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Nuclear cardiology and electron-beam computed tomography: competitive or complementary?

  • Daniel S Berman
    Correspondence
    Address for reprints: Daniel S. Berman, MD, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room A-041, Los Angeles, California 90048
    Affiliations
    Department of Imaging, Cedars-Sinai Medical Center Burns and Allen Research Institute, Los Angeles, California, USA (DSB, EFS, RM, JDF, SWH, HCL)

    Department of Medicine (DSB, JDF, HCL, GG), University of California-Los Angeles, School of Medicine, Los Angeles, California, USA
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  • Enrique F Schisterman
    Affiliations
    Department of Imaging, Cedars-Sinai Medical Center Burns and Allen Research Institute, Los Angeles, California, USA (DSB, EFS, RM, JDF, SWH, HCL)

    Department of Biostatistics (EFS), University of California-Los Angeles, School of Medicine, Los Angeles, California, USA
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  • Romalisa Miranda
    Affiliations
    Department of Imaging, Cedars-Sinai Medical Center Burns and Allen Research Institute, Los Angeles, California, USA (DSB, EFS, RM, JDF, SWH, HCL)
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  • John D Friedman
    Affiliations
    Department of Imaging, Cedars-Sinai Medical Center Burns and Allen Research Institute, Los Angeles, California, USA (DSB, EFS, RM, JDF, SWH, HCL)

    Department of Medicine (DSB, JDF, HCL, GG), University of California-Los Angeles, School of Medicine, Los Angeles, California, USA
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  • Sean W Hayes
    Affiliations
    Department of Imaging, Cedars-Sinai Medical Center Burns and Allen Research Institute, Los Angeles, California, USA (DSB, EFS, RM, JDF, SWH, HCL)
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  • Howard C Lewin
    Affiliations
    Department of Imaging, Cedars-Sinai Medical Center Burns and Allen Research Institute, Los Angeles, California, USA (DSB, EFS, RM, JDF, SWH, HCL)

    Department of Medicine (DSB, JDF, HCL, GG), University of California-Los Angeles, School of Medicine, Los Angeles, California, USA
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  • Guido Germano
    Affiliations
    Department of Imaging, Cedars-Sinai Medical Center Burns and Allen Research Institute, Los Angeles, California, USA (DSB, EFS, RM, JDF, SWH, HCL)

    Department of Medicine (DSB, JDF, HCL, GG), University of California-Los Angeles, School of Medicine, Los Angeles, California, USA

    Department of Radiological Sciences (GG), University of California-Los Angeles, School of Medicine, Los Angeles, California, USA
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      Abstract

      Electron-beam computed tomography (EBCT) and nuclear cardiology techniques are both valuable in the noninvasive assessment of patients with suspected coronary artery disease. The techniques, however, are different in the information they provide about the patient. EBCT provides anatomic information on coronary atherosclerosis, whereas myocardial perfusion single-photon emission computed tomography assesses the physiologic significance of coronary stenosis. Because of these differences, the techniques are highly complementary.
      In considering the complementary nature of these methods, it is important to clarify the issues being raised. An important question in the consideration of a patient with known or suspected coronary artery disease is, What is the risk in an individual patient of developing clinical coronary artery disease? The answer to this question will determine who needs aggressive medical management. A second question in a suspected coronary artery disease patient is, What is the risk of cardiac death? As will be discussed, this risk, in general, determines the need to consider coronary revascularization. In the former question, EBCT testing and clinical assessment alone is usually sufficient, and in some cases nuclear testing can be of additional value. In answering the second question, on the basis of currently available data, the EBCT and nuclear cardiology studies appear to be operating in a complementary fashion.
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