15283-B-Blokker

106 Chapter 6 Diagnostic performance Acute MI was found in 34/99 cases on conventional autopsy and 36/99 cases on MIA. Chronic MI was found in 40/99 cases on conventional autopsy and 51/99 cases on MIA. The diagnostic accuracy of MRI, and biopsies for the detection of acute and chronic MI is shown in table 3 and for CT (Total Agatston calcium score) in table 4, and the ROC curves for acute and chronic MI are shown in Fig. 1 and 2 respectively. Acute myocardial infarction Sensitivity of MRI for acute MI was 0.50 (95% CI: 0.32-0.68) and specificity was 0.92 (0.83-0.97). Sensitivity of MIA for acute MI was 0.97 (95% CI: 0.85-1.00) and specificity was 0.95 (0.87-0.99). Fig. 3 shows a case with acute MI. The area under the curve (AUC) for the detection of acute MI was 0.60 (95% CI: 0.48- 0.72) for CT (Total Agatston calcium score), 0.71 (95% CI: 0.60-0.83) for MRI and 0.96 (95% CI: 0.92-1.00) for MRI with biopsy (MIA). Five cases were classified as peracute infarction on MRI, in 2 of these cases no evidence for an infarction was found on conventional autopsy. Chronic myocardial infarction Sensitivity of MRI for chronic MI was 0.35 (95% CI: 0.21-0.52) and specificity was 1.00 (95% CI: 0.94-1.00). Sensitivity of MIA for chronic MI was 0.90 (95% CI: 0.76-0.97) and specificity was 0.75 (95% CI: 0.62-0.85). Fig. 4 and 5 are examples of cases with chronic MI. The area under the curve (AUC) for the detection of chronic MI was 0.74 (95% CI: 0.64- 0.84) for CT (Total Agatston calcium score), 0.68 (95% CI: 0.56-0.79) for MRI and 0.82 (95% CI: 0.74-0.91) for MRI with biopsy (MIA). Inter-observer agreement MRI The two radiologists were in agreement in 82 of 99 cases, in the remaining 17 cases consensus was reached in joint sessions. The kappa score of inter-observer agreement was 0.85. DISCUSSION In this study we investigated the diagnostic accuracy of a minimally invasive autopsy (MIA) consisting of MRI, CT and CT-guided biopsy for detection of ischemic heart disease in a hospital setting. We found that the combination of MRI and biopsies, had the highest accuracy for detecting acute and chronic MI with conventional autopsy as