Added value of hybrid myocardial perfusion SPECT and CT coronary angiography in the diagnosis of coronary artery disease

Abstract

Current analysis resembles clinical routine of layered testing and shows that hybrid SPECT/CCTA imaging has a substantially higher yield than standalone SPECT or CCTA in the diagnostic workup of patients suspected of significant CAD.

Myocardial perfusion imaging with PET

“…The limited number of studies on the diagnostic value of PET/CT seem to confirm the theoretical enhanced accuracy as compared with either modality alone [18, 19, 70, 71]. Other studies revealed analogous improvement of diagnostic performance when fusing SPECT and CCTA [72, 73]. It is shown that especially the moderate specificity of CCTA benefits from the use of hybrid imaging and results in a more judicious referral pattern for invasive coronary angiography [74–76].…”

State of the art in nuclear cardiology

“…Hybrid techniques have given variable results in the assessment of patients with chest pain with some early positive55 results for the hybrid imaging technique. Radiation burden to the patient with a combined MPS and CTCA approach does require justification, as the dose may vary anywhere between 2 and 20 mSv depending on a large number of variables.…”

Cardiac CT: present and future applications

“…In a recent study that analysed the incremental utility of CTCA, SPECT and their combination over ECG stress testing for the diagnosis of functionally significant CAD, the ECG stress testing C-statistic increased from 0.73 to 0.85 when adding SPECT alone, to 0.90 when adding CTCA alone and to 0.96 when adding hybrid SPECT/CTCA data 57. A similar study using hybrid PET/CT showed 98% accuracy for the detection of obstructive CAD using radiation doses <10 mSv in most patients 58.…”