Matthew Budoff, MD

Cardiac Imaging

AI-CCTA Beats SPECT, Again

A recent study out of UCLA added to the growing body of evidence supporting AI-assisted CCTA as an alternative to SPECT for diagnosing obstructive coronary artery disease, especially in women.

• SPECT continues to be a first-line test to diagnose coronary ischemia, often instead of or before invasive coronary angiography.
• However, SPECT’s cost, necessary radiotracers, lower image quality, and radiation exposure have raised doubts about its continued dominance.

To determine if AI-CCTA could hold its own, researchers analyzed CCTA images from 175 patients using Cleerly’s AI-QCT ISCHEMIA model and found it outperformed SPECT when compared to invasive angiography.

• AI-CCTA showed a sensitivity of 75% and specificity of 70% for predicting coronary ischemia, well above SPECT (70% & 53%).
• AI-enhanced CCTA also far surpassed SPECT’s negative predictive value among female patients (91% vs. 68%).
• However, AI-CCTA’s AUCs were only slightly higher than SPECT (0.81 vs. 0.76).

These results support the 2021 AHA/ACC guidelines that established CCTA as a front-line coronary artery disease test for patients with mid-high risk of CAD, stable chest pain, and <65yrs, potentially instead of SPECT. They also add to a growing field of research supporting AI-enhanced CCTA.

• A JACC study from 2023 found that AI-ISCHEMIA was superior to SPECT and similar to PET and FFRCT in ischemia prediction (AUCs: 0.91 vs. 0.71).
• Another 2024 JACC study found the AI-ISCHEMIA + CCTA approach more accurately diagnoses coronary ischemia (AUCs: 0.80 vs. 0.72).

The Takeaway

AI assisted CCTA is still relatively new but it’s on a serious hot streak, given its growing usage, new reimbursements, cost-effectiveness, and greater accuracy. This begs the question – with CCTA’s momentum and benefits growing clearer, what will it take to dethrone SPECT?

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