Primary Thoracic Cancers Incidentally Detected on CT Attenuation Correction Images During Myocardial Perfusion Scintigraphy

Low-dose, non-breath-holding computed tomography (CT) images of a significant portion of the thorax can be used to provide CT attenuation correction (CTAC) in myocardial perfusion scintigraphy, enhancing the accuracy of evaluation for myocardial ischaemia.Incidental findings of potential clinical significance, most commonly pulmonary nodules, are seen on the CTAC images in a considerable number of cases and may represent undiagnosed malignancy.Early detection allowed curative surgical treatment to be undertaken in 40% of cases, with no recurrence or metastasis at 1 year in these patients. The nature and location within the thorax of the incidental low-dose CT findings, which represented undiagnosed malignancy, was varied.Review of CTAC images in MPI for incidental lesions and reporting of any suspicious findings should be mandatory given the ability to detect undiagnosed malignancy and potentially improve patient outcomes.Direct communication of suspicious incidental findings between the nuclear medicine physicians and referring doctors at time of reporting may help to reduce the interval between MPI and definitive diagnosis. The position would be further strengthened if reinforced in the guidelines of the major nuclear medicine associations. (C) 2018 Elsevier Inc. All rights reserved.