Great Debates in Imaging

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Tuesday, April 5, 8:00-9:30 AM

What are the great debates in imaging? Invariably, they go to the heart of emerging data, and invariably the emerging evidence is not quite enough to change the guidelines, but perhaps enough to persuade early adopters. These debates are always informative because they are on the cutting edge of research.

For example, functional vs. anatomical imaging for chest pain. Functional SPECT imaging has been the mainstay for decades to triage chest pain patients, and it will likely remain an important imaging test for these patients. But CT angiography has been gaining ground as a modality that can fit nicely into a gap of intermediate-risk patients that might be misclassified by SPECT and sent on to catheter angiography. It's still a worthy debate because the data are not all in, but there is enough evidence for each side to present persuasive arguments as to the benefits of its chosen test.

Another great debate is whether echo or MRI is best for post-MI assessment. There is no arguing the plethora of information gleaned from an MRI exam, but the modality is not as ubiquitous as the echo probe. It is sessions like these that can tip the balance for attendees to consider the return on investment of MRI in this example to be worth more than just what the balance sheets say.

The final great debate is one that is just emerging: biomarkers or calcium scanning for risk stratification. The problem with biomarkers is that many of them are not specific, although much research is being conducted into biomarkers for specific plaque components. In the meantime, a calcium scan with noncontrast CT has been found to be highly prognostic depending on the amount of calcium. In fact, new guidelines issue last year recommended a calcium scan for asymptomatic patients – a first for the guidelines.

Speaker Information

  • Rory Hachamovitch, MD, Cleveland Clinic -- Functional Imaging Should Be First Test for Chest Pain
  • Gilbert L. Raff, MD, Beaumont Hospital, Royal Oak, Mich. -- Anatomical Imaging Should Be First Test for Chest Pain
  • Rebuttal: Protagonist; Rebuttal: Antagonist
  • Roxy Senior, MD, Northwick Park Hospital, Middlesex, England -- Echocardiography Has the Best Value for Cardiac Assessment in Post-MI Patient
  • Andrew E. Arai, MD, National Heart, Lung and Blood Institute, Bethesda, Md. -- MRI Has the Best Value in Cardiac Assessment In Post-MI Patient
  • Rebuttal: Protagonist; Rebuttal: Antagonist
  • Paul M. Ridker, MD, Brigham and Women's Hospital, Boston -- Biomarkers Are Best for Risk Stratification in the Asymptomatic Person
  • Matthew J. Budoff, MD, Harbor-UCLA Medical Center, Torrance, Calif. -- Atherosclerosis Imaging Is Best for Risk Stratification in the Asymptomatic Person
  • Rebuttal: Protagonist; Rebuttal: Antagonist