Incidental findings on hybrid SPECT-CT and PET-CT scanners: Is it time for new training and reporting guidelines?

Port, Steven C.

doi:10.1007/s12350-018-1257-0

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…We should also consider that the CT component associated with PET is generally non-diagnostic, without contrast media, with low/intermediate dose for attenuation correction and anatomical mapping. Furthermore, historically Nuclear Medicine training does not cover the comprehensive knowledge of critical care, which is traditionally a radiologists’ prerogative [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Actionable imaging findings in the daily PET/CT scenario

Mattana

Zanoni

Nanni

et al. 2023

Clin Transl Imaging

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Background and aim The American College of Radiology (ACR) defines “actionable findings” the ones requiring a special communication between radiologists and referring clinicians, suggesting to organize their categorization in a three-degree scale on the basis of the risk for the patient to develop complications. These cases may fall in a grey-zone communication between different care figures with the risk of being underestimated or even not being considered at all. In this paper, our aim is to adapt the ACR categorization to the most frequent actionable findings encountered when reporting PET/CT images in a Nuclear Medicine Department, describing the most frequent and relevant imaging features and presenting the modalities of communication and the related clinical interventions that can be modulated by the prognostic severity of the clinical cases. Materials and methods We performed a descriptive, observational and critical analysis of the most relevant literature on the topic of “actionable findings”, in particular, starting from the reports of the ACR Actionable Reporting Work Group, we categorised and described, in a narrative review, the most relevant “actionable findings” encountered in the Nuclear Medicine PET/CT daily practice. Results To the best of our knowledge, to date there are no clear indications on this selective PET/CT topic, considering that the current recommendations target mainly radiologists and assume a certain level of radiological expertise. We resumed and classified the main imaging conditions under the term of “actionable findings” according to the corresponding anatomical districts, and we described their most relevant imaging features (independently of PET avidity or not). Furthermore, a different communication timing and strategy was suggested on the basis of the findings’ urgency. Conclusion A systematic categorization of the actionable imaging findings according to their prognostic severity may help the reporting physician to choose how and when to communicate with the referring clinician or to identify cases requiring a prompt clinical evaluation. Effective communication is a critical component of diagnostic imaging: timely receipt of the information is more important than the method of delivery.

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Section: Introductionmentioning

confidence: 99%

Actionable imaging findings in the daily PET/CT scenario

Mattana

Zanoni

Nanni

et al. 2023

Clin Transl Imaging

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“…The clinical dilemma that prompted this study, and which has been previously described 1,8 is what to do with the incidental findings encountered on SPECT/CTwhich findings are clinically significant and who is responsible for investigating these findings? Indeed, during our study period, only 36 (17.6%) of the incidental findings were documented to have been investigated as we had no established protocol to manage these findings.…”

Section: Discussionmentioning

confidence: 99%

Incidental findings on single‐photon emission computed tomography/computed tomography (SPECT/CT) lymphoscintigraphy in breast cancer: the proposed Westmead SPECT/CT incidental findings classification

Quah

French

Gordon

et al. 2022

ANZ Journal of Surgery

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Background: The aim of this study is to determine the prevalence of incidental radiological findings detected on SPECT/CT performed as part of pre-operative lymphoscintigraphy for sentinel lymph node biopsy (SLNB) in patients undergoing breast cancer surgery and development of a modified classification to workup these lesions. Methods: A retrospective audit was performed of all SPECT/CT performed in combination with lymphoscintigrams in breast cancer patients presenting with clinically node negative axillae and operated on by breast surgeons at the Westmead Breast Cancer Institute over a 12-month period. Results: Four hundred and nineteen patients were included in the study. In 149 patients (35.6%), there was a total of 205 incidental findings. The most common findings were, pulmonary abnormalities (38.5%), abdominal findings (27.8%), thyroid nodules (14.6%), cardiac abnormalities (10.7%) and others (8.3%). Using our proposed Westmead SPECT/CT incidental findings (WSIF) classification, 7.8% were known, 17.6% were major findings, 48.3% were minor findings, 15.1% were minimal findings and 11.2% were equivocal findings. 17.6% (n = 36) underwent further workup and investigation and 3.4% of patients (n = 5) required therapeutic intervention, including chemotherapy for primary lung cancer (n = 1) and surgeries (thoracotomy, n = 1; thyroidectomy, n = 2; colonoscopy, n = 1). 93.8% (n = 393) had at least one SLN mapped, most commonly located in Level 1 of the axilla. Conclusion:The incidental findings on SPECT/CT in combination with lymphoscintigraphy is within the range of previous studies (27.3-59.5%). A small proportion of patients required significant major interventions (3.4%). We propose that all incidental findings should be assessed according to our WSIF classification to aid in triaging need for further investigation and management.

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confidence: 99%

“…Inci dental extracardiac findings in patients who undergo PET/CT and SPECT/CT have been documented, with the fraction of incidental findings being as high as 60% (1). The number of incidental findings that led to potentially treatment-altering diagnoses of previously unknown and treatable malignancies was low, at no greater than 0.5% (1). It is important to review incidental findings, as these will occasionally be found when the CT datasets of hybrid SPECT/CT and PET/CT myocardial perfusion imaging (MPI) studies are carefully reviewed in different imaging windows (1).…”

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confidence: 99%

Ancillary Finding on Myocardial Perfusion Imaging Due to Urinary Bladder Displacement

Frye

Bajric

Slavin

2022

J. Nucl. Med. Technol.

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When patients are referred for SPECT myocardial perfusion imaging with 99m Tc agents, attention focuses on the tracer activity in the myocardium. Apart from myocardial activity, normal biodistribution of 99m Tc-sestamibi and 99m Tc-tetrofosmin is seen in the thyroid, liver, gastrointestinal tract, kidneys, and urinary bladder. These structures may be visualized when a g-camera with a large field of view is used for SPECT imaging. This case report presents a serendipitous finding of a pelvic mass, which was identified because of the extended field of view afforded by the conventional g-camera used for SPECT myocardial perfusion imaging and detected because of a review of the raw images by the nuclear medicine technologist. This case emphasizes the importance of training the nuclear medicine technologist to review the raw data in the entire field of view before study completion.

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Incidental findings on hybrid SPECT-CT and PET-CT scanners: Is it time for new training and reporting guidelines?

Cited by 8 publications

References 5 publications

Actionable imaging findings in the daily PET/CT scenario

Actionable imaging findings in the daily PET/CT scenario

Incidental findings on single‐photon emission computed tomography/computed tomography (SPECT/CT) lymphoscintigraphy in breast cancer: the proposed Westmead SPECT/CT incidental findings classification

Ancillary Finding on Myocardial Perfusion Imaging Due to Urinary Bladder Displacement

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