Importance of systematic review of rotating projection images from Tc99m-sestamibi cardiac perfusion imaging for noncardiac findings

Jones, Stephen E.; Aziz, Kusai; Yasuda, Tsunehiro; Gewirtz, Henry; Scott, James A.

doi:10.1097/mnm.0b013e3282f813f3

Cited by 18 publications

(11 citation statements)

References 32 publications

(33 reference statements)

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“…[1][2][3][4][5] The spectrum of pathology revealed by extracardiac findings is diverse and a systematic reading of rotational projection images significantly increases detection of such lesions. 6 …”

Section: Figurementioning

confidence: 97%

Extracardiac Uptake on Myocardial Perfusion Imaging in a Patient With Diaphragmatic Paralysis and Chilaiditi's Sign

Tamam

Tamam²,

Yldrm³

2010

Clinical Nuclear Medicine

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We present a rare case of extracardiac activity in right hemitorax secondary to the Chilaiditi sign and diaphragmatic paralysis due to right hemiplegia identified incidentally during myocardial perfusion scintigraphy. A 77-year-old man with right hemiplegia suspected of having ischemic heart disease, was admitted for myocardial perfusion scintigraphy studies. On raw data images, intense bowel uptake in the right hemithorax was visualized. Chest radiography and CT images of the patient were evaluated and Chilaiditi sign was found. This sign is a relatively rare condition with an incidence ranging between 0.025% and 0.28%, considered as a normal variant. REFERENCES1. Vijayakumar V, Gupta R, Rahman A. Pathologic extracardiac uptake of Tc-99m tetrofosmin. J Nucl Cardiol. 2005;12:473-475. 2. Slavin JD Jr, Engin IO, Spencer RP. Retrocardiac uptake of Tc-99m sestamibi: manifestation of a hiatal hernia. Clin Nucl Med. 1998;23:239 -240. 3. Gratz S, Kempke B, Kaiser W, et al. Tumor uptake during myocardial perfusion scintigraphy. Nucl Med Commun. 2008;29:963-969. 4. Gedik GK, Ergün EL, Aslan M, et al. Unusual extracardiac findings detected on myocardial perfusion single photon emission computed tomography studies with Tc-99m sestamibi. Clin Nucl Med. 2007;32:920 -926. 5. Spieth ME, Kasner DL, Bull MP. diaphragmatic paralysis with an elevated hemidiaphragm masquerading as lung carcinoma found during myocardial perfusion imaging. Clin Nucl Med. 2002;27:903-904. 6. Jones SE, Aziz K, Yasuda T, et al. Importance of systematic review of rotating projection images from Tc-99m-sestamibi cardiac perfusion imaging for noncardiac findings. Nucl Med Commun. 2008;29:607-613. 7. Tzimas T, Baxevanos G, Akritidis N. Chilaiditi's sign. Lancet. 2009;373:836. 8. Haddad CJ, Lacle J. Chilaiditi's syndrome. A diagnostic challenge. Postgrad Med. 1991;89:249 -250.

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Section: Figurementioning

confidence: 97%

Extracardiac Uptake on Myocardial Perfusion Imaging in a Patient With Diaphragmatic Paralysis and Chilaiditi's Sign

Tamam

Tamam²,

Yldrm³

2010

Clinical Nuclear Medicine

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“…Inci dental noncardiac findings occasionally are detected on review of projectional 99m Tc-sestamibi myocardial perfusion images (1). Here, we report a case in which a large abdominal photopenic area was found on myocardial perfusion imaging in a patient with a history of autosomal dominant polycystic kidney disease.…”

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confidence: 89%

Large Abdominal Photopenic Area on 99mTc-Sestamibi Myocardial Perfusion Imaging

Lyon¹,

Spaulding²,

Zack³

2012

Journal of Nuclear Medicine Technology

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99m Tc-sestamibi myocardial perfusion imaging is frequently performed in conjunction with exercise or pharmacologic stress testing for evaluation of coronary heart disease. Interpretation of these studies includes systematic review of unprocessed rotating projectional images for evaluation of cardiac size as well as the presence of motion or attenuation artifacts. Occasionally, incidental noncardiac findings are detected on review of the projectional images. We report a case of a patient with a history of autosomal dominant polycystic kidney disease who was found to have a large abdominal photopenic area on the projectional images. The photopenic area corresponded to the location of large intraabdominal cysts on abdominal CT and was consistent with hepatic cysts associated with the patient's known polycystic kidney disease. We review the differential diagnosis of large abdominal photopenic regions identified on myocardial projectional images and the importance of routinely analyzing these images for incidental noncardiac findings. Inci dental noncardiac findings occasionally are detected on review of projectional 99m Tc-sestamibi myocardial perfusion images (1). Here, we report a case in which a large abdominal photopenic area was found on myocardial perfusion imaging in a patient with a history of autosomal dominant polycystic kidney disease. CASE REPORTA 69-y-old man was seen in our cardiology specialty office for evaluation of symptoms of shortness of breath with exertion and abnormalities found on a standard exercise test. He had experienced occasional symptoms of dyspnea with exertion during the past 3 mo. He denied symptoms of exertional or rest chest pain. His cardiac risk factors included a history of borderline hypertension and a family history of cardiac disease. The past medical history was significant for known autosomal dominant polycystic kidney disease. He had been found to have large renal and hepatic cysts on an earlier CT scan and was undergoing nephrology evaluation for moderate renal insufficiency.On physical examination the blood pressure was 121/82 mm Hg, the heart rate 72 beats per minute, and the respiratory rate 16 breaths per minute. The lungs were clear to auscultation. On cardiac examination, there was a regular rhythm with a soft systolic murmur at the left sternal border. On abdominal examination, there was mild diffuse distention without tenderness to palpation.The electrocardiogram showed sinus rhythm and nonspecific ST-T changes. A recent standard exercise treadmill stress test had demonstrated abnormal electrocardiographic changes at peak exercise in the inferior and lateral precordial leads.In light of the patient's symptoms and electrocardiographic abnormalities observed on standard stress testing, repeated treadmill stress testing was performed in conjunction with same-day stress-rest 99m Tc-sestamibi myocardial perfusion imaging. The patient reached an exertional level of 10 metabolic equivalents and 100% of maximum predicted heart rate without symptoms of chest pain. Abnorm...

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“…However, it is also important to carefully review the rotating cinematic raw projections "rotatograms" for factors that may influence the interpretation and non-cardiac findings. Non-cardiac findings from rotating cinematic images have identified both benign and malignant conditions [1,2]. We report two male patients who underwent stress technetium 99m sestamibi SPECT and were found to have increased focal tracer uptake identified in the breast region on the rotating cine images; case 1 had a diagnosis of invasive ductal adenocarcinoma of the breast and case 2 had bilateral gynecomastia.…”

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confidence: 96%

Male breast uptake of 99m-Tc sestamibi in myocardial perfusion imaging

Uthamalingam

Sidhu

Gurm

et al. 2012

International Journal of Cardiology

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Importance of systematic review of rotating projection images from Tc99m-sestamibi cardiac perfusion imaging for noncardiac findings

Abstract: NCFs are infrequent but often clinically important findings, whose detection is significantly enhanced by systematic reviews of all rotating projectional images.

Cited by 18 publications

References 32 publications

Extracardiac Uptake on Myocardial Perfusion Imaging in a Patient With Diaphragmatic Paralysis and Chilaiditi's Sign

Extracardiac Uptake on Myocardial Perfusion Imaging in a Patient With Diaphragmatic Paralysis and Chilaiditi's Sign

Large Abdominal Photopenic Area on 99mTc-Sestamibi Myocardial Perfusion Imaging

Male breast uptake of 99m-Tc sestamibi in myocardial perfusion imaging

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