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False Positive Findings for Ischemia Due to Improper Axes Alignment

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History

A 60 year-old male with moderate risk factors for cardiovascular disease and an incident of chest pain presents for myocardial perfusion imaging in your Nuclear Medicine department.  What is the most likely cause of the findings in the inferolateral wall?


Findings

Stress (superior rows) and rest (inferior rows) sestamibi myocardial perfusion images along with associated polar maps.

The axes are not properly aligned/not matched between stress and rest MPS slices (dashed yellow lines) causing false positive finding for ischemia in the inferolateral wall.  After correction (images not displayed here), the study appeared normal.


Diagnosis

False Positive Findings for Ischemia Due to Improper Axes Alignment


Discussion

It is important that images are reviewed for potential  technical/processing errors such as in this case.  If the interpreting physician suspects causes such as patient motion, misalignment of the axes, etc., they should ask their technologist to reprocess them.  Many times, the physician has access to a dedicated workstation where he or she can make these corrections themselves.  As a word of caution,be aware that if reading from a PACS system, that there may not be the capability to check for these items, and interpretations may not be properly made unless the necessary corrections are made and resent to PACS.


DDx

1. Improper technical processing 

2. Ischemia 

3. Attenuation artifact


References

Burrell SA, Macdonald A.  Artifacts and pitfalls in myocardial perfusion imaging.  J Nucl Med Technol.  2006; 34:193-211.



Author
Dr Twyla Bartel
Channel
ACNM Clinical cases channel
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