1
|
Le Pennec R, Schaefer W, Tulchinsky M, Lamoureux F, Roach P, Rischpler C, Zukotynski K, O'Brien C, Murphy D, Pascal P, Le Gal G, Salaun PY, Le Roux PY. Performance and Interpretation of Lung Scintigraphy: An Evaluation of Current Practices in Australia, Canada, France, Germany, and United States. Clin Nucl Med 2024:00003072-990000000-01231. [PMID: 39086050 DOI: 10.1097/rlu.0000000000005396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE Although ventilation/perfusion (V/Q) scintigraphy is a widely used imaging test, different options are possible for the acquisition and interpretation of the scan. The aim of this study was to assess current practices regarding the use and interpretation of lung scintigraphy in various clinical indications. PATIENTS AND METHODS An online survey comprising 25 questions was sent to nuclear medicine departments in Australia, Canada, France, Germany, and United States between 2022 and 2023. A single response per department was consolidated. RESULTS Four hundred nineteen responses were collected (Australia: 32, Canada: 58, France: 149, Germany: 92, and United States: 88). For acute pulmonary embolism (PE) diagnosis, 82.8% of centers reported using SPECT acquisitions (Australia: 93.3%, Canada: 91.8%, France: 99.2%, Germany: 96.2%, and United States: 32.1%). Among them, SPECT images were combined with a CT scan in 70.5% of centers. A total of 10.6% of centers reported not using ventilation for acute PE diagnosis. SPECT acquisition was used in 97.8% of centers using 99m Tc carbon particles, 97.1% 81m Kr gas, 58.7% 99m Tc-DTPA, and 19.4% 133 Xe gas, respectively. For V/Q SPECT interpretation, the EANM criteria were used in 65.0% of departments. A very wide variety of practices were observed in pregnant women and in COVID-19 patients. SPECT acquisition was widely used in the follow-up of PE and for the screening of chronic thromboembolic pulmonary hypertension (>90% of centers), with inconsistency regarding the interpretation of matched perfusion defects in this setting. CONCLUSIONS This survey shows the strong adoption of SPECT in the various clinical indications of lung scintigraphy, except in the United States, where planar imaging is still mostly used. The survey also shows variability in interpretation criteria both for PE diagnosis and screening for chronic thromboembolic pulmonary hypertension, highlighting the need for further standardizations of practices.
Collapse
Affiliation(s)
- Romain Le Pennec
- From the Univ Brest, CHU Brest, Médecine Nucléaire, GETBO, UMR1304, Brest, France
| | - Wolfgang Schaefer
- Department of Nuclear Medicine, Maria Hilf Hospital, Mönchengladbach, Germany
| | - Mark Tulchinsky
- Division of Nuclear Medicine, Department of Radiology, Penn State University, Hershey, PA
| | | | - Paul Roach
- Royal North Shore Hospital, Sydney, Australia
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Katherine Zukotynski
- Departments of Radiology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Pierre-Yves Salaun
- From the Univ Brest, CHU Brest, Médecine Nucléaire, GETBO, UMR1304, Brest, France
| | - Pierre-Yves Le Roux
- From the Univ Brest, CHU Brest, Médecine Nucléaire, GETBO, UMR1304, Brest, France
| |
Collapse
|
2
|
Sung C, Han S, Yoon S, Han SA, Kang DY, Kim DH, Park DW, Song JM, Lee JS, Ryu JS, Moon DH. Diagnostic Performance of Perfusion-Only SPECT/CT for Chronic Thromboembolic Pulmonary Hypertension in Comparison With Ventilation-Perfusion Planar, SPECT, and SPECT/CT Imaging. Clin Nucl Med 2024; 49:427-433. [PMID: 38467577 DOI: 10.1097/rlu.0000000000005142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
PURPOSE The aim of this study was to assess the diagnostic performance of perfusion-only SPECT/CT (Q SPECT/CT) in comparison with that of ventilation/perfusion planar scintigraphy (V/Q planar), perfusion SPECT with ventilation scan (V/Q SPECT), and perfusion SPECT/CT with ventilation scan (V/Q SPECT/CT) in chronic thromboembolic pulmonary hypertension (CTEPH). PATIENTS AND METHODS Patients with pulmonary hypertension who underwent ventilation-perfusion planar and SPECT/CT were retrospectively recruited. Two nuclear medicine physicians interpreted V/Q planar, V/Q SPECT, V/Q SPECT/CT, and Q SPECT/CT according to the European Association of Nuclear Medicine criteria. The diagnostic accuracy of these modalities for CTEPH was compared using a composite reference standard of pulmonary angiography, imaging test, cardiorespiratory assessment, and follow-up. RESULTS A total of 192 patients were enrolled, including 85 with CTEPH. The sensitivity of Q SPECT/CT was 98.8%, which similar to that of V/Q planar (97.6%), V/Q SPECT (96.5%), or V/Q SPECT/CT (100.0%). In contrast, Q SPECT/CT exhibited significantly lower specificity (73.8%) compared with V/Q planar (86.9%, P = 0.001), V/Q SPECT (87.9%, P < 0.001), and V/Q SPECT/CT (88.8%, P < 0.001). The significantly lower specificity of Q SPECT/CT, compared with the 3 others, was observed in the subgroup aged ≥50 years ( P < 0.001 for all), but not in those <50 years. CONCLUSIONS Q SPECT/CT exhibited lower specificity compared with V/Q planar, V/Q SPECT, and V/Q SPECT/CT in diagnosing CTEPH. It might underscore the essential role of a ventilation scan in patients with PH, even with the introduction of SPECT/CT.
Collapse
|
3
|
Iftikhar IH, Iftikhar NH, Naeem M, BaHammam A. SPECT Ventilation/Perfusion Imaging for Acute Pulmonary Embolism: Meta-analysis of Diagnostic Test Accuracy. Acad Radiol 2024; 31:706-717. [PMID: 37487880 DOI: 10.1016/j.acra.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/26/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate the diagnostic accuracies of ventilation/perfusion-single photon emission computed tomography (V/Q-SPECT) imaging modalities for acute pulmonary embolism (PE). These included, in addition to V/Q-SPECT, V/Q-SPECT with low-dose computed tomography (CT; V/Q-SPECT-CT), Q-SPECT with low-dose CT (Q-SPECT-CT), and Q-SPECT. MATERIALS AND METHODS PubMed, Embase, CINAHL, and Web of Science databases were searched, and studies included if they studied ≥10 adult participants with acute PE and reported data on the imaging tests' diagnostic performance. Data were meta-analyzed using bivariate random effects regression model. RESULTS Data from participants totaling 4146 from 11 V/Q-SPECT studies, 785 from 7 V/Q-SPECT-CT studies, 1196 from 7 Q-SPECT-CT studies, and 728 from five Q-SPECT studies were separately meta-analyzed. The bivariate weighted mean sensitivity and specificity were 0.94 (95% confidence interval [CI]: 0.88-0.97) and 0.95 (95% CI: 0.87-0.98) for V/Q-SPECT, 0.95 (95% CI: 0.88-0.98) and 0.99 (95% CI: 0.92-1.00) for V/Q-SPECT-CT, 0.92 (95% CI: 0.79-0.97) and 0.92 (95% CI: 0.83-0.96) for Q-SPECT-CT, and 0.89 (95% CI: 0.76-0.95) and 0.86 (95% CI: 0.67-0.95) for Q-SPECT studies. The positive and negative likelihood ratios (+LRs and -LRs) were 17.4 (6.9-44.0) and 0.06 (0.03-0.13), 76.7 (11.8-498.0) and 0.06 (0.02-0.13), 11.0 (5.3-22.9) and 0.09 (0.04-0.23), and 6.4 (2.6-15.8) and 0.13 (0.07-0.27) for V/Q-SPECT, V/Q-SPECT-CT, Q-SPECT-CT, and Q-SPECTs, respectively. CONCLUSION In the diagnosis of acute PE, this meta-analysis showed that V/Q-SPECT-CT had the highest specificity and +LR. Conversely, Q-SPECT showed the lowest specificity and an unfavorably high -LR.
Collapse
Affiliation(s)
- Imran H Iftikhar
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia (I.H.I.); Atlanta Veterans Affairs Medical Center, Atlanta, Georgia (I.H.I.).
| | - Nauman H Iftikhar
- Department of Radiology, Al-Yamamah Hospital, Riyadh, Saudi Arabia (N.H.I.)
| | - Muhammad Naeem
- Division of Cardiovascular and Thoracic Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia (M.N.)
| | - Ahmed BaHammam
- Department of Medicine, University Sleep Disorders Center, and Pulmonary Service, King Saud University, Riyadh, Saudi Arabia (A.B.); Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation, Riyadh, Saudi Arabia (A.B.)
| |
Collapse
|
4
|
Le Roux PY, Le Pennec R, Salaun PY, Zuckier LS. Scintigraphic Diagnosis of Acute Pulmonary Embolism: From Basics to Best Practices. Semin Nucl Med 2023; 53:743-751. [PMID: 37142520 DOI: 10.1053/j.semnuclmed.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
In this article the technique, interpretation, and diagnostic performance of scintigraphy for the diagnosis of acute pulmonary embolism (PE) are reviewed. Lung scintigraphy has stood the test of time as a reliable and validated examination for the determination of PE. Ventilation/perfusion (V/Q) lung scintigraphy assesses the functional consequences of the clot on its downstream vascular bed in conjunction with the underlying ventilatory status of the affected lung region, in contrast to CT pulmonary angiography (CTPA), which visualizes presence of the clot within affected vessels. Most-commonly used ventilation radiopharmaceuticals are Technetium-99m labeled aerosols (such as 99mTechnetium-DTPA), or ultrafine particle suspensions (99mTc-Technegas) which reach the distal lung in proportion to regional distribution of ventilation. Perfusion images are obtained after intravenous administration 99mTc-labeled macro-aggregated albumin particles which lodge in the distal pulmonary capillaries. Both planar and tomographic methods of imaging, each favored in different geographical regions, will be described. Guidelines for interpretation of scintigraphy have been issues by both the Society of Nuclear Medicine and Molecular Imaging, and by the European Association of Nuclear Medicine. Breast tissue is particularly radiosensitive during pregnancy due to its highly proliferative state and many guidelines recommend use of lung scintigraphy rather than CTPA in this population. Several maneuvers are available in order to further reduce radiation exposure including reducing radiopharmaceutical dosages or omitting ventilation altogether, functionally converting the study to a low-dose screening examination; if perfusion defects are present, further testing is necessary. Several groups have also performed perfusion-only studies during the COVID epidemic in order to reduce risk of respiratory contagion. In patients where perfusion defects are present, further testing is again necessary to avoid false-positive results. Improved availability of personal protective equipment, and reduced risk of serious infection, have rendered this maneuver moot in most practices. First introduced 60 years ago, subsequent advances in radiopharmaceutical development and imaging methods have positioned lung scintigraphy to continue to play an important clinical and research role in the diagnosis of acute PE.
Collapse
Affiliation(s)
- Pierre-Yves Le Roux
- Service de Médecine Nucléaire, CHU Brest, INSERM UMR 1304 (GETBO), Université de Bretagne Occidentale, Brest, France
| | - Romain Le Pennec
- Service de Médecine Nucléaire, CHU Brest, INSERM UMR 1304 (GETBO), Université de Bretagne Occidentale, Brest, France
| | - Pierre-Yves Salaun
- Service de Médecine Nucléaire, CHU Brest, INSERM UMR 1304 (GETBO), Université de Bretagne Occidentale, Brest, France
| | - Lionel S Zuckier
- Division of Nuclear Medicine, Department of Radiology, 1695A Eastchester Road, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY.
| |
Collapse
|
5
|
Tan TH, Ismail R. Utility of Lung Perfusion SPECT/CT in Detection of Pulmonary Thromboembolic Disease: Outcome Analysis. Nucl Med Mol Imaging 2023; 57:1-8. [PMID: 35013684 PMCID: PMC8731677 DOI: 10.1007/s13139-021-00726-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose To evaluate the clinical outcome of Q-SPECT/CT in pulmonary thromboembolic disease. Methods From Jan 2020 to Jan 2021, 30 consecutive patients (M:F = 8:22; median age = 52 year (21-89)) suspected of having acute pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension (CTEPH) were referred for non-contrasted Q-SPECT/CT. All patients were COVID-19 PCR negative. MSKCC Q-SPECT/CT and/or PISAPED criteria were used to determine the presence of thromboembolic disease in Q-SPECT/CT. Final diagnosis was made based on composite reference standards that included at least 2-month clinical cardiorespiratory assessment and follow-up imaging. Results Q-SPECT/CT was positive in 19 patients: indeterminate in 1 and 10 were negative. Three false positive cases were observed during follow-up. Of the remaining 16 true positives, all patients' cardiorespiratory symptom were improved or stabilised after treatment with anticoagulants. The overall sensitivity, specificity, PPV, NPV and accuracy of Q-SPECT/CT were 100% (95% CI, 79.41-100%), 78.57% (95% CI, 49.20-95.34%), 84.21% (95% CI, 66.41-93.57%), 100% and 90.00% (95% CI, 73.47-97.89%) respectively. Conclusions In the current COVID-19 pandemic, Q-SPECT/CT can be an alternative modality to detect pulmonary thromboembolic disease. Normal Q-SPECT/CT excludes pulmonary thromboembolic disease with high degree of certainty. However, false positive has been observed.
Collapse
Affiliation(s)
- Teik Hin Tan
- Nuclear Medicine, Sunway Medical Centre, 5, Jalan Lagoon Selatan, Bandar Sunway, 47500 Petaling Jaya, Selangor Malaysia
| | - Rosmadi Ismail
- Internal Medicine, Sunway Medical Centre, 5, Jalan Lagoon Selatan, Bandar Sunway, 47500 Petaling Jaya, Selangor Malaysia
| |
Collapse
|
6
|
Le Roux PY, Schafer WM, Blanc-Beguin F, Tulchinsky M. Ventilation Scintigraphy With Radiolabeled Carbon Nanoparticulate Aerosol (Technegas): State-of-the-Art Review and Diagnostic Applications to Pulmonary Embolism During COVID-19 Pandemic. Clin Nucl Med 2023; 48:8-17. [PMID: 36288606 PMCID: PMC9762616 DOI: 10.1097/rlu.0000000000004426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/01/2022] [Indexed: 12/14/2022]
Abstract
ABSTRACT Invented and first approved for clinical use in Australia 36 years ago, Technegas is the technology that enabled ventilation scintigraphy with 99m Tc-labeled carbon nanoparticles ( 99m Tc-CNP). The US Food and Drug Administration (FDA) has considered this technology for more than 30 years but only now is getting close to approving it. Meanwhile, more than 4.4 million patients benefited from this technology in 64 countries worldwide. The primary application of 99m Tc-CNP ventilation imaging is the diagnostic evaluation for suspicion of pulmonary embolism using ventilation-perfusion quotient (V/Q) imaging. Because of 99m Tc-CNP's long pulmonary residence, tomographic imaging emerged as the preferred V/Q methodology. The FDA-approved ventilation imaging agents are primarily suitable for planar imaging, which is less sensitive. After the FDA approval of Technegas, the US practice will likely shift to tomographic V/Q. The 99m Tc-CNP use is of particular interest in the COVID-19 pandemic because it offers an option of a dry radioaerosol that takes approximately only 3 to 5 tidal breaths, allowing the shortest exposure to and contact with possibly infected patients. Indeed, countries where 99m Tc-CNP was approved for clinical use continued using it throughout the COVID-19 pandemic without known negative viral transmission consequences. Conversely, the ventilation imaging was halted in most US facilities from the beginning of the pandemic. This review is intended to familiarize the US clinical nuclear medicine community with the basic science of 99m Tc-CNP ventilation imaging and its clinical applications, including common artifacts and interpretation criteria for tomographic V/Q imaging for pulmonary embolism.
Collapse
Affiliation(s)
- Pierre-Yves Le Roux
- From the INSERM (National Institute of Health and Medical Research) and Department of Nuclear Medicine, University Hospital of Brest, CHRU Brest, UMR 1304, GETBO, Brest, France
| | - Wolfgang M. Schafer
- Nuclear Medicine Clinic, Maria Hilf Hospital Inc, Academic Teaching Hospital of RWTH Aachen University, Moenchengladbach, Germany
| | - Frédérique Blanc-Beguin
- From the INSERM (National Institute of Health and Medical Research) and Department of Nuclear Medicine, University Hospital of Brest, CHRU Brest, UMR 1304, GETBO, Brest, France
| | - Mark Tulchinsky
- Section of Nuclear Medicine, Department of Radiology, Penn State University Hospital, Hershey, PA
| |
Collapse
|
7
|
Albricker ACL, Freire CMV, Santos SND, Alcantara MLD, Saleh MH, Cantisano AL, Teodoro JAR, Porto CLL, Amaral SID, Veloso OCG, Petisco ACGP, Barros FS, Barros MVLD, Souza AJD, Sobreira ML, Miranda RBD, Moraes DD, Verrastro CGY, Mançano AD, Lima RDSL, Muglia VF, Matushita CS, Lopes RW, Coutinho AMN, Pianta DB, Santos AASMDD, Naves BDL, Vieira MLC, Rochitte CE. Diretriz Conjunta sobre Tromboembolismo Venoso – 2022. Arq Bras Cardiol 2022; 118:797-857. [PMID: 35508060 PMCID: PMC9007000 DOI: 10.36660/abc.20220213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
8
|
Suh M. In the COVID-19 Era, Is It OK to Perform a Perfusion-Only SPECT/CT for the Diagnosis of Pulmonary Embolism? Nucl Med Mol Imaging 2022; 56:67-70. [PMID: 35261689 PMCID: PMC8890985 DOI: 10.1007/s13139-022-00740-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Minseok Suh
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 03080 Republic of Korea
| |
Collapse
|
9
|
Abstract
One of the major effects of the COVID-19 pandemic within nuclear medicine was to halt performance of lung ventilation studies, due to concern regarding spread of contaminated secretions into the ambient air. A number of variant protocols for performing lung scintigraphy emerged in the medical literature which minimized or eliminated the ventilation component, due to the persistent need to provide this critical diagnostic service without compromising the safety of staff and patients. We have summarized and reviewed these protocols, many of which are based on concepts developed earlier in the history of lung scintigraphy. It is possible that some of these interim remedies may gain traction and earn a more permanent place in the ongoing practice of nuclear medicine.
Collapse
Affiliation(s)
- Lionel S. Zuckier
- Address reprint requests to Lionel S. Zuckier, Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Bronx, NY 10467
| |
Collapse
|
10
|
Le Roux PY, Bonnefoy PB, Bahloul A, Denizot B, Barres B, Moreau-Triby C, Girma A, Pallardy A, Ceyrat Q, Sarda-Mantel L, Razzouk-Cadet M, Zsigmond R, Florent C, Karcher G, Salaun PY. Lung scintigraphy for pulmonary embolism diagnosis in COVID-19 patients: a multicenter study. J Nucl Med 2021; 63:1070-1074. [PMID: 34649944 PMCID: PMC9258571 DOI: 10.2967/jnumed.121.262955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
In patients with novel coronavirus disease 2019 (COVID-19) referred for lung scintigraphy for suspected pulmonary embolism (PE), there has been an ongoing debate within the nuclear medicine community as to whether and when the ventilation study should be performed. Indeed, while PE diagnosis typically relies on the recognition of ventilation/perfusion (V/P) mismatched defects, the ventilation procedure potentially increases the risk of contamination to the healthcare workers. The primary aim of this study was to assess the role of ventilation imaging when performing lung scintigraphy for suspected PE in COVID-19 patients. The secondary aim was to describe practices and imaging findings in this specific population. Methods: A national registry was created in collaboration with the French Society of Nuclear Medicine to collect lung scans performed in COVID-19 patients for suspected PE. Practices of departments were assessed regarding imaging protocols and aerosol precautions. A retrospective review of V/P SPECT/CT scans was then conducted. Two physicians blinded to clinical information reviewed each case by sequentially using P SPECT, P SPECT/CT and V/P SPECT/CT images. Scans were classified in one of the four following categories: patients for whom PE could reasonably be excluded based on 1) perfusion SPECT only, 2) P SPECT/CT, 3) V/P SPECT/CT; or 4) patients with mismatched defects suggestive of PE according to the EANM criteria. Results: Data from 12 French nuclear medicine departments were collected. Lung scans were performed between 03/2020 and 04/2021. Personal protective equipment and dedicated cleaning procedures were used in all departments. Out of the 145 V/Q SPECT/CT included in the central review, PE could be excluded using only P SPECT, P SPECT/CT and V/P SPECT/CT in 27 (19%), 55 (38%) and 45 (31%) patients, respectively. V/P SPECT/CT was positive for PE in 18 (12%) patients, including 12 (67%) with a low burden of PE (≤10%). Conclusion: In this population of COVID-19 patients assessed with lung scintigraphy, PE could be confidently excluded without ventilation in only 57% of patients. Ventilation imaging was required to confidently rule out PE in 31% of patients. Overall, the prevalence of PE was low (12%).
Collapse
Affiliation(s)
| | | | | | - Benoit Denizot
- Centre Hospitalier Alpes Léman, Service de Médecine Nucléaire
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Bourhis D, Wagner L, Rioult J, Robin P, Le Pennec R, Tromeur C, Salaün PY, Le Roux PY. Automatic delineation and quantification of pulmonary vascular obstruction index in patients with pulmonary embolism using Perfusion SPECT-CT: a simulation study. EJNMMI Phys 2021; 8:49. [PMID: 34224005 PMCID: PMC8257882 DOI: 10.1186/s40658-021-00396-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background In patients with pulmonary embolism (PE), there is a growing interest in quantifying the pulmonary vascular obtruction index (PVOI), which may be an independent risk factor for PE recurrence. Perfusion SPECT/CT is a very attractive tool to provide an accurate quantification of the PVOI. However, there is currently no reliable method to automatically delineate and quantify it. The aim of this phantom study was to assess and compare 3 segmentation methods for PVOI quantification with perfusion SPECT/CT imaging. Methods Three hundred ninety-six SPECT/CT scans, with various PE scenarios (n = 44), anterior to posterior perfusion gradients (n = 3), and lung volumes (n = 3) were simulated using Simind software. Three segmentation methods were assesssed: (1) using an intensity threshold expressed as a percentage of the maximal voxel value (MaxTh), (2) using a Z-score threshold (ZTh) after building a Z-score parametric lung map, and (3) using a relative difference threshold (RelDiffTh) after building a relative difference parametric map. Ninety randomly selected simulations were used to define the optimal threshold, and 306 simulations were used for the complete analysis. Spacial correlation between PE volumes from the phantom data and the delineated PE volumes was assessed by computing DICEPE indices. Bland-Altman statistics were used to calculate agreement for PVOI between the phantom data and the segmentation methods. Results Mean DICEPE index was higher with the RelDiffTh method (0.85 ± 0.08), as compared with the MaxTh method (0.78 ± 0.16) and the ZTh method (0.67 ± 0.15). Using the RelDiffTh method, mean DICEPE index remained high (> 0.81) regardless of the perfusion gradient and the lung volumes. Using the RelDiffTh method, mean relative difference in PVOI was − 12%, and the limits of agreement were − 40% to 16%. Values were 3% (− 75% to 81%) for MaxTh method and 0% (− 120% to 120%) for ZTh method. Graphycal analysis of the Bland-Altman graph for the RelDiffTh method showed very close estimation of the PVOI for small and medium PE, and a trend toward an underestimation of large PE. Conclusion In this phantom study, a delineation method based on a relative difference parametric map provided a good estimation of the PVOI, regardless of the extent of PE, the intensity of the anterior to posterior gradient, and the whole lung volumes. Supplementary Information The online version contains supplementary material available at 10.1186/s40658-021-00396-1.
Collapse
Affiliation(s)
- David Bourhis
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France. .,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France.
| | - Laura Wagner
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Julien Rioult
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Philippe Robin
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
| | - Romain Le Pennec
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
| | - Cécile Tromeur
- EA3878 GETBO, Université de Bretagne Occidentale, Brest, France.,Service de Pneumologie, Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Pierre Yves Salaün
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
| | - Pierre Yves Le Roux
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
| |
Collapse
|
12
|
Mahaletchumy T, Muhamad M, Mohammad Kazmin NE, Kori N, Periyasamy P. Pulmonary Embolism in an Asymptomatic COVID-19 Patient Detected on Ventilation/Perfusion SPECT/CT. Clin Nucl Med 2021; 46:e360-e362. [PMID: 33443945 DOI: 10.1097/rlu.0000000000003513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABSTRACT Severe COVID-19 infection is associated with significant coagulopathy. We would like share a case of an asymptomatic 26-year-old man who tested positive for COVID-19 and had elevated d-dimer levels. Because of inconclusive CTPA findings, V/Q (ventilation/perfusion) SPECT/CT was performed, which confirmed the presence of pulmonary embolism. This case highlights the fact that pulmonary embolism should not be overlooked in a COVID-19 patient who has raised d-dimer levels, even in the absence of symptoms. It also highlights the importance of performing a V/Q study when CTPA results are inconclusive or when there are contraindications for iodinated contrast media.
Collapse
Affiliation(s)
| | | | | | - Najma Kori
- Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras
| | | |
Collapse
|
13
|
Le Pennec R, Iravani A, Woon B, Dissaux B, Gest B, Le Floch PY, Salaün PY, Le Gal G, Hofman MS, Hicks RJ, Le Roux PY. Gallium-68 Ventilation/Perfusion PET-CT and CT Pulmonary Angiography for Pulmonary Embolism Diagnosis: An Interobserver Agreement Study. Front Med (Lausanne) 2021; 7:599901. [PMID: 33665194 PMCID: PMC7921798 DOI: 10.3389/fmed.2020.599901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives:68Ga Ventilation/Perfusion V/Q PET-CT is a promising imaging tool for pulmonary embolism diagnosis. However, no study has verified whether the interpretation is reproducible between different observers. The aim of this study was to assess the interobserver agreement in the interpretation of V/Q PET-CT for the diagnosis of acute PE, and to compare it to the interobserver agreement of CTPA interpretation. Methods: Twenty-four cancer patients with suspected acute PE underwent V/Q PET-CT and CTPA within 24 h as part of a prospective pilot study evaluating V/Q PET-CT for the management of patients with suspected PE. V/Q PET-CT and CTPA scans were reassessed independently by four nuclear medicine physicians and four radiologists, respectively. Physicians had different levels of expertise in reading V/Q scintigraphy and CTPA. Interpretation was blinded to the initial interpretation and any clinical information or imaging test result. For each modality, results were reported on a binary fashion. V/Q PET/CT scans were read as positive if there was at least one segmental or two subsegmental mismatched perfusion defects. CTPA scans were interpreted as positive if there was a constant intraluminal filling defect. Interobserver agreement was assessed by calculating kappa (κ) coefficients. Results: Out of the 24 V/Q PET-CT scans, the diagnostic conclusion was concordantly negative in 22 patients and concordantly positive in one patient. The remaining scan was interpreted as positive by one reader and negative by three readers. Out of the 24 CTPA scans, the diagnostic conclusion was concordantly negative in 16 and concordantly positive in one. Out of the seven remaining scans, PE was reported by one reader in four cases, by two readers in two cases, by three readers in one case. Most of discordant results on CTPA were related to clots reported on subsegmental arteries. Mean kappa coefficient was 0.79 for V/Q PET-CT interpretation and 0.39 for CTPA interpretation. Conclusions: Interobserver agreement in the interpretation of V/Q PET-CT for PE diagnosis was substantial (kappa 0.79) in a population with a low prevalence of significant PE. Agreement was lower with CTPA, mainly as a result of discrepancies at the level of the subsegmental arteries.
Collapse
Affiliation(s)
- Romain Le Pennec
- Nuclear Medicine, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France
| | - Amir Iravani
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Beverley Woon
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Brieg Dissaux
- Radiology, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France
| | - Bibiche Gest
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Pierre-Yves Salaün
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Rodney J Hicks
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Pierre-Yves Le Roux
- Nuclear Medicine, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France.,Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| |
Collapse
|
14
|
Kannan S, Rose DS, Lee JC, Yeung FYF. An audit of ventilation and perfusion SPECT reporting for the diagnosis of pulmonary embolism in a tertiary cardiothoracic centre. Intern Med J 2020; 50:1419-1422. [PMID: 33215825 DOI: 10.1111/imj.15065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/05/2020] [Accepted: 07/19/2020] [Indexed: 01/03/2023]
Abstract
The aim of the study was to identify reporting patterns of ventilation and perfusion single-photon emission computed tomography (V/Q SPECT) scans done in our department over 3 months in 2016. Factors impacting on reporting and patient groups that would most benefit from the addition of low-dose computed tomography (CT) to V/Q SPECT were analysed. Among 178 patients, 173 (97.2%) had a definitive (positive/negative) report and 2.8% had an equivocal report. As the majority of the equivocal reports were seen in patients aged ≥70 years, we believe that addition of low-dose CT with V/Q SPECT to this patient group will reduce the non-diagnostic rate.
Collapse
Affiliation(s)
- Shanthi Kannan
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - David S Rose
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Joseph C Lee
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Francis Y F Yeung
- Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
15
|
Le Roux PY, Le Gal G, Salaun PY. Lung scintigraphy for pulmonary embolism diagnosis during the COVID-19 pandemic: does the benefit-risk ratio really justify omitting the ventilation study? Eur J Nucl Med Mol Imaging 2020; 47:2499-2500. [PMID: 32700057 PMCID: PMC7375202 DOI: 10.1007/s00259-020-04964-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Pierre-Yves Le Roux
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, CHRU Morvan, Médecine nucléaire, 2 avenue Foch, 29609, Brest Cedex, France.
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Pierre-Yves Salaun
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, CHRU Morvan, Médecine nucléaire, 2 avenue Foch, 29609, Brest Cedex, France
| |
Collapse
|
16
|
Bajc M, Schümichen C, Grüning T, Lindqvist A, Le Roux PY, Alatri A, Bauer RW, Dilic M, Neilly B, Verberne HJ, Delgado Bolton RC, Jonson B. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging 2019; 46:2429-2451. [PMID: 31410539 PMCID: PMC6813289 DOI: 10.1007/s00259-019-04450-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 12/18/2022]
Abstract
These guidelines update the previous EANM 2009 guidelines on the diagnosis of pulmonary embolism (PE). Relevant new aspects are related to (a) quantification of PE and other ventilation/perfusion defects; (b) follow-up of patients with PE; (c) chronic PE; and (d) description of additional pulmonary physiological changes leading to diagnoses of left ventricular heart failure (HF), chronic obstructive pulmonary disease (COPD) and pneumonia. The diagnosis of PE should be reported when a mismatch of one segment or two subsegments is found. For ventilation, Technegas or krypton gas is preferred over diethylene triamine pentaacetic acid (DTPA) in patients with COPD. Tomographic imaging with V/PSPECT has higher sensitivity and specificity for PE compared with planar imaging. Absence of contraindications makes V/PSPECT an essential method for the diagnosis of PE. When V/PSPECT is combined with a low-dose CT, the specificity of the test can be further improved, especially in patients with other lung diseases. Pitfalls in V/PSPECT interpretation are discussed. In conclusion, V/PSPECT is strongly recommended as it accurately establishes the diagnosis of PE even in the presence of diseases like COPD, HF and pneumonia and has no contraindications.
Collapse
Affiliation(s)
- Marika Bajc
- Department of Clinical Sciences, Clinical Physiology and Nuclear Medicine, University of Lund, Lund, Sweden.
| | - Carl Schümichen
- University of Rostock, Formerly Clinic for Nuclear Medicine, Rostock, Germany
| | - Thomas Grüning
- Department of Nuclear Medicine, University Hospitals Plymouth, Plymouth, UK
| | - Ari Lindqvist
- Research Unit of Pulmonary Diseases, Clinical Research Institute, HUS Helsinki University Hospital, Helsinki, Finland
| | | | - Adriano Alatri
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Ralf W Bauer
- RNS Gemeinschaftspraxis, Wiesbaden, Germany
- Department of Diagnostic and Interventional Radiology, Goethe University Frankfurt (Main), Frankfurt, Germany
| | - Mirza Dilic
- Clinic of Heart and Blood Vessel Disease, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Brian Neilly
- Department of Nuclear Medicine, Royal Infirmary, Glasgow, UK
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Bjorn Jonson
- Department of Clinical Sciences, Clinical Physiology and Nuclear Medicine, University of Lund, Lund, Sweden
| |
Collapse
|
17
|
Le Roux PY, Iravani A, Callahan J, Burbury K, Eu P, Steinfort DP, Lau E, Woon B, Salaun PY, Hicks RJ, Hofman MS. Independent and incremental value of ventilation/perfusion PET/CT and CT pulmonary angiography for pulmonary embolism diagnosis: results of the PECAN pilot study. Eur J Nucl Med Mol Imaging 2019; 46:1596-1604. [PMID: 31044265 DOI: 10.1007/s00259-019-04338-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/15/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE This pilot study assessed the independent and incremental value of 68Ga-V/Q PET/CT as compared with CT pulmonary angiography (CTPA) for the management of cancer patients with suspected acute pulmonary embolism (PE). METHODS All 24 cancer patients with suspected acute PE prospectively recruited underwent both 68Ga-V/Q PET/CT and CTPA within 24 h. PET/CT was acquired after inhalation of Galligas prepared using a Technegas generator and administration of 68Ga-macroaggregated albumin. Initially, PET/CT and CTPA scans were read independently with the reader blinded to the results of the other imaging study. CTPA and PET/CT were then coregistered and reviewed by consensus between a radiologist and nuclear medicine physician. The therapeutic management was established by the managing physician based on all available data. RESULTS The diagnostic conclusion was concordantly negative in 18 patients (75%). Of the six discordant diagnoses on independent reading, combined interpretation of V/Q PET/CTPA enabled a consensus conclusion in two patients, excluding PE in one and confirming PE in the other, similar to the initial diagnostic conclusion of the V/Q PET/CT. Of the remaining four patients, three had a single subsegmental thrombus on CTPA but a negative V/Q PET/CT scan, and two of these did not receive long-term anticoagulation and did not have a venous thromboembolic event during a 3-year follow-up period. The third patient, along with a patient with a positive V/Q PET/CT scan but a negative CTPA scan, presented with acute complications preventing any conclusions with regard to the appropriateness of the V/Q PET/CT results in the management of PE. Overall, V/Q PET had an impact on management in four patients (17%). CONCLUSION In this pilot study, we demonstrated the feasibility and potential utility of V/Q PET/CT for the management of patients with suspected PE. V/Q PET/CT may be of particular relevance in patients with equivocal findings or isolated subsegmental findings on CTPA, adding further discriminatory information to allow important decision-making regarding the use or withholding of anticoagulation. Given the other advantages of V/Q PET/CT (reduced acquisition time, low radiation dose), and with the increasing availability of 68Ga generators, PET/CT is a potential replacement for V/Q SPECT/CT imaging.
Collapse
Affiliation(s)
- Pierre-Yves Le Roux
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Nuclear Medicine, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France.
| | - Amir Iravani
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jason Callahan
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kate Burbury
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Peter Eu
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Daniel P Steinfort
- Respiratory Medicine, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Eddie Lau
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Beverly Woon
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Pierre-Yves Salaun
- Nuclear Medicine, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France
| | - Rodney J Hicks
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael S Hofman
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| |
Collapse
|
18
|
Time trend analysis of pulmonary embolism diagnosis with single-photon emission computed tomography ventilation/perfusion imaging. Nucl Med Commun 2019; 40:576-582. [PMID: 30741839 DOI: 10.1097/mnm.0000000000000990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Following the implementation of single-photon emission computed tomography ventilation/perfusion (SPECT V/Q) in our department, we previously carried out an observational study over the period 2011-2013 that showed the safety of SPECT V/Q to rule out pulmonary embolism (PE). However, PE prevalence (28%) was high compared with some studies. Our hypothesis was that the use of SPECT V/Q may be responsible for an overdiagnosis of PE, especially at the implementation phase of the test. The aim was to carry out a time trend analysis of the evolution over the years of PE diagnosis with SPECT V/Q. PATIENTS AND METHODS To evaluate the time trend of SPECT V/Q results, the conclusions of all SPECT V/Q scans performed for a suspected acute PE in our department from April 2011 to December 2016 were collected. To confirm the safety of a diagnostic management on the basis of SPECT V/Q to rule out PE, a retrospective observational study of the outcome of patients assessed with SPECT V/Q for suspected acute PE was carried out during the period 2014-2016. SPECT V/Q was interpreted using a diagnostic cutoff of one segmental or two subsegmental mismatches. The final diagnostic conclusion was established by the physician responsible for patient care. The safety of SPECT V/Q was assessed by monitoring the risk of thromboembolic events during the 3-month follow-up period in patients left untreated on the basis of a negative SPECT V/Q. RESULTS Over the period 2011-2016, an average 16% (95% confidence interval: 10-22%) annual reduction in the proportion of positive SPECT V/Q results was observed. The percentage of positive SPECT V/Q results was 25.3% over the period 2011-2013 compared with 16.3% in 2014-2016 (P<0.0001). Out of the 696 patients analyzed over the period 2014-2016, the SPECT V/Q was positive, indeterminate, and negative in 118, 3, and 575 patients, respectively. The 3-month thromboembolic risk in patients in whom PE was deemed absent according to the SPECT V/Q was 3/543=0.55% (95% confidence interval 0.19-1.61). CONCLUSION A continuous decrease in the annual proportion of positive SPECT V/Q results was mainly observed while maintaining the safety of the test to rule out PE. Explanatory factors include the introduction of a combined SPECT/CT scan, increased experience and familiarity with the test, and an increased awareness of the risks and consequences of overdiagnosing PE.
Collapse
|
19
|
Le Roux PY, Hicks RJ, Siva S, Hofman MS. PET/CT Lung Ventilation and Perfusion Scanning using Galligas and Gallium-68-MAA. Semin Nucl Med 2019; 49:71-81. [DOI: 10.1053/j.semnuclmed.2018.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
20
|
Robin P, Delcroix O, Abgral R, Le Roux PY, Salaun PY. An aortic intra mural hematoma in ventilation/perfusion SPECT/CT: A case report. Medicine (Baltimore) 2018; 97:e12928. [PMID: 30412098 PMCID: PMC6221740 DOI: 10.1097/md.0000000000012928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ventilation/perfusion (V/Q) single-photon-emission computed tomography (SPECT) has arisen as an alternative to computed tomography pulmonary angiography (CTPA) in patients with pulmonary embolism (PE) suspicion. The addition of low dose CT (ldCT) to V/Q SPECT improves the specificity of the test, allowing for potential alternative diagnosis. PATIENT CONCERNS AND DIAGNOSIS Here we presented a case of an aortic intramural hematoma (IMH) diagnosed on the ldCT portion of V/Q SPECT combined with CT. A 74-year-old man suffering from sudden-onset chest pain was referred to our nuclear medicine department for PE suspicion. INTERVENTION AND OUTCOME A V/Q SPECT combined with nonenhanced ldCT ruled out PE diagnosis. Nevertheless, ldCT revealed high attenuation aortic wall thickening suggestive of aortic IMH. Chest CT angiography showed mild dilatation and circumferential thickening of aortic wall confirming Stanford type A IMH involving the entire ascending aorta. LESSON This case illustrates the potential usefulness of combining ldCT to V/Q SPECT in providing alternative diagnosis in suspected PE patients.
Collapse
|
21
|
State-of-the-Art Imaging for the Evaluation of Pulmonary Embolism. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:71. [DOI: 10.1007/s11936-018-0671-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
22
|
Toney LK, Kim RD, Palli SR. The Economic Value of Hybrid Single-photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis. Acad Emerg Med 2017. [PMID: 28650562 PMCID: PMC5601189 DOI: 10.1111/acem.13247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective The objective was to quantify the potential economic value of single‐photon emission computed tomography (SPECT) with computed tomography (CT; SPECT/CT) versus CT pulmonary angiography (CTPA), ventilation–perfusion (V/Q) planar scintigraphy, and V/Q SPECT imaging modalities for diagnosing suspected pulmonary embolism (PE) patients in an emergency setting. Methods An Excel‐based simulation model was developed to compare SPECT/CT versus the alternate scanning technologies from a payer's perspective. Clinical endpoints (diagnosis, treatment, complications, and mortality) and their corresponding cost data (2016 USD) were obtained by performing a best evidence review of the published literature. Studies were pooled and parameters were weighted by sample size. Outcomes measured included differences in 1) excess costs, 2) total costs, and 3) lives lost per annum between SPECT/CT and the other imaging modalities. One‐way (±25%) sensitivity and three scenario analyses were performed to gauge the robustness of the results. Results For every 1,000 suspected PE patients undergoing imaging, expected annual economic burden by modality was found to be 3.2 million (SPECT/CT), 3.8 million (CTPA), 5.8 million (planar), and 3.6 million (SPECT) USD, with a switch to SPECT/CT technology yielding per‐patient‐per‐month cost savings of $51.80 (vs. CTPA), $213.80 (vs. planar), and $36.30 (vs. SPECT), respectively. The model calculated that the incremental number of lives saved with SPECT/CT was six (vs. CTPA) and three (vs. planar). Utilizing SPECT/CT as the initial imaging modality for workup of acute PE was also expected to save $994,777 (vs. CTPA), $2,852,014 (vs. planar), and $435,038 (vs. SPECT) in “potentially avoidable”’ excess costs per annum for a payer or health plan. Conclusion Compared to the currently available scanning technologies for diagnosing suspected PE, SPECT/CT appears to confer superior economic value, primarily via improved sensitivity and specificity and low nondiagnostic rates. In turn, the improved diagnostic accuracy accords this modality the lowest ratio of expenses attributable to potentially avoidable complications, misdiagnosis, and underdiagnosis.
Collapse
Affiliation(s)
- Lauren K. Toney
- Division of Nuclear Medicine; Valley Medical Center; Renton WA
- Division of Nuclear Medicine; University of Washington Medical Center; Seattle WA
| | - Richard D. Kim
- Southlake Clinic; University of Washington Medical Center; Seattle WA
| | - Swetha R. Palli
- Health Outcomes Research; CTI Clinical Trial and Consulting, Inc.; Covington KY
| |
Collapse
|
23
|
Le Roux PY, Robin P, Salaun PY. New developments and future challenges of nuclear medicine and molecular imaging for pulmonary embolism. Thromb Res 2017; 163:236-241. [PMID: 28673474 DOI: 10.1016/j.thromres.2017.06.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/20/2017] [Accepted: 06/25/2017] [Indexed: 11/29/2022]
Abstract
Although widely validated, current tests for pulmonary embolism (PE) diagnosis, i.e. computed tomography pulmonary angiography (CTPA) and V/Q planar scintigraphy, have some limitations. Drawbacks of CTPA include the radiation dose, some contra indications and a rising concern about a possible overdiagnosis/overtreatment of PE. On the other hand, V/Q planar scintigraphy has a high rate of non-diagnostic tests responsible for complex diagnostic algorithms. Since the PIOPED study, imaging equipment and radiopharmaceuticals have greatly evolved allowing the introduction of techniques that improve imaging of lung ventilation and perfusion. Single photon emission computed tomography (SPECT) and SPECT/CT techniques are already largely used in daily practice and have been described to have greater diagnostic performance and much fewer non-diagnostic tests as compared with planar scintigraphy. However, they have not yet been firmly validated in large scale prospective outcome studies. More recently, it has also been proposed to image pulmonary perfusion and ventilation using positron emission tomography (PET), which has an inherent technical superiority as compared to conventional scintigraphy and may provide new insight for pulmonary embolism. Regardless of modality, these new thoracic imaging modalities have to be integrated into diagnostic strategies. The other major challenge for venous thromboembolism diagnosis may be the potential additional value of molecular imaging allowing specific targeting of thrombi in order, for example, to differentiate venous thromboembolism from tumor or septic thrombus, or acute from residual disease. In this article, the new imaging procedures of lung ventilation perfusion imaging with SPECT, SPECT/CT and PET/CT are discussed. We also review the current status and future challenge of molecular imaging for the in vivo characterization of venous thromboembolism.
Collapse
Affiliation(s)
- Pierre-Yves Le Roux
- Université Européenne de Bretagne, Université de Brest, EA3878 (GETBO) IFR 148, CHRU de Brest, Service de Médecine Nucléaire, Brest, France.
| | - Philippe Robin
- Université Européenne de Bretagne, Université de Brest, EA3878 (GETBO) IFR 148, CHRU de Brest, Service de Médecine Nucléaire, Brest, France
| | - Pierre-Yves Salaun
- Université Européenne de Bretagne, Université de Brest, EA3878 (GETBO) IFR 148, CHRU de Brest, Service de Médecine Nucléaire, Brest, France
| |
Collapse
|
24
|
Robert-Ebadi H, Le Gal G, Righini M. Evolving imaging techniques in diagnostic strategies of pulmonary embolism. Expert Rev Cardiovasc Ther 2016; 14:495-503. [DOI: 10.1586/14779072.2016.1134316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|