Should patients with an incidental finding of focal myocardial 18FDG uptake be screened by myocardial perfusion scintigraphy

Abstract Purpose Focal F-18-fluoro-deoxy-glucose uptake in the myocardium can be a sign of resting myocardial ischemia. The purpose of our study was to assess the relevance of performing myocardial perfusion scintigraphy to screen for myocardial ischemia in patients with an incidental finding of focal myocardial F-18-fluoro-deoxy-glucose uptake on a routine F-18-fluoro-deoxy-glucose positron-emission-tomography-computed-tomography. Methods In our retrospective multicentric study, patients were included if they had had an incidental finding of myocardial focal F-18-fluoro-deoxy-glucose uptake on a routine F-18-fluoro-deoxy-glucose positron-emission-tomography-computed-tomography and had also undergone myocardial perfusion scintigraphy within 3 months before or after the F-18-fluoro-deoxy-glucose positron-emission-tomography-computed-tomography. Patients with a pattern of ischemia or scar on the myocardial perfusion scintigraphy in the same territory as the focal F-18-fluoro-deoxy-glucose uptake were considered positive. Results Seven of the 34 included patients were positive, with an abnormality on the MPS data in the same territory as the focal myocardial F-18-fluoro-deoxy-glucose uptake. 2 of the 6 patients with focal F-18-fluoro-deoxy-glucose uptake in the left anterior descending vascular supply territory and 2 of the 4 patients with focal F-18-fluoro-deoxy-glucose uptake in the standard right coronary artery territory had an abnormal myocardial perfusion scintigraphy. All 12 patients with focal F-18-fluoro-deoxy-glucose uptake restricted to the basal anterolateral and basal inferolateral segments were negative. Conclusion Patients with an incidental finding of focal F-18-fluoro-deoxy-glucose uptake on a routine F-18-fluoro-deoxy-glucose positron-emission-tomography-computed-tomography may be considered as being at risk for coronary artery disease, when this uptake is multisegmentary in the same typical coronary territory and not restricted to the basal anterolateral and basal inferolateral segments.