What is the role of PET scanning in the workup of coronary artery atherosclerosis?

Updated: Apr 09, 2021
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Answer

For the diagnosis of obstructive CAD, rubidium-82 (82 Rb) PET appears superior to technetium-99m (99m Tc)–based SPECT. In a systematic review of studies that used82 Rb PET or99m Tc SPECT, with coronary angiography as a reference standard, PET and SPECT had sensitivities of 90% and 85%, respectively, and specificities of 88% and 85%, respectively. PET had even greater superiority when patients with low likelihood ratio were excluded. [44]

Although the approximate estimated cost per scan is higher with PET than with SPECT ($1850 versus $1000), radiation exposure was estimated to be 4- to 5-fold lower with PET. [44] In addition, PET offers better spatial and temporal resolution and shorter imaging time. [45]

One study has shown that assessment with PET is a powerful, independent predictor of cardiac mortality in patients with known or suspected coronary artery disease and provides meaningful incremental risk stratification over clinical and gated myocardial perfusion imaging variables. [46]


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