RESUMO
BACKGROUND: The appropriate clinical approach to incidentally detected lesions (IDLs) on CT attenuation correction (CTAC) images in myocardial perfusion imaging (MPI) remains uncertain. We sought to establish their prevalence and clinical significance in a large cohort and compared to previous studies to help provide further clarity and guide future clinical practice. METHODS AND RESULTS: A total of 3758 MPI studies were reviewed retrospectively. IDLs of potential clinical significance-not known before MPI - were reported in 245 (6.5%) of these cases. Following appropriate further investigation/follow-up, these were of proven clinical significance in 30 (12.2%) cases with 14 patients (5.7%) harboring previously undiagnosed or progressive malignancies. The positive predictive value (PPV) for clinically significant incidental findings on CTAC images was 17.2% and the PPV value for incidental malignant findings was 8.0%. CONCLUSION: Although incidental findings on CTAC images in MPI are common and often clearly insignificant at time of MPI reporting, many are clinically significant with a relatively high positive predictive value. This is especially so for malignancies. Our findings, therefore, in combination with previous studies as described here support routine reporting and appropriate further investigation of incidental CTAC findings in MPI.
Assuntos
Imagem de Perfusão do Miocárdio , Humanos , Achados Incidentais , Imagem de Perfusão do Miocárdio/métodos , Prevalência , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodosAssuntos
Amiloidose , Pré-Albumina , Amiloidose/diagnóstico por imagem , Difosfonatos , Humanos , CintilografiaRESUMO
We present a case of lung cancer incidentally detected as a pulmonary nodule on computed tomography attenuation correction (CTAC) images during myocardial perfusion scintigraphy (MPS). Unfortunately, the incidental lesion was not fully investigated following MPS report and had developed into metastatic lung carcinoma when diagnosed over 1 year later, with failure of subsequent emergent chemotherapy. The disease appeared to be localized when initially detected during MPS. This case highlights the importance and potential clinical value of routine review of CTAC images in MPS with appropriate reporting and further investigation of suspicious incidental findings. In addition, the importance of effective communication between nuclear medicine department and treating team is clear to ensure suspicious incidental findings are given sufficient credence and thoroughly investigated promptly to avoid adverse clinical outcomes.