Illustrations of abdominal abnormalities on 99mTc tetrofosmin gated cardiac SPECT

Abstract

(1) The bone marrow uptake of the vertebrae accounts for almost 40% of the abdominal abnormalities, and is usually concordant with anaemia; (2) DG and EG refluxes represent 20% of abdominal abnormalities; they may have a clinical impact and may or may not interfere with SPECT processes and result in artifacts of the inferior wall of the left ventricle; (3) non-visualization of the gallbladder should prompt a search for cholelithiasis; and (4) benign renal cyst or cirrhosis of the liver could also be demonstrated. These coincidental findings may be included in routine cardiac SPECT reports that may have clinical impact because they give the referring physician the chance to pursue further clinical investigation.

The prevalence and significance of increased gastric wall radiotracer uptake in sestamibi myocardial perfusion SPECT

“…Physiologic and also abnormal activity of the myocardial perfusion imaging agents in the abdominal organs has been widely described [4,5]. In the comprehensive report of Shih et al [4], intra-abdominal abnormalities in the myocardial perfusion scan using a similar agent ( 99m Tc-tetrofosmin) included bone marrow visualization (39.7%); duodeno-gastric and enterogastric reflux (20.1%); nonvisualization of the gallbladder (including possible causes of cholelithiasis, acute cholecystitis, or cholecystectomy, 13.2%); renal abnormalities (including renal atrophy and cyst, 5.1%); splenomegaly (4.3%); and hepatomegaly and cirrhosis of the liver (3.4%).…”

“…Although viewing the raw data rotating cine images has been considered as an important part of the interpretation of myocardial SPECT [5], in routine clinical practice this approach is underutilized and is neglected frequently. However, in few reports it has been suggested that excluding the intrathoracic abnormalities and intra-abdominal abnormalities are one of the most important parts of routine evaluation of cardiac SPECT imagings [4,5]. Even in those situations that particular attention to the visceral activities has been taking into account, usually the presence of radiotracer uptake by the stomach has been missed [4,5].…”

“…On the other hand, with the currently-used myocardial agents such as 99m Tc-sestamibi ( 99m Technetium-2-methoxyisobutylisonitrile), relatively high abdominal uptake is usually present, which are generally attributed to physiologic hepatobiliary or renal excretion of such radiopharmaceuticals [4]. There are few reports indicating that these visceral uptakes are not physiologic always and sometimes are in association with different underlying pathologies [4].…”

“…There are few reports indicating that these visceral uptakes are not physiologic always and sometimes are in association with different underlying pathologies [4]. In fact, accidental pathological findings during myocardial perfusion scintigraphies are not uncommon in current practice of nuclear medicine and careful analysis of the full field of images acquisition had been successful in detecting these accidental findings [5][6][7][8][9][10].…”

Clinical Significance of Tetrofosm in Extracardiac Uptake During Myocardial Perfusion Imaging

“…Hepatocellular carcinoma, melanoma, sarcomas and multiple myeloma have also been described in the abdomen, accumulating Tc-99m tetrofosmin in MPS (Fisher et al, 2000;Hadase et al, 2003;Vijayakumar et al, 2005;Yi & Jacobs, 2004). Others, reviewing the raw data cine images of 566 patients during Tl-201 dipyridamole Tc99m tetrofosmin rest-stress MPS, found 234 abnormalities (Shih et al, 2002;Shih et al, 2005) such as: bone marrow visualisation (39.7%), duodenogastric and enterogastric reflux (20.1%), non-visualisation of the gallbladder (13.2%), small-atrophic-scarred, vaguely seen or ectopic kidneys, splenomegaly, liver diseases like hepatomegaly and cirrhosis and breast attenuation causing photopenia in the liver. The authors suggested that Tc-99m tetrofosmin is accumulated in the red bone marrow due to high and/or expanded haematopoetic activity.…”