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Clinically Significant Abnormal Findings on the "Nondiagnostic" CT Portion of Low-Amperage-CT Attenuation-Corrected Myocardial Perfusion SPECT/CT Studies

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland

Correspondence: For correspondence or reprints contact: Richard L. Wahl, MD, Division of Nuclear Medicine/PET, 601 N. Caroline St., Room 3223, Baltimore, MD 21287-0817. E-mail: rwahl{at}jhmi.edu

Attenuation correction is recommended to optimize the performance of cardiac SPECT. The 2.5-mA CT commonly used for this purpose in myocardial perfusion SPECT is generally considered "nondiagnostic" in quality. In other areas of cardiac and hybrid imaging, diagnostically relevant abnormal findings on higher-quality CT studies have been described. The purpose of this study was to establish the frequency and significance of abnormal findings on low-amperage-CT cardiac SPECT/CT scans and to assess whether a systematic review of the nondiagnostic CT findings should be recommended. Methods: Two hundred consecutive patients who underwent clinical low-amperage-CT attenuation-corrected myocardial perfusion studies acquired on a SPECT/CT system were included in the study. The cardiac CT images were reviewed in consensus by both an experienced CT reader and a nuclear medicine resident less experienced in CT. Abnormal CT findings of varying significance were recorded. Results: Eighty-one patients had no abnormal CT findings. In the remaining 119 patients, 234 abnormalities were detected. Twenty-five major findings (in 21 patients) were seen, and 16 of these had been previously unrecognized. Sixty-four minor and 131 minimal findings were noted. Fourteen findings were labeled as equivocal (i.e., the CT findings were not definite). Conclusion: Potentially significant abnormal findings on the nondiagnostic-CT portion of the cardiac SPECT/CT examination were detected in 10.5% of our patients. These data suggest that, in addition to the review of the emission image dataset, low-amperage-CT findings should routinely be assessed for major diagnostic abnormalities.

Key Words: SPECT/CT • tomography • incidental findings • myocardial perfusion imaging

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