Altered biodistribution and incidental findings on myocardial perfusion imaging

Myocardial perfusion studies routinely are performed to evaluate for the presence and extent of coronary artery disease. The findings have prognostic and therapeutic implications. Routine display of the raw projection images allows visualization of regions adjacent to the heart in which there may be incidental findings that are nonsignificant but in other instances are clinically important. Such incidental findings may cause artifacts and therefore need to be considered when interpreting the perfusion images. These findings may also indicate other cardiovascular conditions and sometimes show important noncardiac pathology. To properly interpret these findings, one must be familiar with normal uptake and kinetics of the cardiac perfusion tracers and have a solid understanding of image acquisition, reconstruction, and processing techniques. Thus, on single-photon emission computed tomography radionuclide myocardial perfusion imaging, raw projection images must be reviewed routinely and systematically for any incidental findings that might affect image interpretation and/or could indicate other disease.