Cardiac MRI shows promise as a diagnostic tool for coronary artery disease

Cardiac magnetic resonance imaging (MRI) is a suitable non-invasive procedure for functional diagnosis in patients who, as a result of basic diagnostics, are suspected of having chronic coronary artery disease (CHD) or progression of known CAD does not expose patients to radiation. This is the final conclusion of the benefit assessment.

The (German) report was published in October 2025, an English translation in January 2026.

On behalf of the Federal Joint Commission (G-BA), the Institute for Quality and Efficiency in Healthcare (IQWiG) examined the advantages and disadvantages of cardiac MRI compared to a non-MRI diagnostic strategy.

We identified only one, poorly informative study in which patients were randomized to either MRI or SPECT. IQWiG researchers therefore also investigated the question of the diagnostic accuracy of cardiac MRI compared to SPECT. In the studies on this topic, all patients underwent MRI and SPECT, and all findings were verified by a further diagnostic method, namely interventional coronary angiography (ICA).

Results from six studies showed that cardiac MRI had at least a comparable success rate (diagnostic accuracy). Since MRI, unlike SPECT, does not involve radiation exposure, there was an overall benefit for patients, which IQWiG assessed as “hints at greater benefit”.

“MRI represents a useful extension of the range of diagnostic options for suspected CAD. We expect that practitioners will continue to use CHD diagnostics in a differentiated manner based on the individual patient’s situation and that duplicate diagnoses will be avoided.says Martina Lietz, scientific associate in the IQWiG Department of Non-Pharmaceutical Interventions and project manager of this benefit evaluation. The general availability of MRI should also not be problematic.

Differential diagnosis of CHD is necessary and possible

Four different diagnostic techniques are primarily considered when a person with heart problems is found to have about a 15 to 85 percent chance of coronary heart disease after the basic diagnosis: MRI, SPECT, and stress echocardiography are referred to as functional procedures because they look at heart function and are essentially comparable to each other. However, Stress echocardiography is used less and less for various clinical reasons and is therefore considered of secondary importance. IQWiG therefore did not include this comparison.

Cardiac computed tomography (CT), or computed tomography coronary angiography (CCTA), is a morphological procedure that examines the coronary arteries and is therefore fundamentally different from cardiac MRI. Therefore, comparing these two methods did not seem to make much sense.

The decision in favor of a particular diagnostic procedure depends on the pre-test probability, the individual patient’s condition (eg co-morbidities) and the local availability of diagnostic data. In addition, contraindications and side effects must be considered, especially regarding the ability of the heart to undergo functional stress diagnostic procedures or the feasibility of administering contrast media during an examination.

Interventional coronary angiography (ICA, “cardiac catheterization”), on the other hand, should only be used when the probability of HF is very high (> 85 percent), and thus in many cases should only be done after signs of HF have been identified by MRI, SPECT, stress echocardiography, or cardiac CT. When used in a differentiated manner, the findings of any of these four procedures are ideally clear, so that no more than one of these tests is required to detect or rule out CAD with relative certainty.

Report production process

On 26 September 2024, the G-BA commissioned IQWiG to conduct a benefit assessment of cardiac magnetic resonance imaging in coronary artery disease. IQWiG published preliminary results in July 2025 and interested parties were invited to submit comments. After the comment process was completed, the report was revised and sent to the contracting agency in October 2025. The written comments submitted and the minutes of the scientific discussion are published in a separate document at the same time as the final report.