Dynamic CZT-SPECT demonstrated good diagnostic accuracy for coronary artery disease, yielding a pooled sensitivity of 0.79, specificity of 0.85, and a diagnostic odds ratio of 17.82 compared to reference standards.
Meta-Analysis (n=421)
Does dynamic CZT-SPECT accurately diagnose coronary artery disease compared to quantitative CAG, FFR, or PET in patients evaluated for CAD?
Dynamic CZT-SPECT demonstrates good sensitivity and specificity for diagnosing coronary artery disease compared to reference standards like CAG, FFR, and PET.
Odds Ratio: 17.82 (95% CI 8.8–36.08)
p-value: p=<0.001
BACKGROUND: With the appearance of cadmium-zinc-telluride (CZT) cameras, dynamic myocardial perfusion imaging (MPI) has been introduced, but comparable data to other MPI modalities, such as quantitative coronary angiography (CAG) with fractional flow reserve (FFR) and positron emission tomography (PET), are lacking. This study aimed to evaluate the diagnostic accuracy of dynamic CZT single-photon emission tomography (SPECT) in coronary artery disease compared to quantitative CAG, FFR, and PET as reference. MATERIALS AND METHODS: Different databases were screened for eligible citations performing dynamic CZT-SPECT against CAG, FFR, or PET. PubMed, OvidSP (Medline), Web of Science, the Cochrane Library, and EMBASE were searched on the 5th of July 2020. Studies had to meet the following pre-established inclusion criteria: randomized controlled trials, retrospective trails or observational studies relevant for the diagnosis of coronary artery disease, and performing CZT-SPECT and within half a year the methodological references. Studies which considered coronary stenosis between 50% and 70% as significant based only on CAG were excluded. Data extracted were sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Quality was assessed with QUADAS-2 and statistical analysis was performed using a bivariate model. RESULTS: Based on our criteria, a total of 9 studies containing 421 patients were included. For the assessment of CZT-SPECT, the diagnostic value pooled analysis with a bivariate model was calculated and yielded a sensitivity of 0.79 (% CI 0.73 to 0.85) and a specificity of 0.85 (95% CI 0.74 to 0.92). Diagnostic odds ratio (DOR) was 17.82 (95% CI 8.80 to 36.08, P < 0.001). Positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 3.86 (95% CI 2.76 to 5.38, P < 0.001) and 0.21 (95% CI 0.13 to 0.33, P < 0.001), respectively. CONCLUSION: Based on the results of the current systematic review and meta-analysis, dynamic CZT-SPECT MPI demonstrated a good sensitivity and specificity to diagnose CAD as compared to the gold standards. However, due to the heterogeneity of the methodologies between the CZT-SPECT MPI studies and the relatively small number of included studies, it warrants further well-defined study protocols.
Panjer et al. (Wed,) conducted a meta-analysis in Coronary artery disease (n=421). Dynamic CZT-SPECT vs. Quantitative CAG, FFR, or PET was evaluated on Diagnostic accuracy (Diagnostic odds ratio) (DOR 17.82, 95% CI 8.80 to 36.08, p=<0.001). Dynamic CZT-SPECT demonstrated good diagnostic accuracy for coronary artery disease, yielding a pooled sensitivity of 0.79, specificity of 0.85, and a diagnostic odds ratio of 17.82 compared to reference standards.