Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis
Abstract Background Stress cardiovascular magnetic resonance (CMR) perfusion imaging is a promising modality for the evaluation of coronary artery disease (CAD) due to high spatial resolution and absence of radiation. Semi-quantitative and quantitative analysis of CMR perfusion are based on signal-i...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2017-11-01
|
| Series: | Journal of Cardiovascular Magnetic Resonance |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12968-017-0393-z |
| _version_ | 1797205293523795968 |
|---|---|
| author | R. van Dijk M. van Assen R. Vliegenthart G. H. de Bock P. van der Harst M. Oudkerk |
| author_facet | R. van Dijk M. van Assen R. Vliegenthart G. H. de Bock P. van der Harst M. Oudkerk |
| author_sort | R. van Dijk |
| collection | DOAJ |
| description | Abstract Background Stress cardiovascular magnetic resonance (CMR) perfusion imaging is a promising modality for the evaluation of coronary artery disease (CAD) due to high spatial resolution and absence of radiation. Semi-quantitative and quantitative analysis of CMR perfusion are based on signal-intensity curves produced during the first-pass of gadolinium contrast. Multiple semi-quantitative and quantitative parameters have been introduced. Diagnostic performance of these parameters varies extensively among studies and standardized protocols are lacking. This study aims to determine the diagnostic accuracy of semi- quantitative and quantitative CMR perfusion parameters, compared to multiple reference standards. Method Pubmed, WebOfScience, and Embase were systematically searched using predefined criteria (3272 articles). A check for duplicates was performed (1967 articles). Eligibility and relevance of the articles was determined by two reviewers using pre-defined criteria. The primary data extraction was performed independently by two researchers with the use of a predefined template. Differences in extracted data were resolved by discussion between the two researchers. The quality of the included studies was assessed using the ‘Quality Assessment of Diagnostic Accuracy Studies Tool’ (QUADAS-2). True positives, false positives, true negatives, and false negatives were subtracted/calculated from the articles. The principal summary measures used to assess diagnostic accuracy were sensitivity, specificity, andarea under the receiver operating curve (AUC). Data was pooled according to analysis territory, reference standard and perfusion parameter. Results Twenty-two articles were eligible based on the predefined study eligibility criteria. The pooled diagnostic accuracy for segment-, territory- and patient-based analyses showed good diagnostic performance with sensitivity of 0.88, 0.82, and 0.83, specificity of 0.72, 0.83, and 0.76 and AUC of 0.90, 0.84, and 0.87, respectively. In per territory analysis our results show similar diagnostic accuracy comparing anatomical (AUC 0.86(0.83–0.89)) and functional reference standards (AUC 0.88(0.84–0.90)). Only the per territory analysis sensitivity did not show significant heterogeneity. None of the groups showed signs of publication bias. Conclusions The clinical value of semi-quantitative and quantitative CMR perfusion analysis remains uncertain due to extensive inter-study heterogeneity and large differences in CMR perfusion acquisition protocols, reference standards, and methods of assessment of myocardial perfusion parameters. For wide spread implementation, standardization of CMR perfusion techniques is essential. Trial registration CRD42016040176. |
| first_indexed | 2024-04-24T08:48:49Z |
| format | Article |
| id | doaj.art-6dee3048548249358b214fb78b23497c |
| institution | Directory Open Access Journal |
| issn | 1532-429X |
| language | English |
| last_indexed | 2024-04-24T08:48:49Z |
| publishDate | 2017-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj.art-6dee3048548249358b214fb78b23497c2024-04-16T12:46:46ZengElsevierJournal of Cardiovascular Magnetic Resonance1532-429X2017-11-0119111610.1186/s12968-017-0393-zDiagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysisR. van Dijk0M. van Assen1R. Vliegenthart2G. H. de Bock3P. van der Harst4M. Oudkerk5Center for Medical Imaging, University Medical Center Groningen, University of GroningenCenter for Medical Imaging, University Medical Center Groningen, University of GroningenCenter for Medical Imaging, University Medical Center Groningen, University of GroningenDepartment of Epidemiology, University Medical Center Groningen, University of GroningenDepartment of Cardiology, University Medical Center Groningen, University of GroningenCenter for Medical Imaging, University Medical Center Groningen, University of GroningenAbstract Background Stress cardiovascular magnetic resonance (CMR) perfusion imaging is a promising modality for the evaluation of coronary artery disease (CAD) due to high spatial resolution and absence of radiation. Semi-quantitative and quantitative analysis of CMR perfusion are based on signal-intensity curves produced during the first-pass of gadolinium contrast. Multiple semi-quantitative and quantitative parameters have been introduced. Diagnostic performance of these parameters varies extensively among studies and standardized protocols are lacking. This study aims to determine the diagnostic accuracy of semi- quantitative and quantitative CMR perfusion parameters, compared to multiple reference standards. Method Pubmed, WebOfScience, and Embase were systematically searched using predefined criteria (3272 articles). A check for duplicates was performed (1967 articles). Eligibility and relevance of the articles was determined by two reviewers using pre-defined criteria. The primary data extraction was performed independently by two researchers with the use of a predefined template. Differences in extracted data were resolved by discussion between the two researchers. The quality of the included studies was assessed using the ‘Quality Assessment of Diagnostic Accuracy Studies Tool’ (QUADAS-2). True positives, false positives, true negatives, and false negatives were subtracted/calculated from the articles. The principal summary measures used to assess diagnostic accuracy were sensitivity, specificity, andarea under the receiver operating curve (AUC). Data was pooled according to analysis territory, reference standard and perfusion parameter. Results Twenty-two articles were eligible based on the predefined study eligibility criteria. The pooled diagnostic accuracy for segment-, territory- and patient-based analyses showed good diagnostic performance with sensitivity of 0.88, 0.82, and 0.83, specificity of 0.72, 0.83, and 0.76 and AUC of 0.90, 0.84, and 0.87, respectively. In per territory analysis our results show similar diagnostic accuracy comparing anatomical (AUC 0.86(0.83–0.89)) and functional reference standards (AUC 0.88(0.84–0.90)). Only the per territory analysis sensitivity did not show significant heterogeneity. None of the groups showed signs of publication bias. Conclusions The clinical value of semi-quantitative and quantitative CMR perfusion analysis remains uncertain due to extensive inter-study heterogeneity and large differences in CMR perfusion acquisition protocols, reference standards, and methods of assessment of myocardial perfusion parameters. For wide spread implementation, standardization of CMR perfusion techniques is essential. Trial registration CRD42016040176.http://link.springer.com/article/10.1186/s12968-017-0393-zMagnetic resonance imagingCoronary artery diseaseMyocardial perfusion imaging |
| spellingShingle | R. van Dijk M. van Assen R. Vliegenthart G. H. de Bock P. van der Harst M. Oudkerk Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis Journal of Cardiovascular Magnetic Resonance Magnetic resonance imaging Coronary artery disease Myocardial perfusion imaging |
| title | Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis |
| title_full | Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis |
| title_fullStr | Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis |
| title_full_unstemmed | Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis |
| title_short | Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis |
| title_sort | diagnostic performance of semi quantitative and quantitative stress cmr perfusion analysis a meta analysis |
| topic | Magnetic resonance imaging Coronary artery disease Myocardial perfusion imaging |
| url | http://link.springer.com/article/10.1186/s12968-017-0393-z |
| work_keys_str_mv | AT rvandijk diagnosticperformanceofsemiquantitativeandquantitativestresscmrperfusionanalysisametaanalysis AT mvanassen diagnosticperformanceofsemiquantitativeandquantitativestresscmrperfusionanalysisametaanalysis AT rvliegenthart diagnosticperformanceofsemiquantitativeandquantitativestresscmrperfusionanalysisametaanalysis AT ghdebock diagnosticperformanceofsemiquantitativeandquantitativestresscmrperfusionanalysisametaanalysis AT pvanderharst diagnosticperformanceofsemiquantitativeandquantitativestresscmrperfusionanalysisametaanalysis AT moudkerk diagnosticperformanceofsemiquantitativeandquantitativestresscmrperfusionanalysisametaanalysis |