Abstract
1651
Introduction: New state-of-art hybrid imaging systems provide high quality CT images along with myocardial perfusion imaging (MPI), which introduces new opportunities and challenges for interpreting and referring physician. In recent years the American and European societies have recommended reporting incidental findings detected during MPI studies. The objective of this study was to describe the prevalence of CT incidental findings during MPI PET/CT. We hypothesized that the veteran population may have a high prevalence of incidental CT findings based on their risk factor profile.
Methods: This IRB approved single-center retrospective study included 2260 patients, who underwent 82Rubidium-chloride PET/CT MPI between December 2016 and December 2018. Each patient received a low dose CT of the chest and upper abdomen for attenuation correction and anatomic localization. At our institution, the CT reports are an integral part of the final reporting system for each patient generated by board certified nuclear medicine physicians or cardiologists with special competency in CT interpretation. Data collected by reviewing the MPI reports resided in the PACS system. Incidental CT findings were identified, and percentages of each finding calculated. Additionally, if ordered, follow up studies for each individual was reviewed in the electronic health records.
Results: In addition to abnormal PET MPI findings including ischemia and/or scar, the thoracic CT implicated incidental findings in the heart (23%), aorta (10%), pulmonary artery (26%), coronary arteries (88%), lung (61%), lymph nodes (13%), breast (0.6%), and bone (3%). The upper abdominal CT findings involved the liver (11%), gallbladder (8%), spleen (3%), pancreas (2%), adrenal glands (2%), kidneys (10%), stomach (5%), and colon (2%). In 20% of patients the interpreting physician recommended a follow up study, majority of them related to lung nodules or other suspicious findings in the breast, kidney, and bone. Conclusion: The CT images and reports included with the hybrid MPI studies frequently demonstrate incidental thoracic and upper abdominal findings, some of which required further workup impacting the health of patients. However these findings can be burdensome for the referring physician and may cause patient anxiety. Hence, adequate training and experience or a multispecialty approach may be necessary to identify such findings and provide accurate differential diagnosis and recommendation to maximize the clinical benefits and minimize the healthcare burden and anxiety for patients.