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Artifactual reverse distribution pattern in myocardial perfusion SPECT with technetium-99m sestamibi.

W Araujo¹, E G DePuey, M Kamran

¹Diagnostico Medico Nuclear, Campinas, Sao Paulo, Brazil.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology

|January 6, 2001

Summary

The reverse distribution pattern (RDP) on cardiac SPECT scans is an artifact, particularly common in obese patients. This imaging artifact is linked to body habitus, not coronary artery disease.

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Area of Science:

Nuclear Cardiology
Medical Imaging Physics

Background:

The reverse distribution pattern (RDP) in myocardial perfusion imaging shows more severe defects at rest than during stress.
RDP is frequently observed in patients with a low probability of coronary artery disease.

Purpose of the Study:

To investigate if the RDP is an artifact.
To identify the causes of RDP in cardiac SPECT imaging.

Main Methods:

Retrospective analysis of 202 patients with low coronary artery disease likelihood undergoing technetium-99m sestamibi SPECT.
Correlation of RDP presence and location with patient body habitus parameters.
Cardiac SPECT phantom experiments to assess soft tissue attenuation effects.

Main Results:

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RDP was observed in 15.3% of patients.
RDP was significantly more frequent in obese patients, men with abdominal protuberance, and women with prominent breast shadows.
Soft tissue attenuation in low count density SPECT studies contributes to RDP, especially in obese individuals.

Conclusions:

RDP is a common artifact in rest/stress Tc-99m sestamibi SPECT.
Obesity, specifically abdominal protuberance in men and large breasts in women, increases the likelihood of RDP.
Soft tissue attenuation is the primary cause of this artifactual finding.