Single Photon Computed Tomography-Myocardial Perfusion Scintigraphy. Diagnostic Tool Anticipating the Disease

Without making any value judgment, a large percentage of physicians who request tests to make diagnoses is observed in the contemporary clinical practice. On the other hand, a considerable percentage of physicians who make the diagnosis and possibly ask for tests to confirm the diagnosis is also observed. Both behaviors are considered valid when common good is achieved: The patients’ benefit. However, the request for tests without an appropriate criterion is not only harmful to the patient, but also to the system.

In present-day medicine, there is a large collection of tests considered normal throughout the medical knowledge area, including cardiology. In a publication by Dippe Jr et al. in this issue, the authors, in a retrospective analysis of a database, found this trend. Of 5,526 scans of myocardial perfusion scans performed on obese patients (grade 1), 77% were considered normal. Assuming that the exams were requested for investigation of myocardial ischemia, the authors related the presence of perfusion deficit with myocardial ischemia in only 23%. Based on these data, they found, after applying a “creative statistic”, a 245% risk-ratio for typical angina. It is known, in principle, that perfusion deficit is an expression of intrinsic myocardial abnormality.

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