Vol. 149 No. 1920 (2019)
Use of cardiac magnetic resonance imaging and single photon emission computed tomography for the diagnosis of stable coronary artery disease in Switzerland
- Jeanne du Fay de Lavallaz
- Michael J. Zellweger
- Stefan Felder
Direct invasive testing in the diagnosis of stable coronary artery disease (CAD) involves high costs and relevant risks. By comparison, single-photon emission computed tomography (SPECT) and cardiac magnetic resonance imaging (CMR) are noninvasive diagnostic tests. SPECT is currently the most widely used diagnostic technique, but new medical and economic evidence favours CMR. Guidelines do not recommend one technique in preference to the other, and their use in Switzerland is poorly documented, as a scoping study by the Swiss Medical Board reported. We aimed at a quantitative and qualitative analysis of the use of these diagnostic techniques in Swiss hospitals.
We contacted nine Swiss hospitals to obtain the number of SPECT/CMR investigations used to diagnose stable CAD in 2014–2016 and submitted a questionnaire to investigate the advantages and limitations of the two imaging techniques. In addition, two experts in SPECT and CMR, respectively, at two university hospitals were interviewed, using open questions.
Data were obtained from 8 hospitals, and 22 questionnaires were returned. In Switzerland, both techniques have been implemented very differently in different hospitals, but the overall number of diagnostic procedures has increased. The questionnaires reported lower scores for CMR regarding the availability of the scans, contraindications and the suitability of the technique for the diagnosis of CAD. The experts described potential conflicts of interest in some institutions, depending on how the cardiology and radiology departments collaborated, and highlighted the debated results of studies comparing CMR with SPECT for the diagnosis of CAD. The main conclusion drawn from the interviews was the recommendation of a patient-centred evaluation.
The use of SPECT versus CMR in Switzerland for the diagnosis of stable CAD is heterogeneous, but reflects the guidelines, which do not distinguish between the two diagnostic techniques. Expert opinions underlined that discussion should not be so much about the choice of the diagnostic modality but about how a clinical question in a patient can best be answered.
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