What are the sensitivity and specificity of Myocardial Perfusion Imaging (MPI) for Coronary Artery Disease (CAD)?

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Sensitivity and Specificity of MPI for CAD

Myocardial perfusion imaging demonstrates a sensitivity of 82-91% and specificity of 70-90% for detecting obstructive coronary artery disease, with pharmacological stress slightly outperforming exercise stress. 1

Diagnostic Performance by Stress Modality

Exercise Stress Nuclear MPI

  • Sensitivity: 82-88% 1
  • Specificity: 70-88% 1

Pharmacological Stress Nuclear MPI

  • Sensitivity: 88-91% 1
  • Specificity: 75-90% 1
  • Pharmacological stress achieves higher sensitivity and specificity compared to exercise stress, making it preferable for patients with limited exercise capacity 1

Performance in Specific Populations

Women

  • Technetium-99m agents with gated SPECT achieve sensitivity of 87% and specificity of 91% after bias correction 1
  • This represents substantial improvement over thallium-201 imaging, which had specificity of only 67% due to breast tissue attenuation 1
  • Vasodilator stress with Tc-99m sestamibi demonstrates sensitivity of 91% and specificity of 86% for detecting significant stenoses 1

Diabetic Patients

  • SPECT MPI shows sensitivity of 87-89% and specificity of 73-75% for detecting angiographically significant CAD in diabetic populations 1

Important Performance Caveats

Lower Accuracy in Meta-Analysis

  • A large meta-analysis of 114 SPECT studies revealed considerably lower pooled performance: sensitivity 78% and specificity only 52%, though negative predictive value remained high at 83% 1
  • This discrepancy reflects real-world heterogeneity in patient populations, technical factors, and referral bias 1

Technical Limitations

  • Balanced ischemia: Global perfusion reduction in left main or three-vessel disease can appear falsely normal, underestimating ischemic burden 1
  • Breast tissue artifact: Affects image quality in women and men with large breasts, though Tc-99m agents and attenuation correction reduce this problem 1
  • Obesity: Degrades diagnostic image quality, though PET maintains higher accuracy in obese patients 1

PET vs SPECT Performance

PET myocardial perfusion imaging achieves slightly higher sensitivity than SPECT, particularly in women and obese patients, due to superior spatial resolution and photon attenuation correction 1

Hybrid Imaging Enhancement

Combining SPECT with coronary CT angiography dramatically improves diagnostic accuracy to sensitivity 96% and specificity 95%, compared to SPECT alone (93% sensitivity, 79% specificity) or CCTA alone (98% sensitivity, 62% specificity) 1

Prognostic Value

  • Normal stress SPECT predicts excellent outcomes: annual cardiac event rate of only 1% in patients with intermediate to high pretest probability of CAD 1
  • Abnormal perfusion studies stratify risk proportionally to defect extent and severity, with three-year survival declining from 99% (no ischemia) to 85% (three-vessel territory ischemia) 1

References

1
Guideline

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Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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