Imaging Modality with Highest Accuracy in Diagnosing Myocardial Ischemia

PET provides the highest accuracy for diagnosis of myocardial ischemia, according to an article published in JAMA Cardiology.

Researchers from the Netherlands, Finland, Canada, and the United States, performed a prospective clinical study to establish the diagnostic accuracy of coronary computed tomography angiography (CCTA), single-photon emission tomography (SPECT), and PET, and explore the incremental value of hybrid imaging compared with fractional flow reserve.

A total of 208 patients (132 men and 76 women, mean age of 58) participated in the study. All had suspected coronary artery disease (CAD) and had undergone CCTA, technetium 99m/tetrofosmin–labeled SPECT, and [15O]H2O PET with examination of all coronary arteries by fractional flow reserve. Two patients had incomplete or failed SPECT procedures caused by technical problems. Four patients failed to complete the cardiac PET protocol mainly because of claustrophobia or technical reasons. The scans were interpreted by core laboratories on an intention-to-diagnose basis. Hybrid images were generated in case of abnormal noninvasive anatomical or functional test results.

The results showed that 92 patients (44.2%) had significant CAD, with a fractional flow reserve of ≤0.80.

The researchers concluded that PET exhibited the highest accuracy for the diagnosis of myocardial ischemia, adding, “a combined anatomical and functional assessment does not add incremental diagnostic value but guides clinical decision-making in an unsalutary fashion.”