Cost-Effectiveness of stress-only myocardial perfusion single photon emission computed tomography (SPECT) imaging

Single photon emission computed tomography (SPECT) myocardial perfusion imaging is widely used for diagnosing coronary artery disease (CAD). However, SPECT costs, imaging time, and radiation exposure, limit SPECT indications. Objective: Determine whether a stress-only SPECT imaging would be enough to obtain a diagnosis of CAD improving nuclear laboratory efficiency Methods: 122 patients with unknown CAD were evaluated with stress-only SPECT imaging. In order to evaluate diagnostic accuracy and the prognostic value of the stress-only protocol, patients with abnormal SPECT underwent invasive angiography and patients with normal SPECT were followed-up during 3 years. Results: Diagnosis time, SPECT cost, and radiopharmaceutical dosage were significantly lower as compared with the conventional SPECT imaging protocol (30,40 and 55%, respectively). Diagnostic accuracy and cardiac prognosis information were comparable to those obtained with the conventional imaging protocol (positive predictive value for CAD of 85% and negative predictive value for cardiac events of 97%). Conclusions: In patients with intermediate risk for CAD, stress-only SPECT imaging will significantly improve nuclear laboratory efficiency and with similar accuracy than that the one obtained with the conventional protocol.