Jaarsma C et al. – SPECT, CMR, and PET all yielded a high sensitivity, while a broad range of specificity was observed. SPECT is widely available and most extensively validated; PET achieved the highest diagnostic performance; CMR may provide an alternative without ionizing radiation and a similar diagnostic accuracy as PET. Authors suggest that referring physicians consider these findings in the context of local expertise and infrastructure.

• Studies published between 1990 and 2010 identified by PubMed search and citation tracking were examined.
• A study was included if a perfusion imaging modality was used as a diagnostic test for the detection of obstructive CAD and coronary angiography as the reference standard (50% diameter stenosis).

• Of the 3,635 citations, 166 articles (n = 17,901) met the inclusion criteria: 114 SPECT, 37 CMR, and 15 PET articles.
• There were not enough publications on other perfusion techniques such as perfusion echocardiography and computed tomography to include these modalities into the study.
• The patient–based analysis per imaging modality demonstrated a pooled sensitivity of 88% (95% confidence interval [CI]: 88% to 89%), 89% (95% CI: 88% to 91%), and 84% (95% CI: 81% to 87%) for SPECT, CMR, and PET, respectively; with a pooled specificity of 61% (95% CI: 59% to 62%), 76% (95% CI: 73% to 78%), and 81% (95% CI: 74% to 87%).
• This resulted in a pooled diagnostic odds ratio (DOR) of 15.31 (95% CI: 12.66 to 18.52; I 2 63.6%), 26.42 (95% CI: 17.69 to 39.47; I 2 58.3%), and 36.47 (95% CI: 21.48 to 61.92; I 2 0%).
• Most of the evaluated test and study characteristics did not affect the ranking of diagnostic performances.