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FDG USING CAMERA BASED IMAGING (FDG-SPECT) RAD604.005 POSTED DATE: 6/11/2003 EFFECTIVE DATE: 8/15/2003 _____________________________________________________________________________ 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. ______________________________________________________________________ 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. ______________________________________________________________________ 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. ______________________________________________________________________ PRICING: None ______________________________________________________________________ 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. ______________________________________________________________________ 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. HMO Blue Texas physicians who are contracted/affiliated with a 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