title: Does rubidium-82 PET have superior accuracy to SPECT perfusion imaging for the diagnosis of obstructive coronary disease?: A systematic review and meta-analysis.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the accuracy of rubidium (Rb)-82 positron emission tomography (PET) for the diagnosis of obstructive coronary artery disease (CAD) in comparison to single-photon emission tomography (SPECT).
  
  
  BACKGROUND
  Myocardial perfusion imaging is widely used in the assessment of patients with known or suspected CAD. PET using Rb-82 has potential advantages over SPECT that may make it more accurate and that reduce radiation exposure compared with SPECT but has increased costs. Comparisons of these technologies are highly relevant for policy makers and practice guidelines. However, studies directly comparing Rb-82 PET with contemporary SPECT have been limited.
  
  
  METHODS
  The authors therefore undertook a systematic review of studies where either Rb-82 PET or technetium-99m SPECT with both attenuation correction and electrocardiography-gating were used as a diagnostic test for obstructive CAD with invasive coronary angiogram as a reference standard. These technologies were then compared.
  
  
  RESULTS
  Fifteen PET and 8 SPECT studies (1,344 and 1,755 patients, respectively) met inclusion criteria and pooled accuracy using weighted averages according to the size of the patient population was determined for PET and SPECT with sensitivities of 90% (confidence interval [CI]: 0.88 to 0.92) and 85% (CI: 0.82 to 0.87) and specificities of 88% (CI: 0.85 to 0.91) and 85% (CI: 0.82 to 0.87), respectively. Summary receiver-operating characteristic curves were computed: area under the curve was 0.95 and 0.90 for PET and SPECT, respectively (p < 0.0001). There was heterogeneity among study populations and some studies were limited by referral bias.
  
  
  CONCLUSIONS
  Rb-82 PET is accurate for the detection of obstructive CAD and, despite advances in SPECT technology, remains superior. More widespread use of Rb-82 PET may be beneficial to improve CAD detection.
authors.affiliation: Molecular Function and Imaging Program, National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Mc Ardle
authors.forename: Taylor F
authors.initials: TF
authors.lastname: Dowsley
authors.forename: Robert A
authors.initials: RA
authors.lastname: deKemp
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
authors.forename: Rob S
authors.initials: RS
authors.lastname: Beanlands
mesh_terms: D002309:Cardiology / Q000379:methods / Q000639:trends; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012414:Rubidium Radioisotopes; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D012414:Rubidium Radioisotopes