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Incidental extra-cardiac findings on 13N-ammonia myocardial perfusion PET/CT

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The objective of this study was to describe the prevalence of incidental extra-cardiac findings (IECFs) on myocardial perfusion PET/CTs and the prevalence of potentially clinically relevant and clinically irrelevant IECFs, as well as detection rate of previously unknown malignancies.

Methods and Results

From September 2013 until February 2016, a total of 1397 consecutive patients referred for the evaluation of possible ischemia by 13NH3 PET/CT were prospectively included in a database. IECFs were categorized into three groups: potentially clinically relevant IECFs, IECFs that could potentially cause chest pain, and clinically irrelevant IECFs. Additionally, the prevalence of previously unknown malignancies was determined. In 717 (51%) of these patients, 775 IECFs were reported and 115 IECFs were categorized as potentially clinically relevant in 109 (8%) patients. A total of 145 IECFs that could potentially cause chest pain were detected in 139 (10%) patients and 515 clinically irrelevant IECFs were detected in 469 (34%) of the patients. An unknown primary malignancy was histologically proven in 19 patients (1.4%).

Conclusions


IECFs are detected on myocardial perfusion PET/CT in approximately half of the patients. In the present study, IECFs were potentially clinically relevant in 8% of the patients and in 1.4% an unknown malignancy was found, most of which were lung cancers.

Spanish Abstract

Antecedentes

El objetivo de este estudio fue describir la prevalencia de los hallazgos incidentales extra cardiacos (HIECs) en el estudio de PET/CT de perfusión miocárdica y la prevalencia de los HIECs clínicamente relevantes y clínicamente irrelevantes, así como la tasa de detección de patología maligna previamente desconocida.

Métodos y Resultados

De Septiembre 2013 a Febrero 2016, un total de 1397 pacientes consecutivos referidos para la evaluación de posible isquemia con PET/CT con 13NH3 fuero incluidos de manera prospectiva en una base de datos. Los HIECs fueron categorizados en 3 grupos: HIECs clínicamente relevantes, HIECs que potencialmente pudieran causar dolor torácico, y HIECs clínicamente irrelevantes. Adicionalmente, la prevalencia de patología maligna previamente desconocida fue determinada. En 717 (51%) de estos pacientes 775 HIECs fueron reportados y 115 HIECs fueron categorizados como clínicamente relevantes en 109 (8%) pacientes. Un total de 145 HIECs que potencialmente pudieran causar dolor torácico fueron detectados en 139 (10%) pacientes y 515 HIECs clínicamente irrelevantes fueron detetados en 469 (34%) de los pacientes. Enfermedad maligna primaria desconocida fue histológicamente demostrada en 19 pacientes (1.4%).

Conclusiones


Los HIECs son detectados en el estudio PET/CT de perfusión miocárdica en aproximadamente la mitad de los pacientes. En el presente estudio, los HIECs fueron clínicamente relevantes en 8% de los pacientes y en el 1.4% se encontró enfermedad maligna primaria desconocida, en su mayoría fueron cáncer de pulmón.

Chinese Abstract

背景

本文旨在探讨心肌灌注PET/CTs心脏外发现(IECFs)的检出率,包括潜在临床相关、非潜在临床相关的IECFs,以及未知恶性肿瘤。

方法和结果

从2013年9月到2016年2月,前瞻性地纳入1397名疑似心肌缺血并接受 13NH3 PET/CT检查的患者。将IECFs分为三组:潜在临床相关的IECFs、可能引起胸痛的IECFs和非潜在临床相关的IECFs。此外,未知恶性肿瘤的检出率也作为观察指标。最终,717(51%)名患者有775处IECFs。其中,109(8%)名患者有115处 潜在临床相关的IECFs;139(10%)名患者有145处可能引起胸痛的 IECFs;469(34%)患者有515处非临床相关的IECFs;19(1.4%)名患者检出未知恶性肿瘤(经组织学证实)。

结论


心肌灌注PET/CTs患者中,约一半检出IECFs。其中8%的患者,IECFs呈潜在临床相关, 1.4%的患者检查未知恶性肿瘤,且多为肺癌。

French Abstract

Contexte

L’objectif de cette étude était d’evaluer la prévalence des anomalies extra-cardiaques (IECF) découvertes sur les images de perfusion myocardique obtenues par tomodensitometrie à positrons, leur signification clinique et le pourcentage de tumeurs non diagnostiquées précédemment.

Méthodes et Résultats

De Septembre 2013 à Février 2016, un total de 1397 patients évalués pour ischemie myocardique par tomodensitometrie à positrons (13NH3) ont été inclus prospectivement dans notre base de données. Les anomalies extra cardiaques découvertes ont été classées en trois groupes: celles ayant une signification clinique importante, celles susceptibles de causer des douleurs thoraciques et celles sans signification clinique. Nous avons également determiné la prévalence de tumeurs thoraciques malignes jusqu’alors inconnues. Chez 717 des patient revus (51%), 775 anomalies extracardiaques ont été signalées. 115 d’entre elles (9%) ont été classées comme potentiellement cliniquement significative (8% des patients). Un total de 145 anomalies susceptibles de causer des douleurs thoraciques a été détecté chez 139 patients (10%). A total de 515 anomalies furent considerées comme cliniquement non significative chez 469 (34%) des patients. Le diagnostic histologique de tumeur primitive (inconnue jusqu’alors) fut etabli chez 19 patients (1.4%).

Conclusions

Des anomalies extra-cardiaques peuvent être détectées sur les images de perfusion myocardique par tomodensitometrie à positrons chez environ 50% des patients. Dans la présente étude, les anomalies extra-cardiaques se sont révelées cliniquement significative chez 8% des patients. Parmi ceux-ci, 1.4% furent diagnostiqués avec un cancer (le souvent du poumon).

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Abbreviations

BMI:

Body mass index

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CT:

Computed tomography

IECFs:

Incidental extra-cardiac findings

MI:

Myocardial infarction

MPS:

Myocardial perfusion scintigraphy

PCI:

Percutaneous coronary intervention

PET/CT:

Positron emission tomography/computed tomography

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Disclosure

H kan, F.M. van der Zant, M. Wondergem and R.J.J. Knol have nothing to disclose.

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Authors and Affiliations

  1. Cardiac Imaging Division Alkmaar, Northwest Clinics, Alkmaar, The Netherlands

    H. Kan BSc, F. M. van der Zant MD, PhD, M. Wondergem MD & R. J. J. Knol MD, PhD

  2. Department of Nuclear Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands

    H. Kan BSc, F. M. van der Zant MD, PhD, M. Wondergem MD & R. J. J. Knol MD, PhD

Authors
  1. H. Kan BSc
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  2. F. M. van der Zant MD, PhD
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  3. M. Wondergem MD
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  4. R. J. J. Knol MD, PhD
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Corresponding author

Correspondence to H. Kan BSc.

Additional information

JNC thanks Erick Alexanderson MD, Carlos Guitar MD, and Diego Vences MD, UNAM, Mexico, for providing the Spanish abstract; Haipeng Tang MS, Zhixin Jiang MD, and Weihua Zhou PhD, for providing the Chinese abstract; and Jean-Luc Urbain, MD, PhD, CPE, Past President CANM, Chief Nuclear Medicine, Lebanon VAMC, PA, for providing the French abstract.

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Kan, H., van der Zant, F.M., Wondergem, M. et al. Incidental extra-cardiac findings on 13N-ammonia myocardial perfusion PET/CT. J. Nucl. Cardiol. 24, 1860–1868 (2017). https://doi.org/10.1007/s12350-017-0824-0

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