The presence of left ventricular hypertrophy (LVH) causes a decrease in the normal lateral-to-septal ratio. In other words, the normal finding of increased counts in the lateral wall compared to the septum (due to distance from the camera) is decreased, lost, or even reversed. Failure to take this into consideration may lead to false positive finding of a fixed defect in the lateral wall.
On a broader level, there is concern that the increased prevalence of LVH due to increased prevalence of obesity and diabetes may lead to a decrease in SPECT specificity.
References
Jaber WA, DiFilippo FP, Cerqueira MD. Left ventricular hypertrophy and SPECT myocardial perfusion imaging: finding the diamonds in the rough. J Nucl Cardiol. 2007 May-Jun;14(3):398-407.
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