The use of positron emission tomography (PET), computed tomography (CT), and magnetic resonance imaging (MRI) for assessing coronary artery disease (CAD) has increased in Medicare patients from 2018 to 2022, while single-photon emission computed tomography (SPECT) and stress echocardiography have declined over the same period, according to researchers.
Despite the increase, PET remained the second most common modality used after SPECT, noted lead author Mouaz Al-Mallah, MD, of the Houston Methodist DeBakey Heart and Vascular Center in Texas, and colleagues. The findings were published September 2 in the Journal of Nuclear Cardiology.
“Taken together, these findings call for efforts to address barriers impeding wider uptake of PET,” the group wrote.
Studies have shown that PET myocardial perfusion imaging (MPI) is superior to SPECT for assessing CAD, given advantages such as higher resolution, lower radiation exposure, and its ability to assess myocardial blood flow and myocardial flow reserve.
The researchers analyzed Medicare data and found that in 2022, Medicare was billed with a total of 212,106 PET MPI scans. In comparison, SPECT was six times more frequent (1.3 million procedures), stress echocardiography was slightly less frequent (201,676 procedures), and coronary CT angiography was approximately half as frequent (118,734 procedures). Stress MRI (3,932 procedures) was the least commonly used modality.
Notably, of the 212,106 PET MPI scans, 54% were PET/CT and 46% were PET only, which limits the technology’s ability to assess concomitantly for atherosclerosis.
A total of 1,993 unique readers interpreted PET MPI studies compared to 15,135 SPECT readers — more than seven times higher. There were 5,260 stress echocardiography readers, 2,376 CCTA readers, and only 122 stress MRI readers.
Overall, the number of PET studies increased by 25% from 169,334 in 2018 to 212,106 in 2022, accompanied by an increase in the number of readers from 1,489 to 1,993 over the period. CT and MRI studies also saw an increase, while SPECT and stress echocardiography saw declining trends.
“SPECT has experienced a decline in use over the last five years, likely due to the advantages of PET over SPECT,” the group wrote.
The findings may inform efforts to enhance education and awareness of PET’s advantages and to address barriers to its wider adoption, which are essential to maximize its clinical benefits and improve patient outcomes, the authors wrote.