Extracardiac findings on computed tomography attenuation correction: Is it worth paying extra attention?

Prevalence and clinical significance of incidental findings on CT attenuation correction for myocardial perfusion imaging

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.

Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2018. Part 1 of 2: Positron emission tomography, computed tomography, and magnetic resonance

In this review, we summarize key articles that have been published in the Journal of Nuclear Cardiology in 2018 pertaining to nuclear cardiology with advanced multi-modality and hybrid imaging including positron emission tomography, cardiac-computed tomography, and magnetic resonance. In an upcoming review, we will summarize key articles that relate to the progress made in the field of single-photon emission computed tomography. We hope that these sister reviews will be useful to the reader to navigate the literature in our field.