A Sex-Based Comparison of Cardiac MRI and SPECT for Diagnosing Coronary Artery Disease

Joanne Foody, MD

Data from a CE-MARC substudy show significant diagnostic underperformance of SPECT in women.

In the single-center CE-MARC trial, cardiac magnetic resonance imaging (cMRI) outperformed single-photon emission computed tomography (SPECT) for detecting obstructive coronary artery disease (CAD) in patients with suspected angina (NEJM JW Gen Med Feb 7 2012). Now, in a prespecified CE-MARC substudy, researchers compared the diagnostic accuracy of cMRI with that of SPECT by sex.

In all, 235 women and 393 men with suspected angina underwent cMRI and SPECT. To avoid referral bias, the study protocol mandated that all patients also undergo x-ray coronary angiography regardless of their cMRI or SPECT results. The sensitivity of cMRI was statistically similar in women and men (88.7% and 85.6%, respectively, P=0.57), as was the specificity (83.5% and 82.8%). In contrast, the sensitivity of SPECT was significantly lower in women than in men (50.9% vs. 70.8%; P=0.007), although the specificity was similar (84.1% and 81.3%, respectively).

Citation(s):

Greenwood JP et al. Comparison of cardiovascular magnetic resonance and single-photon emission computed tomography in women with suspected coronary artery disease from the CE-MARC Trial. Circulation 2013 Dec 19; [e-pub ahead of print].