1
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Liu A, Cain L, Munemo LT, Ahmed R, Kouranos V, Sharma R, Wechalekar K. Characterisation and management of expected and unexpected urgent findings from positron emission tomography with 18F-fluorodeoxyglucose integrated with computed tomography in cardiovascular disease. J Nucl Cardiol 2024; 35:101826. [PMID: 38387737 DOI: 10.1016/j.nuclcard.2024.101826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Cardiac 18F-fluorodeoxyglucose (FDG)-PET-CT plays an important role in the assessment of cardiovascular diseases. Effective management of urgent scan findings facilitates optimal patient care. METHODS We characterised the management of urgent, expected and unexpected findings in patients referred for cardiac [18F]fluorodeoxyglucose integrated with computed tomography (FDG-PET-CT) at the Royal Brompton Hospital (United Kingdom). Urgent findings are escalated by the reporting physicians/radiologists raising RadAlert notifications to the referring clinician. We characterised the indications and time to management (TTM) between the RadAlert and the resulting management. As controls, we characterised the TTM of 33 urgent findings identified before the RadAlert system was implemented. RESULTS Of the 1497 consecutive FDG-PET-CT scans screened (April 2021 to February 2023), 93 RadAlerts were suitable for analysis (TTM 7 days [interquartile range: 2-14]). Expected urgent findings included active cardiac sarcoidosis (56%; TTM 8 days [5-18]), heart transplant rejection (12%; 6 ± 4 days), infective endocarditis (9%; 2 days [1-12]), cardiac device infections (5%; 1 day [0-2]), acute myocarditis (2%; 5 and 14 days) and epicardial mass (1%; 1 day). TTM did not differ significantly between indications (P = 0.06). RadAlert cases had significantly shorter TTM than controls without RadAlert, P = 0.001. After the RadAlerts, 81% of patients had clinical reviews, and 55% had escalation of medical/surgical therapies. Unexpected findings (total N = 45; median TTM 6 days [1-10]) included malignancies (N = 3), infections (N = 2), pneumothorax (N = 1), benign diagnosis (N = 30), unclear diagnosis (N = 5) and 4 findings disappeared on repeat imaging. CONCLUSIONS Cardiac FDG-PET-CT identifies expected and unexpected findings in a range of cardiovascular diseases. Serious, unexpected findings are rare and can be effectively escalated by the RadAlert system.
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Affiliation(s)
- Alexander Liu
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, UK
| | - Liam Cain
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, UK
| | - Lionel T Munemo
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, UK
| | - Raheel Ahmed
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, UK
| | - Vasileios Kouranos
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, UK
| | - Rakesh Sharma
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, UK
| | - Kshama Wechalekar
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, UK.
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2
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Yu X, Xu L, Zhu L, Liu J, Chen Y. Incidental Tongue Cancer Detected With Total-Body 13 N-NH 3 PET/CT. Clin Nucl Med 2024; 49:188-190. [PMID: 37976436 DOI: 10.1097/rlu.0000000000004938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
ABSTRACT A 68-year-old man with chest tightness underwent cardiac blood perfusion imaging on total-body 13 N-NH 3 PET/CT. Incidentally, mildly increased 13 N-NH 3 activity was observed in the left side of the body of the tongue. Pathological diagnosis proved to be mucosal squamous cell carcinoma.
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Affiliation(s)
- Xiaofeng Yu
- From the Department of Nuclear Medicine, Renji Hospital
| | - Lian Xu
- From the Department of Nuclear Medicine, Renji Hospital
| | - Lijing Zhu
- Department of Emergency and Intensive Care, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jianjun Liu
- From the Department of Nuclear Medicine, Renji Hospital
| | - Yumei Chen
- From the Department of Nuclear Medicine, Renji Hospital
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3
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Jochumsen MR, Overgaard DL, Vendelbo MH, Madsen MA, Tolbod LP, Gormsen LC, Barkholt TØ. Extracardiac findings with increased perfusion during clinical O-15-H 2O PET/CT myocardial perfusion imaging: A case series. J Nucl Cardiol 2023; 30:1458-1468. [PMID: 36600173 PMCID: PMC9812748 DOI: 10.1007/s12350-022-03156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/08/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Coincidental extracardiac findings with increased perfusion were reported during myocardial perfusion imaging (MPI) with various retention radiotracers. Clinical parametric O-15-H2O PET MPI yielding quantitative measures of myocardial blood flow (MBF) was recently implemented at our facility. We aim to explore whether similar extracardiac findings are observed using O-15-H2O. METHODS AND RESULTS All patients (2963) were scanned with O-15-H2O PET MPI according to international guidelines and extracardiac findings were collected. In contrast to parametric O-15-H2O MBF images, extracardiac perfusion was assessed using summed images. Biopsy histopathology and other imaging modalities served as reference standards. Various malignant lesions with increased perfusion were detected, including lymphomas, large-celled neuroendocrine tumour, breast, and lung cancer plus metastases from colonic and renal cell carcinomas. Furthermore, inflammatory and hyperplastic benign conditions with increased perfusion were observed: rib fractures, gynecomastia, atelectasis, sarcoidosis, pneumonia, chronic lung inflammation and fibrosis, benign lung nodule, chronic diffuse lung infiltrates, pleural plaques and COVID-19 infiltrates. CONCLUSIONS Malignant and benign extracardiac coincidental findings with increased perfusion are readily visible and frequently seen on O-15-H2O PET MPI. We recommend evaluating the summed O-15-H2O PET images in addition to the low-dose CT attenuation images.
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Affiliation(s)
- Mads Ryø Jochumsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
| | - David Lyse Overgaard
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Mikkel Holm Vendelbo
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000 Aarhus C, Denmark
| | - Michael Alle Madsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
| | - Trine Ørhøj Barkholt
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
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4
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David S, Packard RRS. Prevalence and nature of extracardiac findings in PET/CT myocardial perfusion imaging. J Nucl Cardiol 2023; 30:1469-1473. [PMID: 37012524 PMCID: PMC10871668 DOI: 10.1007/s12350-023-03239-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Sthuthi David
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave., CHS Building Room 17-054A, Los Angeles, CA, 90095, USA
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA
| | - René R Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave., CHS Building Room 17-054A, Los Angeles, CA, 90095, USA.
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA.
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA.
- Molecular Biology Institute, University of California, Los Angeles, CA, USA.
- California NanoSystems Institute, University of California, Los Angeles, CA, USA.
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5
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Girard AA, Elrod J, Bhambhvani P, Hage FG. Cases from a busy nuclear cardiology laboratory. J Nucl Cardiol 2023; 30:1103-1109. [PMID: 36207574 PMCID: PMC9542470 DOI: 10.1007/s12350-022-03114-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew A Girard
- Department of Medicine, The University of Alabama at Birmingham, 1720 2nd Ave S, BDB 327, Birmingham, AL, 35233, USA.
| | - Jacob Elrod
- Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pradeep Bhambhvani
- Division of Molecular Imaging and Therapeutics, Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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6
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Tavoosi A, deKemp RA, Dennie C, Glineur D, Crean AM, Beanlands RS. Diagnosis of unrecognized aortic dissection by hybrid PET/CT rubidium-82 imaging. J Nucl Cardiol 2023; 30:848-850. [PMID: 34935106 DOI: 10.1007/s12350-021-02871-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Anahita Tavoosi
- Division of Cardiology (Department of Medicine), University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON, K1Y 4W7, Canada
| | - Robert A deKemp
- Division of Cardiology (Department of Medicine), University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON, K1Y 4W7, Canada
| | - Carole Dennie
- Department of Radiology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - David Glineur
- Division of Cardiac Surgery (Department of Surgery), University of Ottawa Heart Institute, Ottawa, Canada
| | - Andrew M Crean
- Division of Cardiology (Department of Medicine), University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON, K1Y 4W7, Canada
| | - Rob S Beanlands
- Division of Cardiology (Department of Medicine), University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON, K1Y 4W7, Canada.
- Department of Radiology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada.
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7
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Chen Z, Long Y, Zhang Y, Zhang B, He Q, Zhang X. Detection efficacy of analog [ 18F]FDG PET/CT, digital [ 18F]FDG, and [ 13N]NH 3 PET/CT: a prospective, comparative study of patients with lung adenocarcinoma featuring ground glass nodules. Eur Radiol 2023; 33:2118-2127. [PMID: 36322193 DOI: 10.1007/s00330-022-09186-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This prospective study compared the detection efficacy of analog 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) (aF PET/CT), digital [18F]FDG PET/CT (dF PET/CT), and digital 13N-ammonia (13N-NH3) PET/CT (dN PET/CT) for patients with lung adenocarcinoma featuring ground glass nodules (GGNs). METHODS Eighty-seven patients with lung adenocarcinoma featuring GGNs who underwent dF and dN PET/CT were enrolled. Based on the GGN component, diameter, and solid-part size, 87 corresponding patients examined using aF PET/CT were included, with age, sex, and lesion characteristics closely matched. Images were visually evaluated, and the tumor to background ratio (TBR) was used for semi-quantitative analysis. RESULTS Ultimately, 40 and 47 patients with pure GGNs (pGGNs) and mixed GGNs (mGGNs), respectively, were included. dF PET/CT revealed more positive lesions and higher tracer uptake in GGNs than did aF PET/CT (53/87 vs. 26/87, p < 0.05; TBR: 3.08 ± 4.85 vs. 1.42 ± 0.93, p < 0.05), especially in mGGNs (44/47 vs. 26/47, p < 0.05; TBR: 4.48 ± 6.17 vs. 1.78 ± 1.16, p < 0.05). However, dN PET/CT detected more positive lesions than did dF PET/CT (71/87 vs. 53/87, p < 0.05), especially in pGGNs (24/40 vs. 9/40, p < 0.05). CONCLUSIONS dF PET/CT provides superior detection efficacy over aF PET/CT for patients with lung adenocarcinoma featuring GGNs, particularly mGGNs. dN PET/CT revealed superior detection efficacy over dF PET/CT, particularly in pGGNs. aF, dF, and dN PET/CT are valuable non-invasive examinations for lung cancer featuring GGNs, with dN PET/CT offering the best detection performance. KEY POINTS • Digital PET/CT provides superior detection efficacy over analog PET/CT in patients with lung adenocarcinoma featuring GGNs. • dN PET/CT can offer more help in the early detection of malignant GGN.
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Affiliation(s)
- Zhifeng Chen
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yali Long
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yuying Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Bing Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Qiao He
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Xiangsong Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China.
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8
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Al-Mallah MH, Bateman TM, Branch KR, Crean A, Gingold EL, Thompson RC, McKenney SE, Miller EJ, Murthy VL, Nieman K, Villines TC, Yester MV, Einstein AJ, Mahmarian JJ. 2022 ASNC/AAPM/SCCT/SNMMI guideline for the use of CT in hybrid nuclear/CT cardiac imaging. J Nucl Cardiol 2022; 29:3491-3535. [PMID: 36056224 DOI: 10.1007/s12350-022-03089-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 01/29/2023]
Affiliation(s)
- Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Timothy M Bateman
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kelley R Branch
- Division of Cardiovascular, University of Washington, Seattle, WA, USA
| | - Andrew Crean
- Division of Cardiovascular Medicine, Ottawa Heart Institute, Ottawa, ON, Canada
| | - Eric L Gingold
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Randall C Thompson
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sarah E McKenney
- Department of Radiology, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Michael V Yester
- Department of Radiology, School of Medicine, University of Alabama Medical Center, Birmingham, AL, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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9
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Broos WA, Knol RJ, Zant FMVD, Schaper NC, Wondergem M. Incidental Findings on 18F-Fluorocholine PET/CT for Parathyroid Imaging. World J Nucl Med 2022; 21:192-199. [PMID: 36060082 PMCID: PMC9436517 DOI: 10.1055/s-0042-1751031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction
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F-choline positron emission tomography/computed tomography (PET/CT) is an upcoming imaging technique for the localization of hyperfunctioning parathyroid glands. However,
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F-choline is a nonspecific tracer that also accumulates in malignancies, inflammatory lesions, and several other benign abnormalities. The aim of this study was to determine the occurrence and relevance of incidental findings on
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F-choline PET/CT for parathyroid localization.
Materials and Methods
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F-choline PET/CTs performed in our center for parathyroid localization from 2015 to 2019 were reviewed. Abnormal uptake of
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F-choline, with or without anatomical substrate on the co-registered low-dose CT and also incidental findings on CT without increased
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F-choline uptake were recorded. Each finding was correlated with follow-up data from the electronic medical records.
Results
A total of 388
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F-choline PET/CTs were reviewed, with 247 incidental findings detected in 226 patients (58%): 82
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F-choline positive findings with corresponding pathology on CT, 16 without CT substrate, and 149
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F-choline negative abnormalities on CT. Malignant lesions were detected in 10/388 patients (2.6%). Of all 98 detected
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F-choline positive lesions, 15 were malignant (15.3%), concerning 4 metastases and 11 primary malignancies: breast carcinoma (
n
= 7), lung carcinoma (
n
= 2), thyroid carcinoma (
n
= 1), and skin melanoma (
n
= 1).
Conclusion
Clinically relevant incidental findings were observed in a substantial number of patients. In 15.3% of the incidental
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F-choline positive findings, the lesions were malignant. These data contribute to better knowledge of
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F-choline distribution, enhance interpretation of
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F-choline PET/CT, and guide follow-up of incidental findings. Attention should especially be paid to breast lesions in this particular patient group with hyperparathyroidism in which women are typically over-represented.
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Affiliation(s)
- Wouter A.M. Broos
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
- CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, the Netherlands
| | - Remco J.J. Knol
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | | | - Nicolaas C. Schaper
- CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, the Netherlands
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maurits Wondergem
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
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10
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Novel Findings on SPECT-CT Tc-99 Sestamibi Imaging for Primary Hyperparathyroidism. J Surg Res 2020; 252:216-221. [DOI: 10.1016/j.jss.2020.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/14/2020] [Accepted: 03/08/2020] [Indexed: 01/12/2023]
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11
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Incidental Breast Carcinoma Detected With 13N-NH3 Cardiac PET Imaging. Clin Nucl Med 2020; 45:e252-e253. [DOI: 10.1097/rlu.0000000000002993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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He BJ, Malm BJ, Carino M, Sadeghi MM. Prevalence and variability in reporting of clinically actionable incidental findings on attenuation-correction CT scans in a veteran population. J Nucl Cardiol 2019; 26:1688-1693. [PMID: 29492838 DOI: 10.1007/s12350-018-1232-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/25/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) often employs attenuation-correction computed tomography (CTAC) to reduce attenuation artifacts and improve specificity. While there is no specific guideline on how they should be reported, incidental noncardiac findings identified on these scans may be clinically significant. The prevalence of these findings in veterans is not currently known. In addition, variability in reporting these findings may depend on the interpreting physician's specialty. METHODS To guide future decision-making, CTACs in veterans referred for MPI were prospectively evaluated in a quality-control project for a set of prespecified actionable incidental findings by cardiologists and a radiologist. RESULTS On the 771 scans performed over eight months, 285 incidental noncardiac findings were identified by the interpreting cardiologists and 378 were identified by the interpreting radiologist. Pulmonary nodules were the most common occurring in 20% of studies read by the radiologist. Interreader agreements between cardiologists and the radiologist were poor for pulmonary nodules ≥ 10 mm and hiatal hernias; fair for pulmonary nodules < 10 mm, extracardiac masses, and aortic aneurysms; and moderate for pleural plaques. CONCLUSION Incidental noncardiac findings on CTACs are common in our veteran population. Overall interobserver agreement in identifying these findings between cardiologists and radiologists is fair. Specific guidelines are needed on how CTACs should be read and reported.
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Affiliation(s)
- B Julie He
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Brian J Malm
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Michelle Carino
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Mehran M Sadeghi
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
- Yale Cardiovascular Research Center, 300 George Street #770G, New Haven, CT, 06511, USA.
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13
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Port S. Incidental findings on hybrid SPECT-CT and PET-CT scanners: Is it time for new training and reporting guidelines? J Nucl Cardiol 2019; 26:1694-1696. [PMID: 29675701 DOI: 10.1007/s12350-018-1257-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Steven Port
- Aurora Cardiovascular Services, Aurora Health Care, Milwaukee, WI, USA.
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14
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AlJaroudi WA, Hage FG. Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2017. Part 1 of 2: Positron emission tomography, computed tomography, and magnetic resonance. J Nucl Cardiol 2018; 25:320-330. [PMID: 29119374 DOI: 10.1007/s12350-017-1120-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022]
Abstract
Several original articles and editorials have been published in the Journal of Nuclear Cardiology in 2017. It has become a tradition at the beginning of each year to summarize some of these key articles in 2 sister reviews. In this first part one, we will discuss some of the progress made in the field of heart failure (cardio-oncology, myocardial blood flow, viability, dyssynchrony, and risk stratification), inflammation, molecular and hybrid imaging using advancement in positron emission tomography, computed tomography, and magnetic resonance imaging.
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Affiliation(s)
- Wael A AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 306 Lyons-Harrison Research Building, 701 19th Street South, Birmingham, AL, 35294-0007, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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