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

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

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.

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Abbreviations

CT:

Computed tomography

CTAC:

Computed tomography attenuation correction

IDL:

Incidentally detected lesion

MPI:

Myocardial perfusion imaging

SPECT:

Single-photon emission computed tomography

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Disclosure

Dr Lee has received travel expenses for attending meetings of his specialty College’s Continuing Professional Development Committee, of which he is a member. Dr Delaney has nothing to disclose.

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Authors and Affiliations

  1. Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, 4032, Australia

    Joseph C. Lee MBBS, FRACP, FAANMS, PGDipClinUS

  2. Faculty of Medicine, The University of Queensland, Herston, Australia

    Joseph C. Lee MBBS, FRACP, FAANMS, PGDipClinUS

  3. Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland

    Francis T Delaney MB BCh BAO, MRCS

Authors
  1. Joseph C. Lee MBBS, FRACP, FAANMS, PGDipClinUS
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  2. Francis T Delaney MB BCh BAO, MRCS
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Correspondence to Joseph C. Lee MBBS, FRACP, FAANMS, PGDipClinUS.

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Lee, J.C., Delaney, F.T. Prevalence and clinical significance of incidental findings on CT attenuation correction for myocardial perfusion imaging. J. Nucl. Cardiol. 29, 1813–1822 (2022). https://doi.org/10.1007/s12350-020-02499-1

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