Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Jan-Mar;18(1):74-76.
doi: 10.4103/wjnm.WJNM_19_18.

The importance of appropriate reporting and investigation of incidental findings on computed tomography attenuation correction images during myocardial perfusion scintigraphy

Francis T Delaney  1 , Emma L Gray  1 , Joseph C Lee  1   2
Affiliations
Case Reports

The importance of appropriate reporting and investigation of incidental findings on computed tomography attenuation correction images during myocardial perfusion scintigraphy

Francis T Delaney et al. World J Nucl Med. 2019 Jan-Mar.

Abstract

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.

Keywords: Computed tomography attenuation correction; incidental findings; low-dose computed tomography; lung carcinoma; myocardial perfusion scintigraphy.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Selected axial low-dose computed tomography (a) image acquired for attenuation correction during myocardial perfusion scintigraphy (acquired in prone position). An incidental 10 mm opacity is seen within the right lower lobe. Further evaluation with full-dose diagnostic-quality computed tomography was recommended. Anatomical equivalent (b) shown on single-photon emission computed tomography
Figure 2
Figure 2
Selected axial (a) and coronal (b) computed tomography images from a CT aorta study Performed 2 months following myocardial perfusion scintigraphy. An incidental right lower lobe opacity, now measuring 12 mm is seen. Urgent further investigation was advised due to suspicion for malignancy
Figure 3
Figure 3
Selected axial (a) and coronal (b) computed tomography images from a CT chest performed 14 months after the initial myocardial perfusion scintigraphy occurred. A 23 mm opacity was now present within the right lower lobe with associated hilar lymphadenopathy and multiple smaller opacities within the lung fields. Subsequent computed tomography-guided biopsy revealed lung squamous cell carcinoma
Figure 4
Figure 4
Selected axial computed tomography images from (a) low-dose attenuation correction CT acquired during myocardial perfusion scintigraphy (acquired in prone position) and (b) staging computed tomography performed following lung cancer diagnosis 14 months later. Within the limits of the lower dose scan, no hepatic lesions are seen at the time of myocardial perfusion scintigraphy compared with multiple metastatic lesions on staging computed tomography
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Frank L, Quint LE. Chest CT incidentalomas: Thyroid lesions, enlarged mediastinal lymph nodes, and lung nodules. Cancer Imaging. 2012;12:41–8. - PMC - PubMed
    1. Pazhenkottil AP, Ghadri JR, Nkoulou RN, Wolfrum M, Buechel RR, Küest SM, et al. Improved outcome prediction by SPECT myocardial perfusion imaging after CT attenuation correction. J Nucl Med. 2011;52:196–200. - PubMed
    1. Goetze S, Pannu HK, Wahl RL. Clinically significant abnormal findings on the “nondiagnostic” CT portion of low-amperage-CT attenuation-corrected myocardial perfusion SPECT/CT studies. J Nucl Med. 2006;47:1312–8. - PubMed
    1. Husmann L, Tatsugami F, Aepli U, Herzog BA, Valenta I, Veit-Haibach P, et al. Prevalence of noncardiac findings on low dose 64-slice computed tomography used for attenuation correction in myocardial perfusion imaging with SPECT. Int J Cardiovasc Imaging. 2009;25:859–65. - PubMed
    1. Coward J, Lawson R, Kane T, Elias M, Howes A, Birchall J, et al. Multi-centre analysis of incidental findings on low-resolution CT attenuation correction images. Br J Radiol. 2014;87:20130701. - PMC - PubMed

Publication types