Elsevier

Journal of Nuclear Cardiology

Volume 10, Issue 4, July–August 2003, Pages 395-402
Journal of Nuclear Cardiology

Noncardiac findings on dual-isotope myocardial perfusion SPECT

https://doi.org/10.1016/S1071-3581(03)00524-5Get rights and content

Abstract

Background

This study examined the frequency of reporting noncardiac findings (NCFs), such as malignancies from inspection of raw projection images with dual-isotope single photon emission computed tomography (SPECT) perfusion imaging, which could potentially be of greater clinical importance than myocardial perfusion imaging alone. Dual-isotope (ie, rest thallium 201 and stress technetium 99m sestamibi [MIBI] or Tc-99m tetrofosmin [TET]) SPECT myocardial perfusion imaging combines multipotential tracers for noncardiac purposes (Tl-201 for renal or splenic imaging, inflammation, or lymphoma and MIBI or TET for hepatobiliary imaging and detecting increased mitochondrial number or activity in neoplastic processes). These images are optimally interpreted with cinematic inspection of the raw projection data, but this may not be practiced uniformly in every laboratory.

Methods and results

We reviewed 12,526 computer-generated text reports of dual-isotope perfusion SPECT studies from a 6-year period for NCFs. NCFs were categorized by organ and by probability of malignancy: high (eg, focal breast or lung uptake of MIBI or TET), intermediate (eg, lymph node uptake or thyroid abnormalities), or low (eg, filling defects in liver, kidney, spleen, or gall bladder; ascites; or pleural effusions). Confirmatory imaging studies or clinical confirmation for each NCF was sought. There were a total of 207 NCFs identified in 180 reports (1.7% of reports, ranging from 0% to 2.8% of reports of individual interpreters). Of these, 107 NCFs were unsuspected before SPECT; 24% were considered at high probability for malignancy, and 24% were considered intermediate in likelihood of malignancy. Follow-up data were available for 178 NCFs, confirming 88% of these findings, including 82% of breast foci, 62% of lung foci, 86% of hepatobiliary/spleen abnormalities, and 94% of renal abnormalities. The probability of malignancy was highest (82%) in breast or lung foci in which uptake of both Tl-201 and the Tc-99m–labeled agent was present.

Conclusions

In patients referred for evaluation of myocardial perfusion, NCFs are unusual and require systematic and careful inspection of projection images for their detection. With Tl-201, TET, MIBI, or dual-isotope imaging, detecting and reporting NCFs may occasionally result in life-saving early cancer identification.

Section snippets

Study population

We retrospectively reviewed 12,526 computer-generated text reports of patients who had undergone dual-isotope imaging with Tl-201 at rest and Tc-99m MIBI or TET stress perfusion SPECT over a 6-year period (1993 through 1999). Each report was inspected for a description of an “additional scintigraphic finding” that was noncardiac-related but seen on planar projection images viewed in cine format. Comments about attenuation artifacts (eg, breast shadowing, diaphragmatic attenuation, or

Results

Of the 12,526 reports, a total of 207 NCFs were identified in 180 reports (1.7% of total). The incidence of reporting NCFs varied among interpreters, ranging from 0% to 2.8% of reports, with the highest frequency occurring in the nuclear medicine/cardiology physician who read scans most frequently (56% of all studies) in the laboratory. The overall results are tabulated in Table 1. .

Of the 207 NCFs, 45 (24%) were considered to have a high probability for malignancy (eg, focal breast or lung

Discussion

SPECT myocardial perfusion imaging is a rapidly growing diagnostic technique that plays a pivotal role in the detection and management of patients with ischemic heart disease.1, 2, 3, 4, 5, 6 It is most often performed in older patients, obese subjects, and smokers, all of whom may be at increased risk for development of malignancy or other noncardiac abnormalities that could be detected by nuclear imaging techniques. A widely and increasingly performed SPECT technique, dual-isotope imaging

Acknowledgements

Dr. Williams is a researcher and lecturer for Amersham Healthcare, Inc (manufacturer of thallium 201 and technetium 99m tetrofosmin) and a researcher for Bristol Meyers Squibb, Inc (manufacturer of Tc-99m sestamibi).

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