1.
Diagnostic performance of myocardial perfusion imaging with conventional and CZT single-photon emission computed tomography in detecting coronary artery disease: A meta-analysis.
Cantoni, V, Green, R, Acampa, W, Zampella, E, Assante, R, Nappi, C, Gaudieri, V, Mannarino, T, Cuocolo, R, Di Vaia, E, et al
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology. 2021;(2):698-715
Abstract
BACKGROUND We performed a meta-analysis to compare the diagnostic performance of conventional SPECT (C-SPECT) and cadmium-zinc-telluride (CZT)-SPECT systems in detecting angiographically proven coronary artery disease (CAD). METHODS Studies published between January 2000 and February 2018 were identified by database search. We included studies assessing C-SPECT or CZT-SPECT as a diagnostic test to evaluate patients for the presence of CAD, defined as at least 50% diameter stenosis on invasive coronary angiography. A study was eligible regardless of whether patients were referred for suspected or known CAD. RESULTS We identified 40 eligible articles (25 C-SPECT and 15 CZT-SPECT studies) including 7334 patients (4997 in C-SPECT and 2337 in CZT-SPECT studies). The pooled sensitivity and specificity were 85% and 66% for C-SPECT and 89% and 69% for CZT-SPECT imaging studies. The area under the curve was slightly higher for CZT-SPECT (0.89) compared to C-SPECT (0.83); accordingly, the summary diagnostic OR was 17 for CZT-SPECT and 11 for C-SPECT. The accuracy of the two tests slightly differs between C-SPECT and CZT-SPECT (chi-square 11.28, P < .05). At meta-regression analysis, no significant association between both sensitivity and specificity and demographical and clinical variables considered was found for C-SPECT and CZT-SPECT studies. CONCLUSIONS C-SPECT and CZT-SPECT have good diagnostic performance in detecting angiographic proven CAD, with a slightly higher accuracy for CZT-SPECT. This result supports the use of the novel gamma cameras in clinical routine practices also considering the improvements in acquisition time and radiation exposure reduction.
2.
CACS and the Frequency of Stress-Induced Myocardial Ischemia During MPI: A Meta-Analysis.
Bavishi, C, Argulian, E, Chatterjee, S, Rozanski, A
JACC. Cardiovascular imaging. 2016;(5):580-9
Abstract
OBJECTIVES This study sought to systematically assess the relationship between the magnitude of coronary artery calcium (CAC) and presence of myocardial ischemia. BACKGROUND The likelihood of myocardial ischemia rises with increasing CAC score. However, the likelihood of ischemia according to different CAC abnormality cutoffs has not been systematically evaluated. METHODS A comprehensive systematic search was undertaken to identify all relevant studies that compared CAC with myocardial perfusion imaging and reported ischemia rates by CAC categories. The following thresholds of CAC scores were analyzed and correlated with rates of ischemia: scores of 0, 1 to 100, 101 to 399, and ≥400. RESULTS Overall, 20 studies reported frequencies of stress-induced myocardial ischemia by various CAC categories. Six studies (n = 2,123 patients) reported ischemia rates for all 4 CAC categories. A stepwise increase in the frequency of ischemia according to CAC abnormality was noted. The frequency of ischemia was low among patients with zero or very low CAC score. However, among the patients with CAC scores ≥400, the reported frequencies of ischemia varied widely among studies. Notably, most studies involved small sample sizes; only 5 of 20 studies included >500 patients and very few studies examined clinical parameters that may potentially modify the relationship between CAC score and ischemia. CONCLUSIONS Our meta-analysis indicates the presence of a quantitative relationship between the magnitude of CAC abnormality and the likelihood of inducible myocardial ischemia. Zero to low CAC scores were infrequently associated with ischemia, but there was a wide variance in the frequency of ischemia among patients with intermediate to high CAC scores. Thus, there is a need for prospective study involving larger patient samples to better define the clinical factors that influence the relationship between CAC scores and inducible myocardial ischemia.
3.
Diagnostic performance of myocardial innervation imaging using MIBG scintigraphy in differential diagnosis between dementia with lewy bodies and other dementias: a systematic review and a meta-analysis.
Treglia, G, Cason, E
Journal of neuroimaging : official journal of the American Society of Neuroimaging. 2012;(2):111-7
Abstract
BACKGROUND AND PURPOSE This study was designed to review the diagnostic performance of myocardial innervation imaging using iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy in differential diagnosis between dementia with Lewy bodies (DLB) and other dementias. METHODS A comprehensive computer literature search of studies published through May 2010 regarding MIBG scintigraphy in patients with DLB was performed in PubMed/MEDLINE and Embase databases. Only studies in which MIBG scintigraphy was performed for differential diagnosis between DLB and other dementias were selected. Pooled sensitivity and specificity of MIBG scintigraphy were presented with a 95% confidence interval (CI). The area under the ROC curve was calculated to measure the accuracy of MIBG scintigraphy in differential diagnosis between Lewy body diseases and other dementias. RESULTS Ultimately, we identified 8 studies comprising a total of 346 patients with dementia (152 patients with DLB and 194 patients with other dementias). The pooled sensitivity of MIBG scintigraphy in detection of DLB was 98% (95% CI, 94-100%); the pooled specificity of MIBG scintigraphy in differential diagnosis between DLB and other dementias was 94% (95% CI, 90-97%). The area under the ROC curve was .99. CONCLUSIONS Myocardial innervation imaging with MIBG scintigraphy demonstrated high pooled sensitivity and specificity in patients with suspected DLB. MIBG scintigraphy is an accurate test for differential diagnosis between DLB and other dementias.