Cardiovascular Business - October/November 2007 - (Page 27) Pet/Ct angiography images from the siemens Medical solutions biograph 64 Pet/Ct system. PET/CT cardiac imaging has demonstrated advantages over the more commonly performed nuclear stress tests. First and foremost, it has shown particular superiority in patients with a body-mass index (BMI) greater than 30, so abnormal results are more reliable. Cardiac PET/CT is also the clinical gold standard to determine the viability of heart tissue for revascularization, providing cardiac surgeons greater diagnostic confidence as to whether bypass surgery or transplantation is the appropriate treatment after a heart attack. In addition to lower radiation exposure than other forms of nuclear stress testing, patients benefit from reduced exam time. For example, the entire test (rest and stress) can be completed in 45 minutes or less compared with the 3 to 4 hours required for SPECT stress testing. putting cardiac pET/CT into practice Ronald Korn, MD, PhD, a board-certified radiologist and nuclear medicine physician, recognized the potential for cardiac PET/CT and developed a program for his Phoenix area private practice, Scottsdale Medical Imaging. “The value of PET/CT is that cardiac SPECT studies can be difficult to interpret because of artifacts, problems with image acquisition, and the build of the patient,” Korn says. “PET/CT helps clarify the equivocal SPECT.” When a patient is referred to Korn, the practice pre-qualifies him or her with their payor. If the patient is a Medicare beneficiary, the process is fairly straightforward, as CMS has approved the use of Rb-82 MPI PET studies since 1995. When it comes to private payors, pre-authorization can be a tricky matter. “Most private insurance carriers provide pre-authorization for Rb-82 PET exams, although a few still consider it an investigational study and don’t give authorization,” Korn said. “However, the data are clear that PET/CT is the gold standard for MPI, so it is well beyond investigational.” One of the primary reasons that cardiologists refer their equivocal or non-diagnostic SPECT cases to Korn for PET/CT MPI is the relationships that he has cultivated in his 11 years of Arizona-based practice. “I spent the past 11 years building a very trusting relationship with cardiologists,” Korn notes. “As a result, in difficult nuclear cardiac cases, I’m often called upon in an advisory role to give a secondary opinion.” Those relationships have allowed Korn to educate his referring physician base on the value of PET/CT MPI studies vs. SPECT imaging, particularly for overweight and obese patients. “We really focused our practice on patients who have a BMI greater than 25,” he notes. In addition, because his practice is affiliated with a bariatric surgery center, he says that Scottsdale Medical Imaging is seeing more of these patients, whose weight puts them at greater risk for coronary artery disease. “Not only is PET/CT superior to SPECT in these patients, but if you have a positive SPECT it generally results in downstream procedures and interventions, such as cardiac catheterization, being performed, sometimes unnecessarily,” Korn said. “PET/CT really does offer a very practical and useful application in reducing the number of patients that get unnecessary catheterizations.” In addition to providing greater diagnostic certainty for cardiologists, PET/CT has the side benefit, through the CT portion of the exam, of capturing thoracic anatomic information. These images have allowed Korn, through his extensive radiological education and experience, to discover malignancies for which the patient did not present, also known as “incidentalomas.” “The same patients who are at risk for coronary artery disease because of smoking or other bad habits are also at risk for lung cancer,” he notes. “We’ve found in about 1 to 2 percent of our population an incidental finding that required aggressive evaluation for cancer.” Korn also has found unsuspected aneurysms with the CT CardiovascularBusiness.com Cardiovascular Business 27 http://www.CardiovascularBusiness.com
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