Cardiac magnetic resonance imaging (MRI) is being recognized as a suitable non-invasive diagnostic method for patients suspected of having chronic coronary heart disease (CHD) or progression of existing CHD, according to a recent benefit assessment. The analysis found that cardiac MRI’s diagnostic accuracy is at least comparable to that of single photon emission computed tomography (SPECT), while avoiding patient exposure to radiation.
The Institute for Quality and Efficiency in Health Care (IQWiG) conducted the assessment on behalf of Germany’s Federal Joint Committee (G-BA). The German-language report was released in October 2025, with an English translation following in January 2026.
IQWiG compared cardiac MRI with other diagnostic strategies, focusing primarily on its effectiveness relative to SPECT. Due to limited direct comparative studies—only one randomized study between MRI and SPECT was found—the researchers also reviewed evidence from six studies where all participants underwent both MRI and SPECT, with findings verified by invasive coronary angiography (ICA).
Results indicated that cardiac MRI achieved at least similar rates of accurate diagnosis as SPECT. Additionally, because MRI does not use ionizing radiation, it may offer further benefits for patients. IQWiG concluded there is “a hint of a greater benefit” associated with using cardiac MRI over traditional methods involving radiation.
“MRI represents a useful expansion of the range of diagnostic options for suspected CHD. We expect that practitioners will continue to use CHD diagnostics in a differentiated manner based on the individual patient situation, and that double diagnostics will be avoided,” said Martina Lietz, research associate in IQWiG's Non-Drug Interventions Department and project manager for this assessment. She added that the general availability of MRI should not pose significant challenges.
When assessing potential CHD after initial testing indicates an intermediate probability (15–85 percent), several functional procedures—including MRI, SPECT, and stress echocardiography—are available. However, due to declining clinical use, stress echocardiography was considered less relevant for comparison in this review.
Cardiac computed tomography (CT), specifically CT coronary angiography (CCTA), serves as a morphological rather than functional test and therefore differs fundamentally from cardiac MRI; comparing these two methods was deemed less meaningful by IQWiG.
Selection among these tests depends on factors such as pretest probability for CHD, individual health status including comorbidities, local access to technology, contraindications, possible side effects related to contrast agents or stress procedures, and overall suitability for each patient.
Invasive coronary angiography remains reserved mainly for cases where the likelihood of CHD exceeds 85 percent or when non-invasive tests indicate clear signs requiring further investigation.
The G-BA commissioned this benefit assessment on September 26, 2024. Preliminary results were shared in July 2025 followed by a public comment period before finalization later that year. Written comments and records from scientific discussions are published alongside the final report.
