SPECT or SPECT/CT MPI Rest and Stress Stress SPECT MPI can identify relative myocardial perfusion defects, indicating the presence of myocardial ischemia and/or infarction. The territory of the perfusion defect identifies the likely coronary artery involved and can usually distinguish between significant single-vessel and multivessel coronary arterial obstructions [62,63]. A single-center study of >900 diabetic patients demonstrated that SPECT MPI has a reported sensitivity of 87% to 89% and a specificity of 73% to 75% for detecting angiographically significant CAD [62]. Another single-center study evaluated 100 consecutive patients referred for SPECT MPI because of either chronic chest pain and no known CAD (55%) or patients with a documented history of myocardial infarction (29%) referred for risk stratification [64]. MPI and poststress and reversible regional wall motion abnormalities on exercise stress Tc-99m- gated SPECT MPI were significant predictors of angiographic disease and add incremental value to MPI for the assessment of angiographic severity [64,65]. In patients with typical angina (high pretest likelihood of disease), stress SPECT MPI is useful for estimating the extent (single vessel versus multivessel disease) and severity of coronary stenosis, which has relevance for prognosis, choice among therapeutic options, and advisability of performing coronary arteriography. A meta- analysis including 114 SPECT studies of patients with suspected or established CAD has shown the sensitivity and specificity for the detection of significant CAD and/or myocardial ischemia was 78% and 52%, respectively, with an NPV of 83% [66].
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. SPECT or SPECT/CT MPI Rest and Stress Stress SPECT MPI can identify relative myocardial perfusion defects, indicating the presence of myocardial ischemia and/or infarction. The territory of the perfusion defect identifies the likely coronary artery involved and can usually distinguish between significant single-vessel and multivessel coronary arterial obstructions [62,63]. A single-center study of >900 diabetic patients demonstrated that SPECT MPI has a reported sensitivity of 87% to 89% and a specificity of 73% to 75% for detecting angiographically significant CAD [62]. Another single-center study evaluated 100 consecutive patients referred for SPECT MPI because of either chronic chest pain and no known CAD (55%) or patients with a documented history of myocardial infarction (29%) referred for risk stratification [64]. MPI and poststress and reversible regional wall motion abnormalities on exercise stress Tc-99m- gated SPECT MPI were significant predictors of angiographic disease and add incremental value to MPI for the assessment of angiographic severity [64,65]. In patients with typical angina (high pretest likelihood of disease), stress SPECT MPI is useful for estimating the extent (single vessel versus multivessel disease) and severity of coronary stenosis, which has relevance for prognosis, choice among therapeutic options, and advisability of performing coronary arteriography. A meta- analysis including 114 SPECT studies of patients with suspected or established CAD has shown the sensitivity and specificity for the detection of significant CAD and/or myocardial ischemia was 78% and 52%, respectively, with an NPV of 83% [66].