Kiran R. Nandalur MD, Presenter: Nothing to Disclose

Ben A. Dwamena, Abstract Co-Author: Nothing to Disclose

Asim F. Choudhri MD, Abstract Co-Author: Nothing to Disclose

Ruth C. Carlos MD, MS, Abstract Co-Author: Nothing to Disclose

Although myocardial perfusion Positron Emission Tomography (PET), using either cyclotron-produced ammonia or generator produced rubidium 82, has reported excellent diagnostic capabilities in the detection of coronary artery disease (CAD) in individual studies, the technique is not widely used in practice. This may be driven by cost and availability or by unawareness of performance. The purpose of our study was to conduct an evidence-based evaluation of PET in the diagnosis of CAD.

We examined studies from January 1977 to March 2007 using MEDLINE and EMBASE. A study was included if it: (A) used PET as a diagnostic test for CAD and (B) used catheter x-ray angiography as the reference standard. Analysis was performed on a subject and coronary territory level.

Seventeen studies (1325 patients) met the inclusion criteria, with 9 studies using rubidium-82, 7 studies with nitrogen-13, and 1 study utilizing one or the other. On a patient level, PET demonstrated a sensitivity of 0.92 (95% confidence interval (CI): 0.90-0.94) and specificity of 0.90 (CI: 0.85-0.94), with a positive likelihood ratio (plr) of 8.8 (CI: 4.8-12.7) and negative likelihood ratio (nlr) of 0.09 (CI: 0.06-0.12). On a coronary territory level (n=971), PET showed a sensitivity of 0.83 (CI: 0.80-0.87) and specificity of 0.88 (CI: 0.85-0.90), with a plr of 6.7 (CI: 5.2-8.2) and nlr of 0.19 (CI: 0.15-0.23).

PET demonstrates excellent diagnostic properties in the diagnosis of coronary artery disease, especially at the patient level. The capabilities appear superior to those reported in meta-analyses for perfusion imaging with Tl-201 and sestamibi, or anatomical imaging with coronary MDCT angiography or MRA. Given that previous studies have found PET to be cost-effective and the current findings of excellent sensitivity and specificity, the modality should be more widely considered as an initial test in the diagnosis of CAD.

PET is an underutilized modality in the diagnosis of coronary artery disease and should be more widely considered given its excellent sensitivity and specificity.

Nandalur, K, Dwamena, B, Choudhri, A, Carlos, R, Diagnostic Performance of Positron Emission Tomography in the Detection of Coronary Artery Disease: A Meta-analysis.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5010846.html