Sequential SPECT/CT imaging for detection of coronary artery disease in a large cohort: evaluation of the need for additional imaging and radiation exposure.

Autor: Engbers EM; Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. elsemiekengbers@gmail.com.; Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. elsemiekengbers@gmail.com., Timmer JR; Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. v.r.c.derks@isala.nl., Ottervanger JP; Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands., Mouden M; Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.; Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands., Oostdijk AHJ; Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands., Knollema S; Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands., Jager PL; Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology [J Nucl Cardiol] 2017 Feb; Vol. 24 (1), pp. 212-223. Date of Electronic Publication: 2015 Sep 22.
DOI: 10.1007/s12350-015-0243-z
Abstrakt: Background: Performing both single photon emission computerized tomography (SPECT) and coronary computed tomography angiography (CCTA) in patients suspected for coronary artery disease (CAD) leads to increased radiation exposure. We evaluated the need for additional imaging and following implications for radiation exposure of a sequential SPECT/computed tomography (CT) algorithm.
Methods and Results: 5018 consecutive patients without history of CAD were referred for stress-first SPECT and coronary artery calcium (CAC) scoring. If stress SPECT was abnormal, additional rest SPECT and, if feasible, CCTA were acquired. Stress SPECT was normal in 2617 patients (52%). CCTA was not performed in 1289 of the 2401 patients referred for additional imaging (54%), mainly because of severe CAC (47%) or fast/irregular heart rate (22%). 642 patients with abnormal SPECT underwent CCTA, which excluded significant CAD in 378 patients (59%). Mean radiation dose was 4.5 ± 0.3 mSv for stress-only imaging and 13.2 ± 3.3 mSv for additional imaging (P < 0.001).
Conclusions: Half of the patients do not require additional imaging in our sequential SPECT/CT algorithm, which is accompanied with low radiation exposure. CCTA cannot be performed in half of the patients who undergo additional imaging because of (relative) contra-indications. CCTA is able to correct for false-positive SPECT findings in our algorithm.
Databáze: MEDLINE
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