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

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  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

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.

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Abbreviations

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CAC:

Coronary artery calcium

SPECT:

Single photon emission computed tomography

CT:

Computed tomography

MI:

Myocardial infarction

LBBB:

Left bundle branch block

BMI:

Body mass index

CZT:

Cadmium zinc telluride

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Disclosure

Dr. Engbers, Dr. Timmer, Dr. Ottervanger, Dr. Mouden, Dr. Oostdijk, Dr. Knollema, and Dr. Jager have nothing to disclose.

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Authors and Affiliations

  1. Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands

    Elsemiek M. Engbers MD, Jorik R. Timmer MD, PhD, Jan Paul Ottervanger MD, PhD & Mohamed Mouden MD, PhD

  2. Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands

    Elsemiek M. Engbers MD, Mohamed Mouden MD, PhD, Ad. H. J. Oostdijk MD, Siert Knollema MD, PhD & Pieter L. Jager MD, PhD

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  1. Elsemiek M. Engbers MD
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  2. Jorik R. Timmer MD, PhD
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  3. Jan Paul Ottervanger MD, PhD
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  4. Mohamed Mouden MD, PhD
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  5. Ad. H. J. Oostdijk MD
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  6. Siert Knollema MD, PhD
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Correspondence to Elsemiek M. Engbers MD or Jorik R. Timmer MD, PhD.

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See related editorial, doi:10.1007/s12350-015-0289-y.

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Engbers, E.M., Timmer, J.R., Ottervanger, J.P. et al. Sequential SPECT/CT imaging for detection of coronary artery disease in a large cohort: evaluation of the need for additional imaging and radiation exposure. J. Nucl. Cardiol. 24, 212–223 (2017). https://doi.org/10.1007/s12350-015-0243-z

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  • DOI: https://doi.org/10.1007/s12350-015-0243-z

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