Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, 4032, Australia.
Faculty of Medicine, The University of Queensland, Herston, Australia.
J Nucl Cardiol. 2022 Aug;29(4):1813-1822. doi: 10.1007/s12350-020-02499-1. Epub 2021 Mar 22.
The appropriate clinical approach to incidentally detected lesions (IDLs) on CT attenuation correction (CTAC) images in myocardial perfusion imaging (MPI) remains uncertain. We sought to establish their prevalence and clinical significance in a large cohort and compared to previous studies to help provide further clarity and guide future clinical practice.
A total of 3758 MPI studies were reviewed retrospectively. IDLs of potential clinical significance-not known before MPI - were reported in 245 (6.5%) of these cases. Following appropriate further investigation/follow-up, these were of proven clinical significance in 30 (12.2%) cases with 14 patients (5.7%) harboring previously undiagnosed or progressive malignancies. The positive predictive value (PPV) for clinically significant incidental findings on CTAC images was 17.2% and the PPV value for incidental malignant findings was 8.0%.
Although incidental findings on CTAC images in MPI are common and often clearly insignificant at time of MPI reporting, many are clinically significant with a relatively high positive predictive value. This is especially so for malignancies. Our findings, therefore, in combination with previous studies as described here support routine reporting and appropriate further investigation of incidental CTAC findings in MPI.
在心肌灌注成像（MPI）的 CT 衰减校正（CTAC）图像上偶然发现的病变（IDL）的适当临床处理方法仍不确定。我们旨在在一个大队列中确定其发生率和临床意义，并与之前的研究进行比较，以提供进一步的明确信息并指导未来的临床实践。
回顾性分析了 3758 例 MPI 研究。在这些病例中，有 245 例（6.5%）报告了潜在临床意义的 IDL-在 MPI 之前未知。经过适当的进一步调查/随访，其中 30 例（12.2%）证实具有临床意义，14 例患者（5.7%）存在先前未诊断或进展性恶性肿瘤。CTAC 图像上偶然发现的有临床意义的偶然发现的阳性预测值（PPV）为 17.2%，偶然发现的恶性发现的 PPV 值为 8.0%。
尽管 MPI 的 CTAC 图像上的偶然发现很常见，并且在 MPI 报告时通常明显无意义，但许多发现具有临床意义，且具有相对较高的阳性预测值。对于恶性肿瘤尤其如此。因此，我们的发现，结合这里描述的以前的研究，支持在 MPI 中常规报告和适当进一步调查偶然的 CTAC 发现。
