title: Combining stress-only myocardial perfusion imaging with coronary calcium scanning as a new paradigm for initial patient work-up: an exploratory analysis.
abstract: BACKGROUND
  We conducted an exploratory analysis to test whether the addition of a CAC scan can increase the applicability of stress-only SPECT-MPI.
  
  
  METHODS
  We studied 162 patients referred for rest/stress SPECT-MPI who underwent a CAC scan. Each scan was interpreted by two readers in stepwise fashion: stress-only images; addition of clinical data; and addition of CAC data. At each step, the reader was asked if rest SPECT-MPI was necessary.
  
  
  RESULTS
  Stress-only images were interpreted as normal in 62, probably normal in 42, equivocal in 15, probably abnormal in 5, and definitely abnormal in 38 patients. Rest SPECT-MPI imaging was considered necessary, in 0% of normal studies, but in 88% of probably normal studies, and 100% of those with equivocal/abnormal studies. Addition of the clinical data did not materially change this decision. Additional consideration of the CAC scan results did not influence the deemed lack of need for a rest SPECT-MPI with normal SPECT-MPI or the necessity of rest SPECT-MPI with abnormal SPECT-MPI. However, the CAC scan reduced the deemed need for a rest SPECT-MPI in 72% with a probably normal, 47% with an equivocal, and 40% of those with a probably abnormal SPECT-MPI.
  
  
  CONCLUSIONS
  Our exploratory analysis indicates that addition of a CAC scan to stress SPECT-MPI tends to diminish experienced readers' deemed need to perform rest SPECT-MPI studies among patients with probably normal or borderline stress-only SPECT-MPI studies. Thus, further study appears warranted to assess the utility of using CAC scanning as a means for increasing the percent of SPECT-MPI studies that can be performed as stress-only studies.
authors.affiliation: Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, NJ,100 Madison Avenue, Morristown, NJ 07960, USA. seth.uretsky@atlantichealth.org
authors.forename: Seth
authors.initials: S
authors.lastname: Uretsky
authors.forename: Randy
authors.initials: R
authors.lastname: Cohen
authors.forename: Edgar
authors.initials: E
authors.lastname: Argulian
authors.forename: Kiruthika
authors.initials: K
authors.lastname: Balasundaram
authors.forename: Azhar
authors.initials: A
authors.lastname: Supariwala
authors.forename: Marjorie
authors.initials: M
authors.lastname: Subero
authors.forename: Samridhi
authors.initials: S
authors.lastname: Sinha
authors.forename: Keerthana
authors.initials: K
authors.lastname: Paladugu
authors.forename: E Gordon
authors.initials: EG
authors.lastname: DePuey
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002118:Calcium / Q000378:metabolism; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000378:metabolism / Q000473:pathology*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D012146:Rest; D012307:Risk Factors; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult
chemical_list: D017256:Technetium Tc 99m Sestamibi; D002118:Calcium