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01.02.2017 | Original Article

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

verfasst von: Elsemiek M. Engbers, MD, Jorik R. Timmer, MD, PhD, Jan Paul Ottervanger, MD, PhD, Mohamed Mouden, MD, PhD, Ad. H. J. Oostdijk, MD, Siert Knollema, MD, PhD, Pieter L. Jager, MD, PhD

Erschienen in: Journal of Nuclear Cardiology | Ausgabe 1/2017

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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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Titel: Sequential SPECT/CT imaging for detection of coronary artery disease in a large cohort: evaluation of the need for additional imaging and radiation exposure
verfasst von: Elsemiek M. Engbers, MD
Jorik R. Timmer, MD, PhD
Jan Paul Ottervanger, MD, PhD
Mohamed Mouden, MD, PhD
Ad. H. J. Oostdijk, MD
Siert Knollema, MD, PhD
Pieter L. Jager, MD, PhD
Publikationsdatum: 01.02.2017
Verlag: Springer US
Erschienen in: Journal of Nuclear Cardiology / Ausgabe 1/2017
Print ISSN: 1071-3581
Elektronische ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-015-0243-z

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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