Diagnosis and prognosis of coronary artery disease: PET is superior to SPECT: Con (original) (raw)
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PET Clinics, 2011
PET, a nuclear medicine imaging technique that enables us to image functional processes occurring in the body, has now become an important imaging modality in the workup of several malignancies. Fluorine (F)-18-labeled fluorodeoxyglucose (FDG) is the main radiotracer used for oncologic imaging. Initially developed in the 1970s, it was applied for functional brain imaging and cardiac metabolism assessment. However, these applications did not progress to the routine clinical realm because the technology was limited mostly to research centers. In the last decade, the value of FDG-PET imaging in oncology was established, which has led to widespread use and availability of this modality across the United States and elsewhere in the world for this purpose. Along with the ease of accessibility, Food and Drug Administration (FDA) approval of PET cardiac perfusion radiotracers has led to a rebound in interest for cardiac PET applications. The recent shortage of technetium (Tc)-99m (the main radioisotope used for cardiac single-photon emission computed tomography [SPECT] imaging), the advantages of cardiac PET imaging over cardiac SPECT imaging, and the favorable reimbursement from Centers for Medicare and Medicaid for cardiac PET imaging have all resulted in a significant increase in routine clinical use of cardiac PET imaging for perfusion assessment.
Implementation of a cardiac PET stress program: comparison of outcomes to the preceding SPECT era
JCI insight, 2018
Cardiac positron emission testing (PET) is more accurate than single photon emission computed tomography (SPECT) at identifying coronary artery disease (CAD); however, the 2 modalities have not been thoroughly compared in a real-world setting. We conducted a retrospective analysis of 60-day catheterization outcomes and 1-year major adverse cardiovascular events (MACE) after the transition from a SPECT- to a PET-based myocardial perfusion imaging (MPI) program. MPI patients at Intermountain Medical Center from January 2011-December 2012 (the SPECT era, n = 6,777) and January 2014-December 2015 (the PET era, n = 7,817) were studied. Outcomes studied were 60-day coronary angiography, high-grade obstructive CAD, left main/severe 3-vessel disease, revascularization, and 1-year MACE-revascularization (MACE-revasc; death, myocardial infarction [MI], or revascularization >60 days). Patients were 64 ± 13 years old; 54% were male and 90% were of European descent; and 57% represented a scre...
European Journal of Nuclear Medicine and Molecular Imaging, 2011
Improvements in software and hardware have enabled the integration of dual imaging modalities into hybrid systems, which allow combined acquisition of the different data sets. Integration of positron emission tomography (PET) and computed tomography (CT) scanners into PET/CT systems has shown improvement in the management of patients with cancer over stand-alone acquired CT and PET images. Hybrid cardiac imaging either with single photon emission computed tomography (SPECT) or PET combined with CT depicts cardiac and vascular anatomical abnormalities and their physiologic consequences in a single setting and appears to offer superior information compared with either stand-alone or side-by-side interpretation of the data sets in patients with known or suspected coronary artery disease (CAD). Hybrid systems are also advantageous for the patient because of the single short dual data acquisition. However, hybrid cardiac imaging has also generated controversy with regard to which patients should undergo such integrated examination for clinical effectiveness and minimization of costs and radiation dose, and if software-based fusion of images obtained separately would be a useful alternative.
Journal of Nuclear Cardiology, 2009
Objectives. To design a multicenter study comparing the prognostic value and post-test resource utilization of PET, CT Coronary Angiography (CTA), and SPECT in clinical practice. Background. Although PET, CTA, and SPECT are widely used, their relative clinical-and cost-effectiveness are undefined. Methods. The Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in CAD (SPARC) is a prospective, multicenter, observational registry that has enrolled 3019 patients undergoing clinically referred SPECT, PET, and CTA with the goal of comparing posttest resource utilization and comparative prognostic value. Resource utilization assessment will enroll intermediate-high likelihood patients without prior CAD, while prognostic assessment will include both these patients and patients with prior CAD. Secondary analyses include assessments of diagnostic accuracy, cost, and referral to revascularization. Sites recruited into at least two of the three imaging arms. Except for semi-quantitative interpretation, site protocols will be used for all imaging studies and images forwarded to an image repository. Followup for catheterization, revascularization, cardiac death, myocardial infarction, all-cause death and medication use changes will be performed at 90-day, 1, and 2 years. Standard statistical methods will be used to risk-adjust results within and between study arms. SPARC will have >85% power (two-sided test, a 5 0.01) to detect a 5% catheterization rate difference at 90 days between the three arms and >90% power to detect a 2% difference in cardiac death, or nonfatal MI within 2 years of the index test. Conclusions. SPARC will be the first study comparing outcomes and resource utilization between SPECT, PET, and CTA in daily practice. In addition, the study design offers insights into inter-site and geographic differences in referral patterns and resource utilization.
Evidence-Based PET for Cardiac Diseases
2020
This chapter summarizes 15 meta-analyses published in the literature on the use of PET for cardiac diseases, with the majority (n = 8) concerning the diagnosis of coronary artery disease (CAD) using myocardial perfusion imaging (MPI) in comparison to other modalities. Second in the number of published meta-analyses, three studies concentrated on the prognostic value of MPI for adverse cardiovascular events. Finally, one meta-analysis was published on the use of PET for four indications among myocardial viability assessment, the presence of microvascular disease (impaired coronary vascular function in absence of obstructive, epicardial CAD), the use of cardiac hybrid imaging and the diagnostic of cardiac amyloidosis.
Technical Considerations for Cardiac PET/CT
IAEA Atlas of Cardiac PET/CT
Positron emission tomography (PET) is a non-invasive imaging technique that employs positron-emitting radionuclides labelled to biological molecules. Unlike other imaging techniques, such as computer tomography (CT) and magnetic resonance imaging (MRI) that provide anatomical or structural information, PET allows obtaining unique quantitative information of important biologic processes in vivo (e.g. myocardial perfusion and metabolism, inflammation, innervation, receptor density).
Canadian Journal of Cardiology, 2013
Nuclear cardiology came of age in the 1970s and subsequently has expanded so that more than 9 million single-photon emission computed tomography (SPECT) studies are performed annually in North America. Coronary artery disease management has demanded a reliable technique that will detect, risk stratify, and assist with revascularization decisions. Using cardiac SPECT and positronemission tomography (PET), researchers and clinicians have sought to achieve excellence in coronary artery disease diagnosis and risk stratification, and strive to achieve higher standards in these areas. Developments in other cardiac imaging modalities, however, such as cardiac computed tomography, cardiac magnetic resonance, and echocardiography, have raised expectations in terms of diagnostic accuracy and achieving high quality images with little or no ionizing radiation exposure. The challenge facing nuclear cardiology as it embarks upon a fifth decade of clinical use is whether high quality images can be obtained at lower radiation exposures. In this review we consider current practice in SPECT and PET perfusion imaging. We discuss emerging advances in techniques, technologies, and radiotracers that focus specifically on improvements in image quality that enhance diagnostic accuracy while reducing radiation exposure. We provide a perspective as to the future roles of cardiac SPECT and PET in ischemic heart disease, and consider emerging novel applications
Assessment of myocardial perfusion and function with PET and PET/CT
Journal of Nuclear Cardiology, 2010
There are several excellent review articles that detail the clinical applications, PET radiotracers, 1 quantitative PET, 2 viability assessment, 3 and utility of hybrid PET MPI applications. The focus of this article is to discuss the evolution of PET MPI over the course of the years to highlight some of the major achievements in PET that have culminated in the present day applications of PET MPI.
Journal of the American College of Cardiology, 2001
We sought to prospectively compare nitrogen-13 ( 13 N)-ammonia/ 18 fluorodeoxyglucose ( 18 FDG) positron emission tomography (PET)-guided management with stress/rest technetium-99m ( 99m Tc)-sestamibi single-photon emission computed tomography (SPECT)-guided management. BACKGROUND Patients with evidence of jeopardized (i.e., ischemic or viable) myocardium may benefit from revascularization, whereas patients without it should be treated with drugs. Both PET and SPECT imaging have been proven to delineate jeopardized myocardium. When patient management is based on identification of jeopardized myocardium, it is unknown which technique is most accurate for long-term prognosis.