Diagnostic accuracy of combined dipyridamole stress perfusion and delayed enhancement cardiovascular magnetic resonance imaging for detection of coronary artery disease

Background: The diagnosis of coronary artery disease (CAD) is one of the most common clinical issues that face medical practitioners. Myocardial ischemia can be noninvasively assessed with cardiovascular magnetic resonance imaging (CMRI), which has become an emerging modality. Objective: Determine the accuracy of dipyridamole stress CMRI by using stress and rest perfusion combined with delayed enhancement imaging for detecting CAD. Methods: Thirty-nine patients (24 men, 15 women; mean age 64±11.4 years) who had experienced prior myocardial infarction or had suspected CAD were enrolled. Dipyridamole stress CMRI with subsequent coronary angiography was performed within a mean time interval of 16 days (range: 1-30 days). The dipyridamole stress CMR protocol included stress and rest perfusion followed by delayed enhancement imaging. Per-vessel analysis was done according to 17-segment model recommendation by the American Heart Association. Results: Coronary angiography depicted significant coronary artery stenosis (>70% stenosis of major epicardial artery) in 26 patients (55 coronary arteries). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the combined stress and rest perfusion with delayed enhancement imaging for detection of significant coronary artery stenosis were 76-96%, 79-96%, 87-93%, 83-96%, and 85-95%, in left anterior descending, left circumflex, and right coronary arteries, respectively. Without delayed enhancement imaging, stress and rest perfusion produced slightly lower sensitivity (69-92%), specificity (73- 96%), positive predictive value (79-93%), negative predictive value (80-92%), and accuracy (79-92%). Conclusion: Dipyridamole stress CMRI combined with delayed enhancement imaging yielded high diagnostic accuracy for the detection of coronary artery disease. This modality allows the clinical application for detection of CAD in selected group of patients.