Journal of Nuclear Cardiology

, Volume 24, Issue 1, pp 212–223 | Cite as

Sequential SPECT/CT imaging for detection of coronary artery disease in a large cohort: evaluation of the need for additional imaging and radiation exposure

  • Elsemiek M. Engbers
  • Jorik R. Timmer
  • Jan Paul Ottervanger
  • Mohamed Mouden
  • Ad. H. J. Oostdijk
  • Siert Knollema
  • Pieter L. Jager
Original Article



Performing both single photon emission computerized tomography (SPECT) and coronary computed tomography angiography (CCTA) in patients suspected for coronary artery disease (CAD) leads to increased radiation exposure. We evaluated the need for additional imaging and following implications for radiation exposure of a sequential SPECT/computed tomography (CT) algorithm.

Methods and Results

5018 consecutive patients without history of CAD were referred for stress-first SPECT and coronary artery calcium (CAC) scoring. If stress SPECT was abnormal, additional rest SPECT and, if feasible, CCTA were acquired. Stress SPECT was normal in 2617 patients (52%). CCTA was not performed in 1289 of the 2401 patients referred for additional imaging (54%), mainly because of severe CAC (47%) or fast/irregular heart rate (22%). 642 patients with abnormal SPECT underwent CCTA, which excluded significant CAD in 378 patients (59%). Mean radiation dose was 4.5 ± 0.3 mSv for stress-only imaging and 13.2 ± 3.3 mSv for additional imaging (P < 0.001).


Half of the patients do not require additional imaging in our sequential SPECT/CT algorithm, which is accompanied with low radiation exposure. CCTA cannot be performed in half of the patients who undergo additional imaging because of (relative) contra-indications. CCTA is able to correct for false-positive SPECT findings in our algorithm.


Single photon emission computed tomography coronary artery calcium score coronary computed tomography angiography sequential imaging suspected coronary artery disease 



Coronary artery disease


Coronary computed tomography angiography


Coronary artery calcium


Single photon emission computed tomography


Computed tomography


Myocardial infarction


Left bundle branch block


Body mass index


Cadmium zinc telluride



Dr. Engbers, Dr. Timmer, Dr. Ottervanger, Dr. Mouden, Dr. Oostdijk, Dr. Knollema, and Dr. Jager have nothing to disclose.


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Copyright information

© American Society of Nuclear Cardiology 2015

Authors and Affiliations

  • Elsemiek M. Engbers
    • 1
    • 2
  • Jorik R. Timmer
    • 1
  • Jan Paul Ottervanger
    • 1
  • Mohamed Mouden
    • 1
    • 2
  • Ad. H. J. Oostdijk
    • 2
  • Siert Knollema
    • 2
  • Pieter L. Jager
    • 2
  1. 1.Department of CardiologyIsalaZwolleThe Netherlands
  2. 2.Department of Nuclear MedicineIsalaZwolleThe Netherlands

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