Al-Mallah Mouaz, Alwan Maria, Al Rifai Mahmoud, Sayed Ahmed
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
Houston Methodist Hospital, USA.
J Nucl Cardiol. 2024 Nov;41:102030. doi: 10.1016/j.nuclcard.2024.102030. Epub 2024 Sep 2.
Positron emission tomography (PET) is an important tool for assessing coronary artery disease (CAD), but its widespread utilization is limited due to various factors, including limited local champion availability. This study aims to compare the frequency of PET procedures and their interpreters with other common CAD assessment modalities.
Using Medicare data, we examined the number of cardiac PET procedures billed and compared them with single-photon emission computed tomography (SPECT), coronary computed tomography angiography (CCTA), stress magnetic resonance imaging (MRI), and stress echocardiography. Healthcare Common Procedure Coding System codes were used to identify procedures. We calculated the total number of PET myocardial perfusion imaging (MPI) procedures, the proportion of PET/CT and myocardial blood flow (MBF) assessments, and the median number of studies read per physician. We also analyzed the trends in the use of different CAD assessment modalities between 2018 and 2022. Descriptive statistics summarized the data.
In 2022, Medicare billed for 212,106 PET MPI scans. SPECT was six times more frequent (1,343,519), whereas stress echocardiography (201,676) and CCTA (118,734) had similar or lower use. Stress MRI (3,932) was least used. Of the PET MPI scans, 46% were PET/CT, and 39% included MBF measurements. Cardiologists interpreted 86% of PET scans, with a median of 58 studies per reader; 23% interpreted ≤25 studies annually. SPECT had a median of 63 studies per reader, and CCTA, stress MRI, and stress echocardiography had medians of 27, 20, and 24, respectively. PET, CT, and MRI use increased from 2018 to 2022, whereas SPECT and stress echocardiography declined.
In the Medicare population, radionuclide perfusion imaging (SPECT and PET) remained the preferred method for assessment of CAD, with SPECT being the most frequently used modality and PET being the second most frequently used modality for this application. However, PET/CT and MBF are underutilized, limiting diagnostic and prognostic capabilities. Efforts to enhance education and awareness of PET's advantages and to address barriers to its wider adoption are essential to maximize its clinical benefits and improve patient outcomes.
正电子发射断层扫描（PET）是评估冠状动脉疾病（CAD）的重要工具，但由于包括当地支持者有限等多种因素，其广泛应用受到限制。本研究旨在比较PET检查及其解读人员与其他常见CAD评估方式的使用频率。
利用医疗保险数据，我们检查了计费的心脏PET检查数量，并将其与单光子发射计算机断层扫描（SPECT）、冠状动脉计算机断层血管造影（CCTA）、负荷磁共振成像（MRI）和负荷超声心动图进行比较。使用医疗保健通用程序编码系统代码来识别检查项目。我们计算了PET心肌灌注成像（MPI）检查的总数、PET/CT和心肌血流量（MBF）评估的比例，以及每位医生解读的研究中位数。我们还分析了2018年至2022年期间不同CAD评估方式的使用趋势。描述性统计总结了数据。
2022年，医疗保险为212,106次PET MPI扫描计费。SPECT的使用频率高出六倍（1,343,519次），而负荷超声心动图（201,676次）和CCTA（118,734次）的使用频率与之相似或更低。负荷MRI（3,932次）的使用最少。在PET MPI扫描中，46%为PET/CT，39%包括MBF测量。心脏病专家解读了86%的PET扫描，每位读者的中位数为58项研究；23%的读者每年解读≤25项研究。SPECT每位读者的中位数为63项研究，CCTA、负荷MRI和负荷超声心动图的中位数分别为27、20和24项。从2018年到2022年，PET、CT和MRI的使用增加，而SPECT和负荷超声心动图的使用减少。
在医疗保险人群中，放射性核素灌注成像（SPECT和PET）仍然是评估CAD的首选方法，SPECT是最常用的方式，PET是该应用中第二常用的方式。然而，PET/CT和MBF的利用不足，限制了诊断和预后能力。努力加强对PET优势的教育和认识，并消除其更广泛应用的障碍，对于最大化其临床益处和改善患者结局至关重要。
