Electron beam tomography: Current practice and implications for nuclear cardiology

EBT and nuclear cardiology are complementary, noncompetitive modalities for evaluating patients with suspected or known coronary atherosclerosis; they are partners, not antagonists. The inevitable dissemination of EBT will have an impact on SPECT imaging by dramatically and appropriately increasing the number of nuclear stress imaging procedures; available imaging resources may be insufficient. Application of Bayes' theorem indicates that restricting SPECT imaging to only the higher calcium score individuals will significantly improve its positive predictive accuracy in the primary prevention population by eliminating those with a low pretest likelihood. It will also increase the ability of the nuclear stress test to yield a more definitive posttest likelihood by increasing the disease prevalence to the approximately 50% range.