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Figure 2 | Journal of Cardiovascular Magnetic Resonance

Figure 2

From: Superior diagnostic performance of perfusion-cardiovascular magnetic resonance versus SPECT to detect coronary artery disease: The secondary endpoints of the multicenter multivendor MR-IMPACT II (Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary Artery Disease Trial)

Figure 2

Diagnostic performance in the entire study population – ROC analyses. Diagnostic performance of perfusion-CMR and SPECT imaging compared by receiver operating characteristics curves (ROC) analyses for detection of CAD (per patient analysis). A). CMR performs superior to all SPECT studies in 1–3 vessel disease (1–3 VD) patients and is also superior to the gated-SPECT and ungated-SPECT groups. Difference in AUC between gated-SPECT and ungated-SPECT did not reach statistical significance. The dots on the ROC curve for CMR indicate the sensitivities and specificities for various thresholds (i.e. at summed gradings of 23 [dot on the left], 21 [middle dot], and 19 [dot on the right]) with + and – indicating superiority and inferiority vs SPECT, respectively, and = indicating non-inferiority versus SPECT for both, sensitivity and specificity, as defined as primary end-point of the study (for details on the definition of the primary endpoint see reference [16]). These dots located at various reading thresholds illustrate that comparisons for sensitivity and specificity depend on the thresholds applied for the 2 tests. Thus, for the same data set, superiority or inferiority can be obtained (for sensitivity or specificity comparisons) depending on the reading thresholds used. Reading CMR studies at a high threshold for perfusion deficits (point on the left on the ROC curve) yields CMR inferiority for sensitivity and CMR non-inferiority for specificity vs SPECT, while the same CMR test read with a low threshold (point on the right of the ROC curve) yields a superior sensitivity for CMR vs SPECT with inferiority for specificity. This dependence of comparisons upon reading thresholds is eliminated by the ROC approach, which assesses test performance over the entire range of reading thresholds. B): Perfusion-CMR is superior to SPECT in multi-vessel disease patients. Sub-group analyses for gated-SPECT and ungated-SPECT yielded superiority for CMR, as well.

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