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Scientific statement on noninvasive coronary imaging released
Contains recommendations for MRA and CT angiography.
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The use of noninvasive technologies for imaging of the coronary arteries should be coupled with appropriate use and evidence-based application, according to a scientific consensus statement.
Members of the AHA Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention as well as the Councils on Clinical Cardiology and Cardiovascular Disease in the Young released the statement. The document contains recommendations for the appropriate use of noninvasive magnetic resonance angiography (MRA) and multidetector CT angiography.
Advantages and drawbacks
With MRA, according to the statement, the patient doesn’t receive a dose of ionizing radiation or ionizing contrast media. MRA may also be combined with other MRI modalities to obtain a richer data set that includes assessments of cardiac function, blood flow, viability and structure. MRA, however, tends to have lower spatial resolution relative to CTA, resulting in a lower reported sensitivity and specificity.
Multidetector CTA scanners, which contain anywhere between 16 and 256 rows of detectors, are able to produce high-quality images of coronary arterial tree. The principal drawback of multidetector CTA is the comparably high dose of ionizing radiation the patient receives during the test. Coronary CTA may also be susceptible to giving false positive results due to the presence of coronary artery calcification.
“Coronary MRA and CTA are purely diagnostic tests that do not provide an option for immediate intervention and do not presently serve as the only basis for performing [CABG],” the researchers wrote in the statement.
Among the recommendations supported by the strongest bodies of evidence — data obtained by multiple randomized clinical trials — was that “reporting of CTA and MRA results should describe any limitations to the technical quality of the examination and the size of the vessels, descriptions of coronary anomalies, coronary stenosis and significant cardiac findings not in the field of view.”
Several additional recommendations were supported by data from single randomized or nonrandomized trials, including the preference for CTA vs. MRA in symptomatic patients at immediate risk for CAD. Recommendations at the lowest evidence levels were not supported by data from randomized trials but were instead considered expert consensus, based on case studies or considered the standard of care. – by Eric Raible
This is a good summary of existing literature. The only novel or unusual feature to my reading is giving a “mandate” for multicenter/multivendor trials and giving it a Class I recommendation, as if it were a “treatment” or “procedure.” However, I understand and agree with the principle therein.
– Kim A. Williams, MD
Cardiology Today Editorial Board member
For more information:
- Circulation. 2008; doi:10.1161CIRCULATIONAHA.108.189695.