AR: Cost, availability overshadow PET's ability to diagnose CAD

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Although myocardial perfusion 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, which may be driven by cost and availability or by unawareness of performance, according to the April issue of Academic Radiology.

Kiran R. Nandalur, MD, department of radiology, University of Michigan Health System, in Ann Arbor, Mich., and colleagues examined studies from January 1977 to July 2007 using MEDLINE and EMBASE. A study was included if it (1) used PET as a diagnostic test for CAD and (2) used catheter x-ray angiography as the reference standard (≥50 percent diameter stenosis). Analysis was performed on a subject and coronary territory level.

Nineteen studies (1,442 patients) met the inclusion criteria. The results showed that on a patient level, PET demonstrated 92 percent sensitivity and 85 percent specificity. On a coronary territory level (1,130 patients), PET showed 81 percent sensitivity and 87 percent specificity.

Researchers concluded that PET demonstrates “excellent diagnostic properties in the diagnosis of CAD, especially at the patient level. The capabilities appear superior to those reported in meta-analyses for perfusion imaging with thallium-201 and sestamibi, or anatomical imaging with coronary CT 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, Nandalur said.