Breast Attenuation Artifact on Myocardial Perfusion SPECT
CC BY-SA 4.0 · Sincefalastrum / Wikimedia Commons · source file
Question
In female patients undergoing myocardial perfusion SPECT, breast tissue commonly causes an attenuation artifact. The breast attenuation artifact in women most characteristically appears as a defect in which myocardial territory?
- AAnterior wall — the breast overlies the anterior left ventricular wall
- BInferior wall — same distribution as diaphragmatic attenuation
- CLateral wall — corresponding to the left breast position
- DApical wall — breast tissue overlies the cardiac apex
Show the answer and explanation
A. Anterior wall — the breast overlies the anterior left ventricular wall
In women, breast tissue attenuates photons from the ANTERIOR wall of the left ventricle (LAD territory), creating a false-positive apparent defect in the anterior wall and sometimes the anterolateral region. This is analogous to diaphragmatic attenuation in men (inferior wall). To distinguish breast attenuation artifact from true anterior wall ischemia or infarction: (1) CT attenuation correction; (2) prone imaging (repositions breast tissue); (3) gated SPECT (wall motion is NORMAL in pure artifact, abnormal in true infarction); (4) assess for consistency with breast position across slices.
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