Related Experiment Videos
Comparison of modalities to diagnose coronary artery disease
R E Patterson1, S F Horowitz, R L Eisner
1Department of Medicine, Carlyle Fraser Heart Center, Emory: Crawford Long Hospital, Atlanta, GA 30365.
Insights
This review compares diagnostic tests for coronary artery disease (CAD). Positron emission tomography myocardial perfusion imaging (PET MPI) is the top noninvasive choice, while contrast coronary angiography is the gold standard.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Testing
Background:
- Coronary artery disease (CAD) diagnosis relies on various imaging and clinical assessment modalities.
- Selecting the optimal diagnostic test is crucial for effective patient management.
Purpose of the Study:
- To compare available diagnostic modalities for coronary artery disease (CAD).
- To evaluate each modality's unique clinical information, observer error, sensitivity, specificity, patient selection criteria, incremental benefit, and role in diagnostic algorithms.
Main Methods:
- Comparative review of clinical history, ECG, LV function assessment (radionuclide, echocardiography), myocardial perfusion imaging (SPECT, PET), contrast coronary angiography, MRI, MRA, and UFCT.
- Analysis based on six key questions regarding diagnostic utility and clinical application.
Main Results:
- Positron emission tomography myocardial perfusion imaging (PET MPI) identified as the best noninvasive test for CAD.
- SPECT thallium-201 and dobutamine echocardiography are strong noninvasive alternatives.
- Contrast coronary angiography remains the gold standard; exercise ECG is the least accurate.
- Emerging modalities like MRA and UFCT show promise for arterial visualization.
Conclusions:
- Optimal test selection for CAD depends heavily on patient-specific factors, including clinical history, age, gender, and risk factors to determine pretest probability.
- PET MPI offers superior noninvasive assessment, followed by SPECT and echocardiography.
- Future roles for MRA and UFCT are anticipated in noninvasive CAD detection.
Abstract:
The purpose of this review is to compare several modalities available for detection of coronary artery disease (CAD). We compare the clinical history, rest/exercise electrocardiogram (ECG), rest/stress left ventricular (LV) function by radionuclide or echocardiographic methods, myocardial perfusion imaging (MPI) by single photon emission computed tomography (SPECT) or positron emission tomography (PET), contrast coronary angiography, magnetic resonance imaging (MRI), spectroscopy (MRS) and angiography (MRA), and ultrafast cine computed tomography (UFCT) to assess LV function, myocardial perfusion, and coronary calcification. We compare the modalities by answering six questions: (1) Does the modality provide unique clinical information? (2) What is the observer error? (3) What are sensitivities and specificities to detect CAD? (4) What patient selection criteria should be applied for each modality? (5) What incremental benefit is obtained from one modality versus another modality? and (6) Where do the modalities fit in the overall scheme of diagnostic testing for CAD? PET MPI appears to be the best noninvasive test for CAD, followed by SPECT thallium-201 and then dobutamine echocardiography. MRA and UFCT may soon play a larger role because they visualize the arteries. Contrast coronary angiography remains the gold standard despite its limitations. Exercise ECG is the least accurate test. The choice of tests critically depends on patient selection--based on clinical history, age, gender, and risk factors to estimate the pretest, clinical probability of CAD.