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99mTc tetrofosmin is predominantly cleared by the hepatobiliary system and its scan is analogous to a cholescintigraphy. The radiopharmaceutical may be localized in the bone marrow. During cardiac acquisition, when the area being viewed includes the lower thorax and abdomen, abnormalities of the liver, gallbladder and kidneys, and the radioactivity in the oesophagus, stomach and bowel, as well as bone marrow uptake, can be depicted by routine raw data cine images. Excluding the intrathoracic abnormalities, these abdominal abnormalities are illustrated in this paper.Retrospectively, we reviewed the raw data cine images from 566 patients. These images were 180 degrees or 360 degrees rotation and showed the abdominal organs and thoracic cage, including the ribs, sternum and spine. We found 234 abnormalities, which were correlated with radiography, laboratory and clinical findings.Intra-abdominal abnormalities included bone marrow visualization, 93 occurrences (39.7%); duodeno-gastric (DG) and entero-gastric (EG) reflux, 47 (20.1%); non-visualization of the gallbladder, including possible causes of cholelithiasis, acute cholecystitis, or cholecystectomy, 31 (13.2%); elevation of the right diaphragm and depression of diaphragm, 30 (12.8%); renal abnormalities, including absent kidney, renal atrophy and cyst, 12 (5.1%); splenomegaly, 10 (4.3%); liver, including hepatomegaly and cirrhosis of the liver, eight (3.4%); and breast attenuation resulting in photopenia in the liver, three (1.2%).(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.

Purpose The lower thorax and upper abdomen are visualized during cardiac acquisition of rest Tl-201 and stress Tc-99m tetrofosmin gated SPECT. Thus, abnormal Tl-201 localization in these areas and in organs such as parts of the lungs, liver, spleen, and kidneys can be observed, including rotating raw cine data. Materials and methods Other than cardiac images, the authors retrospectively reviewed Tl-201 rotating (raw data) images of 235 patients. Abnormal findings in the lungs, liver, spleen, and kidneys were identified that correlated with the patients' clinical information; radiographic findings, including computed tomography and ultrasonography of the abdomen; other scintigraphic studies; and laboratory findings. Results In 53 patients, 54 abnormalities were detected. Intrathoracic abnormalities included focal areas of increased uptake, one in the right lower lung and another in the right upper lung that confirmed lung cancer, in 2 patients; diffuse uptake in both lungs in 11 patients; photopenia in the lung bases, which had resulted from pleural effusions, in 3 patients; and abnormal right liver configuration caused by elevation of the right hemidiaphragm in 1 patient. Of the intra-abdominal abnormalities, 12 patients with splenomegaly were identified. Six patients had focal areas of increased uptake in the gastric area. Nonvisualization of one kidney resulted from a congenitally absent right kidney in 1 patient, from right nephrectomy in 1 patient, from end-stage renal disease in another, and from a lower position of the left or right kidneys in 5 patients. Small and decreased uptake of both kidneys resulted from end-stage renal disease in 1 patient. Small and decreased uptake of one kidney was noted in 1 patient with renal scarring, in 1 patient with a renal stone, in 3 patients with chronic pyelonephritis, and in 5 patients with renal cyst(s). Conclusions Discernible intrathoracic and intra-abdominal abnormalities using rotating raw cine data from imaging in three-dimensional displays include diffuse or focal pulmonary uptake, pleural effusion, elevation of a hemidiaphragm, splenomegaly, increased uptake in the gastric area, renal abnormalities including absent or small kidneys, end-stage renal disease, renal scarring, renal cyst(s), and lower position of a kidney. The incidental finding of such abnormalities may prompt further clinical investigation.

Gamma cameras contain energy discriminators that allow only those photons within a specified energy range to be recorded. A spontaneous shift in peak of 1 head of a dual-head gamma camera may cause artifacts. We present our experience with the incidental occurrence of off-peak status in 1 head of a dual-head gamma camera that resulted in subsequent artifacts and poor-quality images.Four patients had been scheduled to undergo imaging on a newly installed dual-head gamma camera on the same morning. The first patient underwent (201)Tl-chloride anterior and posterior total-body imaging to check for metastatic thyroid cancer, and the images were of adequate quality for interpretation. The next 2 patients underwent dual-isotope rest (201)Tl-chloride and gated dipyridamole (99m)Tc-tetrofosmin myocardial SPECT. The rest (201)Tl myocardial SPECT images of both patients showed normal perfusion in the left ventricular wall, but the dipyridamole (99m)Tc SPECT images showed virtual absence of perfusion in the apical, anterior, and lateral walls. These findings might suggest myocardial ischemia. In addition, 1 of 2 patients' cardiac gated SPECT findings led to inaccurate left ventricular ejection fractions. Technologists did not become aware of the artifacts until the fourth patient underwent total-body bone scanning, which showed faint activity with loss of contrast in the entire anterior body. One of the camera heads was then found to have off-peak status. Thus, we abandoned use of 1 detector of the dual-head gamma camera and repeated the anterior bone scanning of the 4th patient and the dipyridamole SPECT of 1 of the 2 cardiac patients.Gated cardiac SPECT abnormalities resulting from off-peak status were difficult to identify and included abnor-mal left ventricular wall perfusion and an inaccurate left ventricular ejection fraction. It was determined later that the off-peak status was caused by malfunction of a photomultiplier tube.Degraded planar images resulting from the off-peak status of a camera head are easily identified. The presence of the same pattern of abnormalities in 2 consecutive myocardial SPECT examinations should alert technologists to the possibility that the abnormalities are, in fact, artifacts.

Forty-two months after irradiation and left pneumonectomy for bronchogenic carcinoma, a 54-year-old man had Tc-99m depreotide chest imaging that showed absent uptake in the upper thoracic spine and sternum and markedly decreased uptake in the entire left thorax. Decreased uptake in the thoracic spine corresponded to the findings of concurrent thoracic bone imaging. Absent uptake of the sternum, left posterior ribs, and left thorax on depreotide imaging was discordant with findings of bone imaging, which showed normal activity in the sternum, partially preserved activity of the left posterior ribs, and relatively increased uptake in the left thorax. Irradiation to the left lung caused depression of the bone marrow and inhibited osteoblastic activity of thoracic vertebrae, resulting in photopenia of the thoracic spine. Discrepant uptake of the sternum and left posterior ribs suggested bone marrow uptake and accounts for the visualization on depreotide images, which indicates that bone marrow is more sensitive to irradiation than is osteoblastic activity.

Bone marrow visualization was noted in two patients with different diseases. One had anemia secondary to gastrointestinal bleeding and the other had polycythemia as a result of pulmonary hypertension secondary to emphysema and impairment of pulmonary function. The second patient also had a cardiac hyperdynamic condition as expressed by a left ventricular ejection fraction of 78%. Visualization of the bone marrow in these patients was secondary to an expanded bone marrow, responding to anemia in one case and hypoxia in the other.