossRef

50.

Ibrahim T, Bulow HP, Hackl T, et al. Diagnostic value of contrast-enhanced magnetic resonance imaging and single-photon emission computed tomography for detection of myocardial necrosis early after acute myocardial infarction. J Am Coll Cardiol. 2007;49:208–16.PubMedCrossRef

51.

Abdel-Aty H, Zagrosek A, Shulz-Menger J, et al. Delayed enhancement and T2 weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction. Circulation. 2004;109:2411–6.PubMedCrossRef

52.

Abdel-Aty H, Cocker M, Meek C, et al. Edema as a very early marker for acute myocardial ischemia: a cardiovascular magnetic resonance study. J Am Coll Cardiol. 2009;53:1194–201.PubMedCrossRef

53.

Friedrich MG, Abdel-Aty H, Taylor A, et al. The salvaged area at risk in reperfused acute myocardial infarction as visualized by cardiovascular magnetic resonance. J Am Coll Cardiol. 2008;51:1581–7.PubMedCrossRef

54.

Kwong RY, Schussheim AE, Rekhraj S, et al. Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging. Circulation. 2003;107:531–7.PubMedCrossRef

55.

Greenwood PS, JP RJP, et al. Assessment of non-ST segment elevation acute coronary syndromes with cardiac magnetic resonance imaging. J Am Coll Cardiol. 2004;44:2173–81.PubMedCrossRef

56.

Bodi V, Sanchis J, Lopez-Lereu MP, et al. Usefulness of a comprehensive cardiovascular magnetic resonance imaging assessment for predicting recovery of left ventricular wall motion in the setting of myocardial stunning. J Am Coll Cardiol. 2005;46:1747–52.PubMedCrossRef

57.

•• Lockie T, Nagel E, Redwood S, et al. Use of cardiovascular magnetic resonance imaging in acute coronary syndromes. Circulation. 2009;109:1671–81. This article represents an excellent guide with wide literature support about the best usage of CMR in the acute coronary syndromes setting.CrossRef

58.

Moon JC, McKenna WJ. Mc Crohon JA, et al. Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance. J Am Coll Cardiol. 2003;41:1561–7.PubMedCrossRef

59.

Adabag AS, Maron BJ, Appelbaum E, et al. Occurrence and frequency of arrhytmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. J Am Coll Cardiol. 2008;51:1369–74.PubMedCrossRef

60.

McCrohon JA, Moon JC, Prasad SK, et al. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cadiovascular magnetic resonance. Circulation. 2003;108:54–9.PubMedCrossRef

61.

Assosmull RG, Prasad SK, Lyne J, et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol. 2006;48:1977–85.CrossRef

62.

Jain A, Tandri H, Calkins, et al. Role of cardiovascular magnetic resonance imaging in arrhythmogenic right ventricular dysplasia. J Cardiovasc Magn Reson. 2008;10:32.PubMedCrossRef

63.

Marcus FI, McKenna WJ, Sherrill D, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Proposed modification of the task force criteria. Circulation. 2010;121:000–0.CrossRef

64.

Assomull RG, Lyne JC, Keenan N, et al. The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Eur Heart J. 2007;28:1242–9.PubMedCrossRef

65.

Friedrich M, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol. 2009;53:1475–87.PubMedCrossRef

66.

Smedema JP, Snoep G, van Kroonenburgh MP, et al. Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis. J Am Coll Cardiol. 2005;45:1683–90.PubMedCrossRef

67.

Peterson SE, Selvanayagam JB, Wiesmann F, et al. Left ventricular non-compaction: insights from cardiovascular magnetic resonance imaging. J Am Coll Cardiol. 2005;46:101–5.CrossRef

68.

Gharib A, Ho V, Rosing D, et al. Coronary artery anomalies and variants: technical feasibility of assessment with coronary MR angiography at 3 T. Radiology. 2008;247:220–7.PubMedCrossRef

69.

Mavrogeni S, Manginas A, Papadakis E, et al. Magnetic resonance angiography, function and viability evaluation in patients with Kawasaki disease. J Cardiovasc Magn Reson. 2006;8:493–8.PubMedCrossRef

Title: MR and CT: When to Use Each
Authors: Aloha Meave
Moises Jimenez-Santos
Erick Alexanderson
Publication date: 01-04-2011
Publisher: Current Science Inc.
Published in: Current Cardiovascular Imaging Reports / Issue 2/2011
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI: https://doi.org/10.1007/s12410-011-9071-y

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