What are the guidelines for reporting nuclear myocardial scan findings?

Updated: Aug 07, 2019
  • Author: Thomas F Heston, MD, FAAFP, FASNC, FACNM; Chief Editor: Eugene C Lin, MD  more...
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Answer

Some variation exists in reporting guidelines for nuclear myocardial scans; however, several common principles are applied. First, pertinent patient history is included in the report. Scanning findings address 3 main sets of images: the raw data, the reconstructed sections, and the gated images. The conclusion should address the presence or absence of reversible defects (suggesting myocardial ischemia) [46] and fixed defects (suggesting myocardial infarction), as well as left ventricular function. Finally, the specific question asked by the clinician must be addressed in the report.

For example, if the clinician orders the test to assist in the diagnosis of CAD, the report should include the note "low risk of CAD," "high risk of CAD," or a similar comment. If the clinician orders the test to determine whether a stent is patent, the report should state whether the scan suggests that the stent is patent or occluded.

A general guideline to reporting nuclear myocardial scans follows; it is based mostly on the approach taken by Germano and Berman and the guidelines established by the Society of Nuclear Medicine. [30] The general data are as follows:

  • Scan data include the type of scan, examination date, and location of the procedure.

  • Patient identification includes the patient's name, date of birth, and age.

  • The patient's history includes symptoms (if chest pain is reported, specify the type of chest pain according to criteria by Diamond and Forrester), relevant history (including the results of previous scans or catheterization reports), medications (state if the medications were withheld for the test or not), CAD risk factors, and the resting ECG; also included is information about the indication for the study and the clinical question asked by the ordering clinician.

  • The report of technique includes the protocol, the radiopharmaceutical used, and the doses.

  • Results of the stress test include the type of stress test used, the clinical response, the ECG response, and the blood pressure response; treadmill stress test results also include the peak heart rate achieved, the associated percentage of the maximum predicted heart rate, and the duration of the exercise.

  • Raw data include an evaluation of the quality of the study, degree of artifacts, pulmonary uptake, and any abnormal noncardiac uptake.

  • Section reports include reconstructed data showing the short, vertical long, and horizontal long axes; if the data show abnormalities, ventricular sizes, uptake by the right ventricle, and the presence or absence of transient ischemic dilation should be noted; be sure to include some degree of quantification (for example, defects may involve the basal inferior wall or may be larger, running from the apex to the base. Stating simply that "an inferior wall defect is present" does not provide the clinician with information concerning how much myocardium is involved; similarly, the severity of the defect and the amount, if any, of redistribution should be noted. Berman recommends using the summed stress score and a summed difference score to help standardize readings between different laboratories. [3] This scale is automated on many nuclear medicine systems, but it can also be calculated visually.).

  • Gated images include the left ventricular ejection fraction. If this fraction is not calculated automatically, estimate the ejection fraction. End-systolic volume should also be included. Provide a qualitative interpretation of wall motion and thickening.

  • Conclusions should include the following: (1) Note whether any reversible defects are present. If they are, describe the extent and severity of the defect and how much redistribution occurs. (2) Note whether any fixed defects are present. Comment on the size and severity of the defects. (3) Answer the clinical question asked by the ordering clinician (for example, if the patient was referred for imaging to assist in the possible diagnosis of CAD, directly address the posttest likelihood of CAD; if the patient was referred for follow-up imaging after stent placement, state whether the scanning results suggest patency or occlusion. Directly answering the clinical question is essential to maximize the value of the study.).

  • Other comments can address any unusual features of the scan, such as a focus of abnormal pulmonary uptake.


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