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Dec 27, 2011

Paper of the Week

Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial

The Lancet, Early Online Publication, 23 December 2011doi:10.1016/S0140-6736(11)61335-4

Dr Greenwood and cols in a prospective trial studied patients with suspected angina pectoris and at least one cardiovascular risk factor were scheduled for CMR, SPECT, and invasive x-ray coronary angiography. The primary outcome was diagnostic accuracy of CMR. In the 752 recruited patients, 39% had significant CHD as identified by x-ray angiography. For multiparametric CMR the sensitivity was 86·5% (95% CI 81·8—90·1), specificity 83·4% (79·5—86·7), positive predictive value 77·2%, (72·1—81·6) and negative predictive value 90·5% (87·1—93·0). The sensitivity of SPECT was 66·5% (95% CI 60·4—72·1), specificity 82·6% (78·5—86·1), positive predictive value 71·4% (65·3—76·9), and negative predictive value 79·1% (74·8—82·8). The sensitivity and negative predictive value of CMR and SPECT differed significantly (p<0·0001 for both) but specificity and positive predictive value did not (p=0·916 and p=0·061, respectively). They concluded that cardiac magnetic resonance is the largest, prospective, real world evaluation of CMR and has established CMR's high diagnostic accuracy in coronary heart disease and CMR's superiority over SPECT. It should be adopted more widely than at present for the investigation of coronary heart disease.
Postado por às

1 comment:

  1. Ricardo ObregónJanuary 13, 2012 at 3:29 AM

    Está ampliamente demostrada la superioridad de la RMC sobre el SPECT en el diagnóstico de enfermedad coronaria. El principal problema para imponer el método radica en que los fabricantes de equipos de Camara Gamma son los mismos que fabrican los equipos de resonancia, si desarrollan la resonancia estarían compitiendo contra ellos mismos! De ahí que todavía quieran darle vida a un método con escaso futuro como el PET uniéndolo ahora a la tomografía computada (PET-CT) En definitiva, la resonancia ya es, y va quedar en el futuro, como el método diagnóstico no-invasivo mas completo para el estudio de la enfermedad coronaria.

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