The latest article from Radiology, August 8, 2012, was reported on by HealthImaging. The results seem conclusive that CCTA can now be depended upon for raising the bar for diagnosing CAD in patients with previously abnormal SPECT scans. But do the results tell the whole story? That’s the question to be answered. Clearly the specificity is better with CCTA but the authors admit the SPECT studies were performed at many sites and not standardized by equipment or protocol. The CCTA was done in a standardized manner. PET might have provided a better result than the other two but what are we seeking? It appears we are still technology centric rather than disease centric.
Read the report at HealthImaging and think about where we go from here.
This study serves to reformat known data which was previously proven: SPECT nuclear cardiology testing provides a significant percentage of equivocal results which require further study to reach reliable diagnosis. The study does not break new ground of informing physician, or patient on the best choice in diagnostics to reach a reliable diagnosis of CAD.
Among the questions which went unasked in this study are how does CCTA compare to PET MPI in resolving equivocal SPECT results? In an age of medical austerity, another unasked question of relevance is how do the costs of a PET MPI scan compare to that of a CCTA, or a conventional catheter procedure?
Should we not also consider patient safety in the mix of questions? Perhaps an analysis of mortality and morbidity rates with the the different diagnostic procedures is appropriate? A final question; how do the the procedures compare for patient comfort? When these questions are asked, PET MPI compares very favorably with either CCTA, or conventional catheterization in resolving equivocal SPECT nuclear diagnosis.