Diagnostic Performance of CMR, SPECT, and PET Imaging for the Identification of Coronary Artery Disease: A Meta-Analysis

Abstract

Background: Myocardial perfusion imaging modalities, such as cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET), are well-established non-invasive diagnostic methods to detect hemodynamically significant coronary artery disease (CAD). The aim of this meta-analysis is to compare CMR, SPECT, and PET in the diagnosis of CAD and to provide evidence for further research and clinical decision-making.Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched. Studies that used CMR, SPECT, and/or PET for the diagnosis of CAD were included. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio with their respective 95% confidence interval, and the area under the summary receiver operating characteristic (SROC) curve were calculated.Results: A total of 203 articles were identified for inclusion in this meta-analysis. The pooled sensitivity values of CMR, SPECT, and PET were 0.86, 0.83, and 0.85, respectively. Their respective overall specificity values were 0.83, 0.77, and 0.86. Results in subgroup analysis of the performance of SPECT with 201Tl showed the highest pooled sensitivity [0.85 (0.82, 0.88)] and specificity [0.80 (0.75, 0.83)]. 99mTc-tetrofosmin had the lowest sensitivity [0.76 (0.67, 0.82)]. In the subgroup analysis of PET tracers, results indicated that 13N had the lowest pooled sensitivity [0.83 (0.74, 0.89)], and the specificity was the highest [0.91 (0.81, 0.96)].Conclusion: Our meta-analysis indicates that CMR and PET present better diagnostic performance for the detection of CAD as compared with SPECT.

Diagnostic Effect of Attenuation Correction in Myocardial Perfusion Imaging in Different Coronary Arteries: A Systematic Review and Meta-Analysis

“…The latest meta-analysis evaluating the diagnostic performance of MPI was conducted by Xu et al ( 42 ). They performed a meta-analysis evaluating the diagnostic performance of cardiac magnetic resonance (CMR), MPI and positron emission tomography (PET) and reported that MPI had a pooled sensitivity of 0.83 and a pooled specificity of 0.77.…”

Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging

“…However, traditional SPECT systems use large sodium iodide crystals, photomultiplier tubes, and parallel-hole collimation, with relevant drawbacks such as prolonged imaging times and relatively large radioisotope doses. Furthermore, overall diagnostic accuracy, having invasive functional assessment as reference standard, has been shown to be lower than desirable [14,21,32].…”

Head-to-head performance comparison of dedicated vs. general-purpose gamma cameras during gated and perfusion myocardial scintigraphy

“…Owing to the suboptimal quality of images obtained with 201 TlCl, as well as the high price and di cult availability of this radiotracer, it has been replaced during the last decade by 99m technetium-labeled agents that are taken up by the myocardiocytes by passive transport, including SestaMIBI in the rst place. Essentially, myocardial perfusion single-photon emission computed tomography (SPECT) studies have been undertaken worldwide exclusively with two-detector gamma cameras dedicated to cardiac imaging, which depict abnormalities of myocardial blood supply with a sensitivity and speci city of 80 per cent on average [2]. Dedicated SPECT cameras developed for cardiac studies allowed to improve image quality, increase resolution, enhance image contrast, and reduce picture noise -consequently reducing patient dose compared to general-purpose gamma cameras [3].…”