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Disappearance of myocardial perfusion defects on prone SPECT imaging : Comparison with cardiac magnetic resonance imaging in patients without established coronary artery disease

Hedén, Bo LU ; Persson, Eva LU ; Carlsson, Marcus LU ; Pahlm, Olle LU and Arheden, Håkan LU (2009) In BMC Medical Imaging 9.
Abstract

Background: It is of great clinical importance to exclude myocardial infarction in patients with suspected coronary artery disease who do not have stress-induced ischemia. The diagnostic use of myocardial perfusion single-photon emission computed tomography (SPECT) in this situation is sometimes complicated by attenuation artifacts that mimic myocardial infarction. Imaging in the prone position has been suggested as a method to overcome this problem. Methods: In this study, 52 patients without known prior infarction and no stress-induced ischemia on SPECT imaging were examined in both supine and prone position. The results were compared with cardiac magnetic resonance imaging (CMR) with delayed-enhancement technique to confirm or... (More)

Background: It is of great clinical importance to exclude myocardial infarction in patients with suspected coronary artery disease who do not have stress-induced ischemia. The diagnostic use of myocardial perfusion single-photon emission computed tomography (SPECT) in this situation is sometimes complicated by attenuation artifacts that mimic myocardial infarction. Imaging in the prone position has been suggested as a method to overcome this problem. Methods: In this study, 52 patients without known prior infarction and no stress-induced ischemia on SPECT imaging were examined in both supine and prone position. The results were compared with cardiac magnetic resonance imaging (CMR) with delayed-enhancement technique to confirm or exclude myocardial infarction. Results: There were 63 defects in supine-position images, 37 of which disappeared in the prone position. None of the 37 defects were associated with myocardial infarction by CMR, indicating that all of them represented attenuation artifacts. Of the remaining 26 defects that did not disappear on prone imaging, myocardial infarction was confirmed by CMR in 2; the remaining 24 had no sign of ischemic infarction but 2 had other kinds of myocardial injuries. In 3 patients, SPECT failed to detect small scars identified by CMR. Conclusion: Perfusion defects in the supine position that disappeared in the prone position were caused by attenuation, not myocardial infarction. Hence, imaging in the prone position can help to rule out ischemic heart disease for some patients admitted for SPECT with suspected but not documented ischemic heart disease. This would indicate a better prognosis and prevent unnecessary further investigations and treatment.

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type
Contribution to journal
publication status
published
subject
in
BMC Medical Imaging
volume
9
article number
16
publisher
BioMed Central (BMC)
external identifiers
  • scopus:70049084163
  • pmid:19664252
ISSN
1471-2342
DOI
10.1186/1471-2342-9-16
language
English
LU publication?
yes
id
7f8c27e9-3b01-4dc8-bb50-69e1a97fcbce
date added to LUP
2019-05-14 14:44:36
date last changed
2021-11-17 08:55:46
@article{7f8c27e9-3b01-4dc8-bb50-69e1a97fcbce,
  abstract     = {<p>Background: It is of great clinical importance to exclude myocardial infarction in patients with suspected coronary artery disease who do not have stress-induced ischemia. The diagnostic use of myocardial perfusion single-photon emission computed tomography (SPECT) in this situation is sometimes complicated by attenuation artifacts that mimic myocardial infarction. Imaging in the prone position has been suggested as a method to overcome this problem. Methods: In this study, 52 patients without known prior infarction and no stress-induced ischemia on SPECT imaging were examined in both supine and prone position. The results were compared with cardiac magnetic resonance imaging (CMR) with delayed-enhancement technique to confirm or exclude myocardial infarction. Results: There were 63 defects in supine-position images, 37 of which disappeared in the prone position. None of the 37 defects were associated with myocardial infarction by CMR, indicating that all of them represented attenuation artifacts. Of the remaining 26 defects that did not disappear on prone imaging, myocardial infarction was confirmed by CMR in 2; the remaining 24 had no sign of ischemic infarction but 2 had other kinds of myocardial injuries. In 3 patients, SPECT failed to detect small scars identified by CMR. Conclusion: Perfusion defects in the supine position that disappeared in the prone position were caused by attenuation, not myocardial infarction. Hence, imaging in the prone position can help to rule out ischemic heart disease for some patients admitted for SPECT with suspected but not documented ischemic heart disease. This would indicate a better prognosis and prevent unnecessary further investigations and treatment.</p>},
  author       = {Hedén, Bo and Persson, Eva and Carlsson, Marcus and Pahlm, Olle and Arheden, Håkan},
  issn         = {1471-2342},
  language     = {eng},
  month        = {08},
  publisher    = {BioMed Central (BMC)},
  series       = {BMC Medical Imaging},
  title        = {Disappearance of myocardial perfusion defects on prone SPECT imaging : Comparison with cardiac magnetic resonance imaging in patients without established coronary artery disease},
  url          = {http://dx.doi.org/10.1186/1471-2342-9-16},
  doi          = {10.1186/1471-2342-9-16},
  volume       = {9},
  year         = {2009},
}