Comparative Diagnostic Accuracy of Cardiac MRI vs. CT Angiography in Suspected Coronary Artery Disease (CAD): A Systematic Review and Meta-Analysis

Background: It is crucial to diagnose coronary artery disease (CAD) accurately and without invasive procedures to benefit patients and avoid unnecessary invasive interventions. Both cardiac magnetic resonance imaging (CMR) and coronary computed tomography angiography (CCTA) are now essential for finding heart problems. Although these tests are often very sensitive, more research is needed to determine which one diagnoses obstructive CAD more accurately. Objectives: The goal of this review was to see how well CMR and CCTA identify CAD when compared to invasive coronary angiography with or without fractional flow reserve. Methodology: The search included PubMed, Scopus, Embase and Web of Science for any original studies published between January 2015 and May 2025. Studies were accepted if they directly compared results from CMR and CCTA in diagnosing suspected CAD with the help of ICA and/or FFR. From the initial selection, seven studies qualified and included 1,942 patients. All data were taken in an independent manner by two reviewers, in accordance with PRISMA 2020. Sensitivity, specificity and area under the receiver operating characteristic curve (AUC) were pooled using a random-effects bivariate meta-analysis model. QUADAS-2 was used to assess how well the studies were done and for bias risks. Results: In total, CCTA had a pooled sensitivity of 94.6% (95% CI: 92.1–96.8%) and specificity of 83.2% (95% CI: 79.1–87.1%), according to the seven studies and a diagnostic accuracy of 0.93. CMR had a slightly lower sensitivity of 88.4% (95% CI: 85.1–91.2%) but higher specificity at 87.9% (95% CI: 84.2–91.1%) and an AUC value of 0.91. The probability of detecting the diagnosis was 77.5 times higher with CCTA than with CMR. CCTA found anatomical stenosis more precisely, whereas CMR proved better at detecting changes in blood flow and did not use radiation. Using 3T MRI scanners for CMR and ≥128-slice CT scanners for CCTA led to a better diagnostic outcome in the studies. Conclusion: Both CCTA and CMR give accurate results for identifying CAD. CCTA showed higher sensitivity and CMR proved to be better at detecting specific ischemia and its effects on the heart. Decisions about the most appropriate modality are based on the patient’s case, the level of experience available and things like kidney function and radiation risk.