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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

View larger version (66K): [in a new window]   FIGURE 1.  Transaxial CT slice of 73-y-old woman with fatigue and exertional dyspnea. Images were obtained with soft-tissue window (A) and with lung window (B). Myocardial perfusion SPECT findings were normal. Large anterior mediastinal mass (1) and lung nodule (2) are seen on CT portion of images. Mediastinal mass is likely pericardial cyst. Both findings were unknown, and there were no follow-up studies for over 1.5 y. Patient was then diagnosed with adenocarcinoma of right lung and underwent resection. Mediastinal cyst was confirmed at surgery.

View larger version (70K): [in a new window]   FIGURE 2.  Transaxial CT slice of 83-y-old man with coronary artery disease and atypical chest pain. Calcification of left anterior descending artery is seen. In patient with established diagnosis of coronary artery disease, finding is of doubtful clinical significance.

View larger version (63K): [in a new window]   FIGURE 3.  Selected transaxial CT slices of 81-y-old man with dilated ischemic cardiomyopathy and substernal chest pain, fatigue, and anorexia. Images were obtained with soft-tissue window (A) and with lung window craniad to soft-tissue window (B). Chest radiography 4 d before SPECT/CT showed small left-sided pericardial effusion. SPECT/CT shows large pericardial effusion (1), at least moderate-sized left-sided pleural effusion (2), and significant compressive atelectasis and consolidation (3). These findings were later confirmed by chest radiography and transthoracic echocardiography. Metal artifact from automatic implantable cardioverter-defibrillator is noted as well.

View larger version (70K): [in a new window]   FIGURE 4.  Four separate CT slices 1 cm apart of 54-y-old man with dyspnea and exertional substernal chest pain. Chest radiography 9 d before SPECT/CT showed large consolidation in right lower lobe appearing compatible with pneumonia. This finding is also seen on SPECT/CT. Follow-up chest radiography approximately 6 wk later showed resolution after antibiotic treatment.

View larger version (60K): [in a new window]   FIGURE 5.  Transaxial CT slice of 58-y-old woman with atypical chest pain. Images were obtained with soft-tissue window (A) and lung window (B) and demonstrate mass in right lower lobe of lung. Five days before SPECT/CT, patient underwent diagnostic CT with intravenous contrast material to rule out pulmonary embolism. CT showed mass or masslike infiltrate in right lower lung. Follow-up was recommended but was not performed so far.