Clinical utility of inappropriate positron emission tomography myocardial perfusion imaging: Test results and cardiovascular events

Abstract

Inappropriate PET-MPI was rarely abnormal, associated with low catheterization rates, and failed to detect occult ischemia for any subjects. The clinical utility of inappropriate PET-MPI is negligible.

The value and appropriateness of positron emission tomography: An evolving tale

“…Therefore, an abnormal SPECT MPI, when appropriate, was associated with death and/or MI or other major cardiac events, but if performed for inappropriate indications, the SPECT study did not predict events. Similar to the SPECT reports describing the prognostic value of AUC, the current report by Winchester et al 15 demonstrated that an abnormal PET study or one which possesses significant ischemia (summed difference score [5) is associated with a hazard ratio for events of 4.5 and 5.1, respectively. Inappropriate PET scans were associated with low angiography rates and the clinical value of these studies appears negligible.…”

“…In this issue of the Journal, Winchester et al 15 report the findings of a retrospective analysis regarding the appropriate use of PET imaging. This unique study is the first report specifically designed to evaluate the AUC for PET and examined not only the categories of appropriate use but also the frequency of abnormal perfusion findings stratified by the level of appropriateness.…”

“…Winchester et al 15 found that appropriate and uncertain indications for PET were present in 79.5% and 10.4%, respectively, with an inappropriate rate of 10.2%. As shown in Table 2, these categorizations for PET appropriate use are similar to those found in the majority of reports with SPECT, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] although there are some reports of SPECT MPI with higher frequency of inappropriate studies.…”

“…The selection of diagnostic catheterization as an endpoint in the investigation by Winchester et al 15 and others 27 is flawed, as physicians were likely biased in their decision to refer a patient for coronary angiography based on scan findings and does not represent a meaningful change in outcome to the patient. Coronary revascularization, while still somewhat subjective, might have been a preferable endpoint except that PCI and CABG were also infrequently performed in the current trail [34 subjects (6.5%)], in keeping with the overall low-risk nature of the study cohort.…”

Appropriately testing patients with intermediate risk for coronary artery disease: how well are we doing?

“…Subsequently, high percentage of these patients with no appropriate indication for cardiac imaging tests underwent diagnostic coronary angiography with no significant coronary lesions were found that warranted coronary intervention 15. Winchester et al 16 have shown that inappropriately ordered cardiac imaging tests were rarely abnormal, highlighting the low diagnostic value of the unnecessarily performed imaging tests.…”