Download FDG-SPECT - Blue Cross and Blue Shield of Texas

FDG USING CAMERA BASED IMAGING (FDG-SPECT)
RAD604.005
POSTED DATE:
6/11/2003
EFFECTIVE DATE: 8/15/2003
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COVERAGE:
FDG-SPECT is considered medically necessary as a technique to evaluate
myocardial viability in patients with known coronary artery disease.
Other cardiac applications of FDG-SPECT are considered experimental or
investigational, including, but not limited to, evaluation of coronary
artery perfusion defects.
FDG-SPECT is considered experimental or investigational as a technique
to evaluate patients with known or suspected malignancies.
Other applications of FDG-SPECT are considered experimental or
investigational, including, but not limited to, evaluation of
neurological disorders, dementias, psychiatric disorders, or motor
neuron disorders.
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DESCRIPTION:
FDG-SPECT is also referred to as metabolic SPECT (single proton
emission computed tomography), or PET using a gamma camera. FDG-SPECT
is a general term describing imaging techniques in which a SPECT gamma
camera is used to detect the paired 511 ke-V photons emitted from
decaying positrons associated with the metabolism of radiolabeled 2fluoro-2 deoxy-D-glucose (FDG), a radiotracer commonly used in PET
(positron emission tomography) imaging. SPECT cameras are
conventionally used to provide scintigraphic studies such as bone
scans or cardiac thallium studies. When used in conjunction with FDG,
specially equipped SPECT cameras can provide images reflecting the
metabolic activity of tissues, similar to PET scanning.
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RATIONALE:
Oncologic Applications
The data suggest that FDG-SPECT cannot be considered an equivalent
diagnostic modality compared to conventional PET scanning,
particularly for small lesions. There are inadequate data regarding
the diagnostic performance of FDG-SPECT compared to other anatomic
imaging techniques, such as CT or MRI scan.
Cardiac Applications
The data suggest that 4 methods (Conventional thallium SPECT, FDGcollimated-SPECT, FDG-collimated-SPECT, FDG-DHC-SPECT, and PET
scanning) may be clinically useful and considered equivalent in most
cases. However, it is difficult to determine in which subsets of
patients one technique may be superior to another, or if the
diagnostic performance is improved with the combination of techniques.
There are no data to suggest that the combination of FDG-SPECT with
PET scans improve diagnostic performance of either technique alone.
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company*
Southwest Texas HMO, Inc.* d/b/a HMO Blue Texas
* Independent Licensees of the Blue Cross and Blue Shield Association
FDG USING CAMERA BASED IMAGING (FDG-SPECT)
RAD604.005
POSTED DATE:
6/11/2003
EFFECTIVE DATE: 8/15/2003
_____________________________________________________________________________
There are no data regarding the use of FDG-SPECT in the evaluation of
coronary perfusion defects.
Neurologic Disorders
PET scans have been widely used in the evaluation of neurological
disorders, ranging from epilepsy to dementias. There are inadequate
data to compare FDG-SPECT to PET for neurological disorders.
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PRICING:
None
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REFERENCES:
• Martin WH, Delbeke D, Patton JA et al. Detection of malignancies
with SPECT versus PET, with 2-[fluoro-18] fluoro-2-deoxy-D-glucose.
Radiology 1996; 198(1): 225-31.
• Lonneuz M, Delval D, Bausart R et al. Can dual-headed 18F-FDG SPECT
imaging reliably supersede PET in clinical oncology? A comparative
study in lung and gastrointestinal tract cancer. Nucl Med Commun
1998; 19(11):1047-54
• Tatsumi M, Yutani K, Watanabe Y et al. Feasibility of
fluorodeoxyglucose dual-head gamma camera coincidence imaging in the
evaluation of lung cancer: comparison with FDG PET. J Nucl Med 1999:
40(4): 566-73.
• Weber W. Young C, Abdel-Dayem HM et al. Assessment of pulmonary
lesions with 18F-fluorodeoxyglucose positron imaging using
coincidence mode gamma cameras. J. Nucl Med 1999; 40(4): 574-8
• Delbeke D, Patton JA, Martin WH et al. FDG PET and dual-head gamma
camera positron coincidence detection imaging of suspected
malignancies and brain disorders. J. Nucl Med 1999; 40(1):110-7
• Shreve PD, Steventon RS, Deters EC et al. Oncologic diagnosis with
2-[fluorine-18] fluoro-2-deoxy-D-glucose imaging: dual-head
coincidence gamma camera versus positron emission tomographic
scanner. Radiology 1998; 207(2):431-7
• Zimmy M, Kaiser HJ, Cremerius U et al. Dual-head gamma camera 2[fluorine-18] fluoro-2-deoxy-D-glucose positron emission tomography
in oncological patients: effects of non-uniform attenuation
correction on lesion detection. Eur J Nucl Med 1999; 26(8): 818-23
• Boren EL, Delbeke D, Patton JA et al. Comparison of FDG PET and
positron coincidence detection imaging using a dual-head gamma
camera with 5/8 inch NaI (T1) crystals in patients with suspected
body malignancies. Eur J Nucl Med 1999; 26(4): 379-87
• Weber WA, Neverve J, Sklarek J et al. Imaging of lung cancer with
fluorine-18 fluorodeoxyglucose: comparison of a dual-head gamma
camera in coincidence mode with a full-ring positron emission
tomography system. Eur J Nucl Med 1999; 26(4): 388-95
• Yutani K, Tatsumi M, Shiba E et al. Comparison of dual-head
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company*
Southwest Texas HMO, Inc.* d/b/a HMO Blue Texas
* Independent Licensees of the Blue Cross and Blue Shield Association
FDG USING CAMERA BASED IMAGING (FDG-SPECT)
RAD604.005
POSTED DATE:
6/11/2003
EFFECTIVE DATE: 8/15/2003
_____________________________________________________________________________
coincidence gamma camera FDG imaging with FDG PET in detection of
breast cancer and axillary lymph node metastasis. J Nucl Med 1999;
40(6): 1003-8
• Srinivasan G, Kitsiou AN, Bachrach SL et al. [18F]
fluorodeoxyglucose single photon emission computed tomography: can
it replace PET and thallium SPECT for the assessment of myocardial
viability? Circulation 1998; 97(9): 833-8.
• Udelson JE. Steps forward in the assessment of myocardial viability
in left ventricular dysfunction. Circulation 1998; 97(9):833-8
• Hasegawa S, Uehara T, Yamaguchi H et al. Validity of 18Ffluorodeoxyglucose imaging with a dual-head coincidence gamma camera
for detection of myocardial viability. J Nucl Med 1999;
40(11):1884-92
• Medicare Decision Memorandum: Positron Emission Tomography Scanner
Technology. Available at www.hcfa.gov/coverage/8B3-oo.htm.
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DISCLAIMER:
State and federal law, as well as contract language, including
definitions and specific inclusions/exclusions, takes precedence over
Medical Policy and must be considered first in determining coverage.
The member’s contract benefits in effect on the date that services are
rendered must be used. Any benefits are subject to the payment of
premiums for the date on which services are rendered. Medical
technology is constantly evolving, and we reserve the right to review
and update Medical Policy periodically.
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capitated IPA/medical group must contact the IPA/medical group for
information regarding HMO claims/reimbursement information and other
general polices and procedures.
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company*
Southwest Texas HMO, Inc.* d/b/a HMO Blue Texas
* Independent Licensees of the Blue Cross and Blue Shield Association