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Excerpt
Comprehensiveness and cost effectiveness are increasingly important in diagnostic imaging, due to cost controls and the growth of managed medical care. We have developed an optimal noninvasive imaging method for the diagnosis and evaluation of coronary artery disease (CAD), gated SPECT thallium imaging (GST). GST has been evaluated in 1480 consecutive patients, employing a variety of imaging configurations and stress methods (exercise = 936; dipryridamole = 415; dobutamine = 129). Image quality for perfusion analysis was uniformly excellent, and gated wall motion analysis for evaluation of global and segmental systolic function was good in >95% of studies.
Angiographic correlations were available for 324 patients; CAD was present in 280 (86%) and absent in 44 (14%). Sensitivity, positive predictive value and overall accuracy for GST were ≥90%. Gated wall motion analysis contributed greatly to image interpretation, but was less accurate alone than myocardial perfusion analysis. Using a derived region of interest method, calculated left ventricular ejection fraction (LVEF) from GST tomographic sections correlated well with RNA, and was superior to angiographic LVEF by cardiac catheterization.
GST is thus the most comprehensive current noninvasive method for CAD evaluation, permitting simultaneous assessment of functional capacity, symptoms, ECG response, myocardial perfusion, global and segmental wall motion and LVEF. The cost effectiveness of GST is excellent, as it eliminates the need for multiple noninvasive procedures and permits optimal selection of patients for cardiac catheterization. Published economic analyses of noninvasive and invasive CAD diagnostic methods have documented the cost effectiveness of thallium imaging for various clinical subsets. We will present evidence indicating that GST is the preferred initial procedure for most patients to have CAD.
