Cardiovascular Business - January/February 2008 - (Page 20)

nUCleaR CaRDIoloGY › By sArAH L AMBErti SPECTProvi ng Its Value N the Facts installed base Considered to be a critical diagnostic tool in imaging patients with suspected or confirmed coronary artery disease (CAD), single photo emission computed tomography (SPECT) is holding its own against emerging cardiovascular imaging modalities such as cardiac CT and MRI and offers considerable advantages that cannot be ignored. uclear medicine utilization (excluding PET procedures) continues to be dominated by cardiovascular applications, which have grown to 60 percent of procedures in 2006 from 54 percent in 2002, according to Lorna Young, senior director, market research, IMV Medical Information Division. IMV estimates that 60 percent of 15.2 million patient visits in the United States in 2006 were for cardiovascular studies, such as cardiac perfusion, echocardiography and SPECT. SPECT is a critical test for the assessment of patients with suspected CAD and one of the most commonly ordered tests for patients presenting with suspected coronary artery stenosis, confirms U. Joseph Schoepf, MD, associate professor of radiology and cardiology, the Medical University of South Carolina (MUSC) in Charleston. SPECT has increasingly come under fire from proponents of cardiac MRI and CT, but Schoepf believes the attacks are not entirely justified. “[SPECT] is fairly entrenched in the diagnostic workup of patients with CAD—people commonly refer to that test whenever managing patients with the disease,” he says. “We also know that one of the most valuable pieces of information derived from SPECT is patient prognosis, which is extremely important in patient management. If a patient presents with no signs of myocardial ischemia on SPECT, we have incremental prognostic value regarding the incidence of cardiovascular events—value that even exceeds that of an invasive catheter angiogram.” Gordon DePuey, MD, division of nuclear medicine, St. Luke’sRoosevelt Hospital, New York, N.Y., is another believer in SPECT’s negative prognostic value. “From virtually every study published on nuclear imaging, we know that the more extensive, the more severe the perfusion abnormality, the higher likelihood of morbidity and mortality, so we can rely very well on the prognostic ability of SPECT and its ability to risk stratify patients,” he says. “Our sensitivity in detecting coronary disease is not all that great—perhaps about 90 percent—meaning we miss about 10 percent. As it turns out, though, in patients where we miss disease and the scan is negative, the prognosis and risk of patients is still very, very low.” DePuey says that despite the other modalities like stress echocardiography and CT coronary angiography that are suitable for cardiac imaging, SPECT continues to prove its value as an important tool in diagnosing CAD. “SPECT is really giving us hemodynamic-significant information necessary for effective patient management,” he says. “Myocardial perfusion SPECT imaging has considerable advantages over stress echo,” says DePuey. He says that there are advantages to stress echo including the ability to look not only at stressinduced left ventricular dysfunction associated with coronary disease, but also other abnormalities like valvular disease. While echo has great advantages in young patients and young women who we do not want to expose to radiation unnecessarily, where › sPeCt: the Deep Dive → nuclear medicine patient visits: 15.2 million → Cardiovascular procedures: 60%, including 57% myocardial ischemia/perfusion and 3% other cardiovascular studies, including MUGa → Patient visits for myocardial ischemia/perfusion scans: 8.54 million → 97%, or 8.3 million, used gated sPeCT (that’s a jump from 88 percent in 2001) → Total: 13,130 stationary installations at 7,180 sites, average of 1.8 cameras per site → Growth: 3% from 2005-2007 → Hospital-based: 9,000 cameras at 3,970 hospitals, average of 2.3 cameras per site → Growth: 2% from 2005-2007 source: 2007 Nuclear Medicine report summary, iMV Medical information Division; Based on 2006 data 20 Cardiovascular Business January/february 2008

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2008

Cardiovascular Business - January/February 2008 Contents The Ticker: Quality Pays in Several Ways Cover Story: The Proof: Why Evidence-based Medicine Improves Cardiac Care Clinical Study Digest: Co-payments and Cath Labs Cardiac PET/CT Fills in Gaps Left by SPECT Tapping into IT to Improve the Office-Based Practice SPECT–Proving Its Value Cardiac Images in the EMR: Just a Click Away The Top 20 Ways to Market Your Cardiac CTA Practice The Big Picture: Medical Displays for Cardiac Images Statins Work But Pharmacoeconomic Caveats Abound Driving Data Protection: Opting for Storage On- or Offsite News & Views Calendar Reader’s Resource

Cardiovascular Business - January/February 2008

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