Elsevier

Journal of Nuclear Cardiology

Volume 13, Issue 1, January–February 2006, Pages 2-7
Journal of Nuclear Cardiology

Editorial
Should PET replace SPECT for evaluating CAD? The end of the beginning

https://doi.org/10.1016/j.nuclcard.2005.12.001Get rights and content

Section snippets

Clinical limitations

Nonetheless, the study has a number of clinical limitations that should be pointed out. An apparent limitation of the study design was the lack of attenuation correction on the SPECT images. Indeed, previous studies have demonstrated an overall improvement in specificity and, in some studies, also in sensitivity2, 3, 4 with the adjunct use of attenuation correction. However, performance of attenuation correction with SPECT appears to be best accomplished in patients undergoing exercise

Detection of multivessel CAD

In this study by Bateman et al,1 PET was better than SPECT for diagnosing multivessel CAD. Although it is unclear what the precise mix of patients with “multivessel” CAD was (eg, 2 vs 3 vessels vs left main disease) and whether the 2 groups were equally balanced (ie, extent and severity of stenoses), this potential advantage of PET is of great clinical interest. It is a generally accepted fact that although the relative assessments of myocardial perfusion (with SPECT or PET) remain a sensitive

Internal and external validity of current results

The use of an observational study design, single-site data, relatively small cohorts, and nonrandomized study populations methodologically challenges investigators examining noninvasive imaging modalities. In this setting both confounding and bias pose serious challenges to the validity and generalizability of planned studies.16, 17 To overcome these potential limitations, investigators control confounding by a number of means. For example, a study can overcome confounding by evenly

Outcomes-based validation of nuclear cardiology technology

The challenges brought to light by this study call attention to the challenges of how to best validate technology, especially with respect to an outcomes-based approach to technology validation. This area includes comparison of isotopes, stress agents, cameras, software, modality (as in the current study), and many other aspects of imaging. The question of how to best compare PET and SPECT is not dissimilar to the question of how to compare 201Tl with 99mTc sestamibi, 99mTc sestamibi with 99mTc

Future role of hybrid PET-CT

The benefits of PET imaging are likely to be expanded in the near future, as most of the newer scanners are going to be hybrid PET/multidetector CT units. Thus, in addition to the functional assessments obtained with PET (ie, myocardial perfusion and metabolism), the new hybrid PET/CT technology allows detection and quantification of the extent and severity of underlying coronary atherosclerosis and obstructive coronary stenoses. PET and CT combined allow measurement of atherosclerotic burden

Need for outcomes data

Although the study by Bateman et al1 provides an important and necessary first step, there is a need for clinical outcomes data to help establish the role of PET in the diagnosis and management of CAD. This is true to determine not only the performance of PET, per se, but also the added value of PET-CT, its relative accuracy compared with other modalities, and how these tests optimally fit together in testing strategies in various patient groups. This is especially important now that the

Acknowledgment

The authors have indicated they have no financial conflicts of interest.

References (27)

  • R. Hachamovitch et al.

    Stress myocardial perfusion single-photon emission computed tomography is clinically effective and cost effective in risk stratification of patients with a high likelihood of coronary artery disease (CAD) but no known CAD

    J Am Coll Cardiol

    (2004)
  • M.F. Di Carli

    Advances in positron emission tomography

    J Nucl Cardiol

    (2004)
  • R.C. Hendel et al.

    Multicenter clinical trial to evaluate the efficacy of correction for photon attenuation and scatter in SPECT myocardial perfusion imaging

    Circulation

    (1999)
  • Cited by (37)

    • SPECT performance evaluation on image of Yttrium 90 - Bremsstrahlung using Monte Carlo simulation

      2021, Applied Radiation and Isotopes
      Citation Excerpt :

      In nuclear medicine, as Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) imaging systems provide a 3D representation of activity distributions within patients (Wernick and Aarsvold, 2004; Ljungberg and Sjӧ;green-Gleisner, 2011). The implementation of hybrid equipment such as (SPECT/CT, PET/CT, and SPECT/MRI) have allowed a better quality for activity bio-distribution analysis techniques (Di Carli and Hachamovitch, 2006; Jones et al., 2013). In SPECT, the photons emitted by the uptake radionuclide are attenuated mainly by the different tissues of the patient's own body.

    • Why, when and how to assess ischemia and viability in patients with chronic total occlusions

      2022, Percutaneous Coronary Intervention for Chronic Total Occlusion: The Hybrid Approach
    • Role of Cardiac PET in Clinical Practice

      2017, Current Treatment Options in Cardiovascular Medicine
    View all citing articles on Scopus
    View full text