C-5 | Cardiac Imaging Titans: A Comprehensive Meta-Analysis Comparing Computed Tomography Coronary Angiography (CTA) and Cardiac Magnetic Resonance (CMR) for Precision Diagnosis of Coronary Artery Disease (CAD)

In a dynamic era of cardiac imaging, computed tomography angiography (CTA) and cardiac magnetic resonance (CMR), vie for supremacy in diagnosing coronary artery disease (CAD). Our study evaluates their diagnostic precision, accuracy, and clinical value, offering insight to guide the choice for optimal CAD evaluation. We scoured PubMed, clinical trials, and Google Scholar databases until March 2023, yielding 252 studies and selecting five pertinent studies comparing CMR against CTA for CAD assessment. Animal studies, expert opinions, and reviews were excluded. According to Figure 1, CMR offers higher sensitivity (67%) than SPECT (59%) but lower specificity (61% vs. 72%) as per MR IMPACT trial in CAD diagnosis. VERDICT trial reports a robust negative predictive value (NPV 90.9%), positive predictive value (PPV 87.9%), sensitivity (96.5%), and specificity (72.4%) for CTA. Chen et al. report high sensitivity (93%) and specificity (96%) for CMR, while CTA boasts higher sensitivity (98%) and NPV (99%). Westra et al. finds CT quantitative flow ratio (CT-QFR) derived from coronary CTA outperforming CMR in accuracy (77.0% vs. 65.5%) with comparable PPV and LR+, plus a trend toward higher sensitivity. In the CMR group, the results for sensitivity, specificity, PPV, and NPV were 41%, 84%, 62%, and 68%. Despite variability among trials, CTA consistently outperformed CMR in terms of sensitivity. Although the Westra et al. trial reported lower sensitivity for CT QFR, it still exhibited better performance than CMR. Therefore, CTA emerges as a superior modality for ruling out CAD, offering better NPV and higher accuracy compared to CMR.