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Whole-Heart Coronary Magnetic Resonance Angiography at 1.5 Tesla: Does a Blood-Pool Contrast Agent Improve Diagnostic Accuracy?

Wagner, Moritz MD*; Rösler, Roberta*; Lembcke, Alexander MD*; Butler, Craig MD; Dewey, Marc MD*; Laule, Michael MD; Huppertz, Alexander MD; Schwenke, Carsten PhD; Warmuth, Carsten PhD*; Rief, Matthias MD*; Hamm, Bernd MD*; Taupitz, Matthias MD*

doi: 10.1097/RLI.0b013e3181fac6ef
Original Article
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Objectives: To evaluate the impact of the blood-pool contrast agent gadofosveset trisodium on diagnostic accuracy of whole-heart coronary magnetic resonance angiography (CMRA) at 1.5 Tesla.

Materials and Methods: Thirty consecutive patients with suspected coronary artery disease underwent free-breathing whole-heart CMRA at 1.5 Tesla. CMRA was performed with a T2-prepared steady-state free precession sequence (unenhanced CMRA) and an inversion-recovery-prepared steady-state free precession sequence after administration of gadofosveset trisodium (contrast-enhanced CMRA). Two readers independently performed a per-segment evaluation of CMRA (8 proximal and mid coronary segments) for detection of significant stenosis (≥50%) using invasive coronary angiography as reference. Disagreement was settled by consensus reading and interobserver variability was assessed using an unweighted kappa statistic.

Results: Whole-heart CMRA was successfully performed in 27 patients. The percentage of assessable segments was significantly lower on unenhanced CMRA compared with contrast-enhanced CMRA (Reader 1: 79% [170/216] vs. 89% [192/216], respectively; Reader 2: 73% [157/216] vs. 87% [188/216], respectively; P < 0.001). Intention-to-diagnose analysis of the consensus reading yielded sensitivity, specificity, and diagnostic accuracy of unenhanced versus contrast-enhanced CMRA as follows: 73.1% versus 73.1% (P = 1.0), 68.3% versus 80.2% (P = 0.002), and 68.9% versus 79.3% (P = 0.004), respectively. The kappa value for interobserver agreement was 0.61 (95% confidence interval = 0.50–0.72) for unenhanced CMRA and 0.72 (95% confidence interval = 0.62–0.82) for contrast-enhanced CMRA.

Conclusions: The blood-pool contrast agent gadofosveset trisodium increased the number of assessable coronary segments on whole-heart CMRA in comparison to unenhanced whole-heart CMRA. The impact of gadofosveset trisodium on diagnostic accuracy, however, was only minor.

From the *Department of Radiology, Charité—Universitätsmedizin Berlin, Germany; †Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada; ‡Department of Cardiology and Angiology, Charité–Universitätsmedizin Berlin, Germany; §Imaging Science Institute Charité Berlin–Siemens, Berlin, Germany; and ¶SCO:SSis Statistical Consulting, Berlin, Germany.

Received May 3, 2010; accepted for publication (after revision) August 9, 2010.

Supported by Bayer Schering Pharma (Berlin, Germany).

This work is part of the dissertation of R. Rösler.

Address for correspondence: Moritz Wagner, MD, Department of Radiology, Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. E-mail: moritz.wagner@charite.de.

© 2011 Lippincott Williams & Wilkins, Inc.