Sensitivity of Cardiac MRI for Detecting Coronary Artery Disease
Stress cardiac MRI demonstrates excellent sensitivity of 89-91% for detecting coronary artery disease when using perfusion imaging techniques, making it one of the most accurate noninvasive functional tests available. 1
Stress Perfusion Cardiac MRI (Preferred Technique)
Stress perfusion cardiac MRI is the highest-performing MRI technique for CAD detection, with the following diagnostic characteristics:
- Sensitivity: 89-91% on a patient-based analysis 1, 2
- Specificity: 81-85% 1, 2
- These values are derived from meta-analyses using fractional flow reserve (FFR) as the reference standard 1
The 2022 ACR Appropriateness Criteria specifically highlight that stress perfusion MRI maintains accuracy across populations with disease prevalence of 57.4% 1, 2
Stress Wall Motion Cardiac MRI (Dobutamine)
Dobutamine stress cardiac MRI using wall motion abnormality detection shows slightly lower but still robust performance:
- Sensitivity: 79-88% 1
- Specificity: 83-86% 1, 2
- Disease prevalence in studied populations was 70.5% 1, 2
Individual prospective studies demonstrate consistent results, with sensitivities ranging from 83-86.2% and specificities of 83-85.7% 1
Coronary MR Angiography (Anatomical Imaging)
Coronary MRA has more variable performance and is less reliable than functional stress imaging:
- With contrast: Sensitivity 82-88%, Specificity 72-90% 1
- Without contrast: Sensitivity 88-96%, Specificity 68-72% 1
The European Society of Cardiology guidelines note that coronary MRA sensitivity at the segment level is only 73% overall, with particular weakness in the left circumflex territory (61% sensitivity) 3
Comparative Context
Stress cardiac MRI substantially outperforms exercise ECG, which has only 45-50% sensitivity 1, 4. The 2013 ESC Guidelines position stress MRI alongside other advanced imaging modalities, noting its superior diagnostic capability compared to standard exercise testing 1
When compared head-to-head with other functional tests in the same patient population, stress cardiac MRI performs comparably to nuclear imaging (SPECT sensitivity 73-92%, PET sensitivity 81-97%) 1
Clinical Caveats
The sensitivity values cited apply specifically to:
- Patients with intermediate to high pretest probability of CAD 1
- Detection of ≥50-70% coronary stenosis or FFR ≤0.8 1
- Evaluable coronary segments (image quality dependent) 3
Key limitation: The 2013 ESC Guidelines emphasize that all noninvasive imaging tests (including cardiac MRI with ~85% sensitivity/specificity) will produce more false results than true results in populations with pretest probability below 15% or above 85% 1. In such populations, testing may cause more harm than benefit through misclassification 1
Prognostic value: Beyond diagnosis, the presence of late gadolinium enhancement (myocardial scar) on cardiac MRI independently predicts mortality and major adverse cardiac events, even when infarct size is <2% of LV mass 1