Comparison of Stress Perfusion MRI and SPECT for Detection of Myocardial Ischemia in Patients With Angiographically Proven Three-Vessel Coronary Artery Disease

OBJECTIVE: This study aims to evaluate the diagnostic value of stress perfusion MRI and SPECT for the detection of myocardial ischemia in patients with angiographically proven three-vessel coronary artery disease. MATERIALS AND METHODS: We retrospectively enrolled 78 patients with angiographically proven three-vessel coronary artery disease who underwent both stress perfusion MRI and SPECT within 4 weeks of each other. Image analysis was performed to compare the diagnostic value of stress perfusion MRI with that of SPECT; coronary angiography was used as the reference standard. The statistical significance of the difference between stress perfusion MRI and SPECT was evaluated by use of the paired McNemar test. RESULTS: Myocardial ischemia was detected significantly more often by stress perfusion MRI than by SPECT, with more abnormal segments (mean +/- SD, 10.1 +/- 3.6 vs 4.9 +/- 2.6; p < 0.001) and abnormal vascular territories (2.55 +/- 0.5 vs 1.64 +/- 0.7; p < 0.001) identified per patient. The overall sensitivity for identifying perfusion defects in three vascular territories was higher for stress perfusion MRI than for SPECT (84.6% vs 55.1%; p < 0.001). The sensitivity of stress perfusion MRI and SPECT for detecting any perfusion defect per patient was 100% and 96.2%, respectively. However, perfusion defects in all three vascular territories were detected in 57.7% of patients by stress perfusion MRI but in only 11.5% of patients by SPECT. CONCLUSION: Stress perfusion MRI is superior to SPECT for detecting myocardial ischemia in patients with angiographically proven three-vessel coronary artery disease.