To investigate the value of cardiac magnetic resonance (CMR) multiparametric imaging in the localization, qualitative assessment, and staging diagnosis of coronary artery disease (CAD).

A retrospective analysis was conducted on 60 patients with suspected CAD who underwent both CMR and coronary angiography (CAG) at the Radiology Department of Huazhong Fuwai Cardiovascular Hospital between January 1, 2023, and February 28, 2025. Using CAG as the gold standard, the diagnostic performance of CMR in detecting myocardial ischemia/infarction was evaluated, and the consistency of CMR in staging CAD lesions was analyzed.

Among the 60 suspected patients, the CAG results showed 3 cases were negative and 57 cases were positive. Using CAG diagnostic results as the gold standard, the specificity, sensitivity, and accuracy of CMR diagnosis were all relatively high. Among the 57 confirmed patients, the agreement between CMR and CAG in detecting varying degrees of stenosis was slight (Kappa = 0.12), and the overall detection concordance rate of CMR for stenosis was relatively low, with particularly frequent missed diagnoses in mild/moderate stenosis. The left ventricular ejection fraction (LVEF) and cardiac output (CO) ranges in CMR diagnostic results were slightly lower than those of healthy adults, while the end-diastolic volume index (EDVI) range was slightly higher than that of healthy adults. Among the 57 confirmed patients, electrocardiogram (ECG) and CMR showed moderate to high agreement in myocardial infarction staging (Kappa ≈ 0.60).

In the diagnosis of suspected CAD, CMR provides indispensable functional and staging assessments, while CAG remains the gold standard for vascular anatomical evaluation. The combined application of CMR and CAG can enhance the diagnostic efficacy of CAD imaging.