Cardiac magnetic resonance angiography (CMRA)

Policy context

There have been a number of cardiac magnetic resonance angiography (CMRA) technological advances in the past decade; however, its accuracy and clinical utility for diagnosis in routine clinical practice are unclear. This topic was selected because of medium-level concerns about the safety and efficacy of CMRA and high-level concern about costs. The objective of the health technology assessment (HTA) is to evaluate the diagnostic validity (i.e., accuracy), clinical utility (i.e., effectiveness), safety, and cost-effectiveness of CMRA in adults or children with known or suspected coronary vessel anomalies or congenital heart disease.

Status: Decision completed

Primary Criteria Ranking

  • Safety = Medium
  • Efficacy = High
  • Cost = High
Documents

Assessment timeline

  • Draft key questions published: March 15, 2021
  • Public comment period: March 16 to March 30, 2021
  • Final key questions published: April 12, 2021
  • Draft report published: September 7, 2021
  • Public comment period: September 7 to October 6, 2021
  • Final report published: October 20, 2021
  • HTCC public meeting: November 19, 2021

Background

CMRA is an imaging modality that provides a mechanism to assess cardiac or vascular anatomy, function, perfusion, and tissue characteristics in a highly reproducible manner, during a single examination. Images can be acquired in patients with various body types, in a time-efficient fashion, without an invasive procedure or exposure to either ionizing radiation or iodinated intravenous contrast medium.

CMRA can also be used to determine coronary artery patency in adults with coronary artery disease (CAD), and as a diagnostic modality for patients with suspected anomalous coronary anatomy. CMRA has been used in the assessment of multivessel CAD, especially in patients presenting with a dilated cardiomyopathy in the absence of a clinical history of myocardial infarction.