1
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Bang JI, Lee WW, Cho SG, Choi M, Song YS. The Diagnostic Accuracy of SPECT Imaging in Patients With Suspected Pulmonary Embolism: Systematic Review and Network Meta-analysis. Clin Nucl Med 2024; 49:637-643. [PMID: 38831512 DOI: 10.1097/rlu.0000000000005167] [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: 06/05/2024]
Abstract
BACKGROUND This meta-analysis and systematic review assessed the diagnostic accuracy of lung SPECT compared with lung planar imaging in patients with suspected acute pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension. PATIENTS AND METHODS A search of Medline, Embase, and Cochrane databases identified suitable articles published before October 2023. Meta-analyses were performed to determine the diagnostic accuracy of SPECT imaging modalities, including perfusion (Q) SPECT, ventilation (V)/Q SPECT, Q SPECT/CT, and V/Q SPECT/CT. Network meta-analyses were performed to compare the diagnostic accuracy of SPECT and planar imaging in paired-design studies. RESULTS Twenty-four articles (total n = 6576) were included in the analysis. For suspected acute PE, the respective sensitivity and specificity of SPECT imaging modalities were as follows: Q SPECT, 0.93 (95% confidence interval [CI], 0.87-0.99; I2 = 49%) and 0.72 (95% CI, 0.54-0.95; I2 = 94%); V/Q SPECT, 0.96 (95% CI, 0.94-0.98; I2 = 51%) and 0.95 (95% CI, 0.92-0.98; I2 = 80%); Q SPECT/CT, 0.93 (95% CI, 0.87-0.98; I2 = 66%) and 0.82 (95% CI, 0.70-0.96; I2 = 87%); and V/Q SPECT/CT, 0.97 (95% CI, 0.93-1.00; I2 = 7%) and 0.98 (95% CI, 0.97-1.00; I2 = 31%). The relative sensitivity and specificity of SPECT compared with planar imaging were 1.17 (95% CI, 1.06-1.30; P < 0.001) and 1.14 (95% CI, 1.00-1.29; P = 0.05), respectively. For suspected chronic thromboembolic pulmonary hypertension, the pooled sensitivity and specificity of SPECT imaging were 0.97 (95% CI, 0.95-1.00; I2 = 0%) and 0.91 (95% CI, 0.87-0.94; I2 = 0%), respectively. CONCLUSIONS SPECT exhibited superior diagnostic performance for PE. V/Q SPECT/CT was the most accurate modality.
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Affiliation(s)
- Ji-In Bang
- From the Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Pocheon
| | | | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
| | - Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
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2
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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.
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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
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3
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Cafferkey J, Serebriakoff P, de Wit K, Horner DE, Reed MJ. Pulmonary embolism diagnosis: clinical assessment at the front door. J Accid Emerg Med 2022; 39:945-951. [PMID: 35868848 DOI: 10.1136/emermed-2021-212000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 07/09/2022] [Indexed: 11/03/2022]
Abstract
This first of two practice reviews addresses pulmonary embolism (PE) diagnosis considering important aspects of PE clinical presentation and comparing evidence-based PE testing strategies. A companion paper addresses the management of PE. Symptoms and signs of PE are varied, and emergency physicians frequently use testing to 'rule out' the diagnosis in people with respiratory or cardiovascular symptoms. The emergency clinician must balance the benefit of reassuring negative PE testing with the risks of iatrogenic harms from over investigation and overdiagnosis.
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Affiliation(s)
- John Cafferkey
- Emergency Medicine Research Group Edinburgh (EMERGE), NHS Lothian, Edinburgh, UK
| | | | - Kerstin de Wit
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Medicine, McMaster University, Ontario, Canada
| | - Daniel E Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Matthew James Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), NHS Lothian, Edinburgh, UK .,Acute Care Group, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
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4
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Perfusion Lung Scans During the Pandemic: COVID-19 Experience in a Large Trauma Hospital. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [PMCID: PMC9130684 DOI: 10.1016/j.jrras.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose Material and methods Results Conclusion
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5
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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
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6
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Schiebler ML, Fain S, van Beek E. Vascular imaging of the lung: perspectives on current imaging methods. Br J Radiol 2022; 95:20200759. [PMID: 32795175 PMCID: PMC9153715 DOI: 10.1259/bjr.20200759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This commentary will discuss the use of advanced non-invasive imaging methodology for the pulmonary vascular system with special attention to a rubric for the imaging and clinical team to use for any particular clinical situation.
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Affiliation(s)
- Mark L. Schiebler
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sean Fain
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Edwin van Beek
- SINAPSE Chair of Clinical Radiology, Director Edinburgh Imaging facility QMRI, Honorary Consultant Radiologist, NHS Lothian Health Board, CO.19 Edinburgh Imaging, Queen’s Medical Research Institute, Edinburgh Bioquarter, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
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7
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Bajc M, Lindqvist A. Pulmonary Embolism: Ventilation/Perfusion Scintigraphy as a Proper Tool in Diagnosing Pulmonary Embolism and Frequent Pulmonary Comorbidities. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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8
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Delcroix M, Torbicki A, Gopalan D, Sitbon O, Klok FA, Lang I, Jenkins D, Kim NH, Humbert M, Jais X, Vonk Noordegraaf A, Pepke-Zaba J, Brénot P, Dorfmuller P, Fadel E, Ghofrani HA, Hoeper MM, Jansa P, Madani M, Matsubara H, Ogo T, Grünig E, D'Armini A, Galie N, Meyer B, Corkery P, Meszaros G, Mayer E, Simonneau G. ERS statement on chronic thromboembolic pulmonary hypertension. Eur Respir J 2021; 57:13993003.02828-2020. [PMID: 33334946 DOI: 10.1183/13993003.02828-2020] [Citation(s) in RCA: 269] [Impact Index Per Article: 89.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/05/2020] [Indexed: 12/25/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism, either symptomatic or not. The occlusion of proximal pulmonary arteries by fibrotic intravascular material, in combination with a secondary microvasculopathy of vessels <500 µm, leads to increased pulmonary vascular resistance and progressive right heart failure. The mechanism responsible for the transformation of red clots into fibrotic material remnants has not yet been elucidated. In patients with pulmonary hypertension, the diagnosis is suspected when a ventilation/perfusion lung scan shows mismatched perfusion defects, and confirmed by right heart catheterisation and vascular imaging. Today, in addition to lifelong anticoagulation, treatment modalities include surgery, angioplasty and medical treatment according to the localisation and characteristics of the lesions.This statement outlines a review of the literature and current practice concerning diagnosis and management of CTEPH. It covers the definitions, diagnosis, epidemiology, follow-up after acute pulmonary embolism, pathophysiology, treatment by pulmonary endarterectomy, balloon pulmonary angioplasty, drugs and their combination, rehabilitation and new lines of research in CTEPH.It represents the first collaboration of the European Respiratory Society, the International CTEPH Association and the European Reference Network-Lung in the pulmonary hypertension domain. The statement summarises current knowledge, but does not make formal recommendations for clinical practice.
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Affiliation(s)
- Marion Delcroix
- Clinical Dept of Respiratory Diseases, Pulmonary Hypertension Center, UZ Leuven, Leuven, Belgium .,BREATHE, Dept CHROMETA, KU Leuven, Leuven, Belgium.,Co-chair
| | - Adam Torbicki
- Dept of Pulmonary Circulation, Thrombo-embolic Diseases and Cardiology, Center of Postgraduate Medical Education, ECZ-Otwock, Otwock, Poland.,Section editors
| | - Deepa Gopalan
- Dept of Radiology, Imperial College Hospitals NHS Trusts, London, UK.,Section editors
| | - Olivier Sitbon
- Université Paris-Saclay; Inserm UMR_S 999, Service de Pneumologie, Hôpital Bicêtre (AP-HP), Le Kremlin-Bicêtre, France.,Section editors
| | - Frederikus A Klok
- Dept of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.,Section editors
| | - Irene Lang
- Medical University of Vienna, Vienna, Austria.,Section editors
| | - David Jenkins
- Royal Papworth Hospital, Cambridge University Hospital, Cambridge, UK.,Section editors
| | - Nick H Kim
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, USA.,Section editors
| | - Marc Humbert
- Université Paris-Saclay; Inserm UMR_S 999, Service de Pneumologie, Hôpital Bicêtre (AP-HP), Le Kremlin-Bicêtre, France.,Section editors
| | - Xavier Jais
- Université Paris-Saclay; Inserm UMR_S 999, Service de Pneumologie, Hôpital Bicêtre (AP-HP), Le Kremlin-Bicêtre, France.,Section editors
| | - Anton Vonk Noordegraaf
- Dept of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Section editors
| | - Joanna Pepke-Zaba
- Royal Papworth Hospital, Cambridge University Hospital, Cambridge, UK.,Section editors
| | - Philippe Brénot
- Marie Lannelongue Hospital, Paris-South University, Le Plessis Robinson, France
| | - Peter Dorfmuller
- University of Giessen and Marburg Lung Center, German Center of Lung Research (DZL), Giessen, Germany.,Dept of Medicine, Imperial College London, London, UK.,Dept of Pneumology, Kerckhoff-Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Elie Fadel
- Hannover Medical School, Hannover, Germany
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, German Center of Lung Research (DZL), Giessen, Germany.,Dept of Medicine, Imperial College London, London, UK.,Dept of Pneumology, Kerckhoff-Clinic Bad Nauheim, Bad Nauheim, Germany
| | | | - Pavel Jansa
- 2nd Department of Medicine, Dept of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Michael Madani
- Sulpizio Cardiovascular Centre, University of California, San Diego, CA, USA
| | - Hiromi Matsubara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takeshi Ogo
- National Cerebral and Cardiovascular Centre, Osaka, Japan
| | - Ekkehard Grünig
- Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany
| | - Andrea D'Armini
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | | | - Bernhard Meyer
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | | | - Eckhard Mayer
- Dept of Thoracic Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany.,Equal contribution.,Co-chair
| | - Gérald Simonneau
- Université Paris-Saclay; Inserm UMR_S 999, Service de Pneumologie, Hôpital Bicêtre (AP-HP), Le Kremlin-Bicêtre, France.,Equal contribution.,Co-chair
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9
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Semi-automated Analysis of Ventilation-Perfusion Single-Photon Emission Tomography in the Diagnosis of Pulmonary Embolism – Does it add extra value? Nuklearmedizin 2020; 59:445-453. [DOI: 10.1055/a-1253-7951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Aim Diagnosis of pulmonary embolism using V/P-SPECT may include the application of advanced image-processing techniques to identify V/P-mismatches. Aim of this study was to evaluate the benefit in clinical decision making in the diagnosis of pulmonary embolism.by whether adding to conventional reading a software that automatically calculates and visualizes the ventilation/perfusion-quotient pixel by pixel.
Methods 63 consecutive patients with a clinical suspicion of PE who underwent V/P-SPECT were included in this retrospective study. Images were randomly ordered both for standard as well as for software-assisted reading using V/P-quotients. Studies were read independently by 2 experienced and 2 inexperienced raters. Diagnostic performance and observer agreement of all readers and both reading methods were determined.
Results Expert observers consistently achieved a high diagnostic accuracy both in conventional as well as in software-assisted reporting (sensitivity: 0.94 vs. 0.94, specificity: 0.96 vs. 0.97, LR+: 17.32 vs. 28.86, LR– stayed constant at 0.06). For inexperienced readers, diagnostic performance improved: sensitivity raised from 0.74 to 0.85 and specificity from 0.86 to 0.95, LR+ raised from 5.20 to 15.69, LR– decreased from 0.31 to 0.16. Inter-rater reliability (Fleiss’ κ) improved from 0.63 to 0.86 by using V/P quotient.
Conclusion Benefit from a software-tool that calculates V/P-ratio automatically is only small when used by experienced physicians If inexperienced readers use the software, the diagnostic accuracy increases. Images generated by automated calculation of V/P-mismatches are easy to read and their use might help to standardize and objectify interpretation of V/P-SPECT in the diagnosis of PE.
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10
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Le Roux PY, Robin P, Tromeur C, Davis A, Robert-Ebadi H, Carrier M, Le Gal G, Salaun PY. Ventilation/perfusion SPECT for the diagnosis of pulmonary embolism: A systematic review. J Thromb Haemost 2020; 18:2910-2920. [PMID: 33433051 DOI: 10.1111/jth.15038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ventilation/perfusion (V/Q) single-photon emission computed tomography (SPECT) has largely replaced conventional planar V/Q scan in nuclear medicine departments for pulmonary embolism (PE) diagnosis. However, the diagnostic performance of the test and its role in the diagnostic management of acute PE are still a matter of debate. OBJECTIVE The primary aim was to establish the diagnostic accuracy (sensitivity, specificity) of V/Q SPECT for PE diagnosis. The secondary aim was to review the clinical outcomes of patients investigated for PE suspicion with a standardized algorithm based on V/Q SPECT. METHODS We conducted a systematic review of diagnostic accuracy and management outcome studies involving patients evaluated with V/Q SPECT for suspected acute PE. We searched from inception to June 23, 2020, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for diagnostic accuracy studies, randomized controlled trials, and observational cohort studies. The methodological quality and risk of bias of eligible studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and the Risk of Bias in Nonrandomized Studies of Interventions tools. RESULTS We identified 13 accuracy studies and one prospective outcome study. Eleven diagnostic accuracy studies were deemed at high risk of bias in at least two of the four domains of QUADAS-2 evaluation and a further two studies raised concerns regarding the applicability of results, precluding the meta-analysis for accuracy indices. The only prospective cohort study demonstrated critical risk of bias. CONCLUSIONS Although V/Q SPECT has been widely implemented in daily clinical practice, the exact diagnostic performance of V/Q SPECT for PE is still unknown. This systematic review clearly identifies knowledge gaps and sets the agenda for future research.
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Affiliation(s)
- Pierre-Yves Le Roux
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
| | - Philippe Robin
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Cécile Tromeur
- Département de Médecine Interne et Pneumologie, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
| | - Alexandra Davis
- Library and Learning Centre, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Marc Carrier
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Grégoire Le Gal
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Centre d'investigation clinique CIC 1412, CHRU de Brest, Brest, France
| | - Pierre-Yves Salaun
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
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11
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Bajc M, Lindqvist A. Ventilation/Perfusion SPECT Imaging Diagnosing PE and Other Cardiopulmonary Diseases. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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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.
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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
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13
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Helmersen D, Provencher S, Hirsch AM, Van Dam A, Dennie C, De Perrot M, Mielniczuk L, Hirani N, Chandy G, Swiston J, Lien D, Kim NH, Delcroix M, Mehta S. Diagnosis of chronic thromboembolic pulmonary hypertension: A Canadian Thoracic Society clinical practice guideline update. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2019. [DOI: 10.1080/24745332.2019.1631663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Doug Helmersen
- Pulmonary Hypertension Program, Division of Respiratory Medicine, Peter Lougheed Centre, University of Calgary, Calgary, Alberta, Canada
| | - Steeve Provencher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université de Laval, Quebec, Quebec, Canada
| | - Andrew M. Hirsch
- Centre for Pulmonary Vascular Disease, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Anne Van Dam
- Canadian Thoracic Society, Ottawa, Ontario, Canada
| | - Carole Dennie
- Thoracic and Cardiac Imaging Sections, The Ottawa Hospital Cardiac Radiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc De Perrot
- Division of Thoracic Surgery, Toronto General Hospital, Toronto Pulmonary Endarterectomy Program, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Mielniczuk
- University of Ottawa Heart Institute Pulmonary Hypertension Clinic, Cardiology Division, University of Ottawa, Ottawa, Ontario, Canada
| | - Naushad Hirani
- Pulmonary Hypertension Program, Division of Respiratory Medicine, Peter Lougheed Centre, University of Calgary, Calgary, Alberta, Canada
| | - George Chandy
- University of Ottawa Heart Institute Pulmonary Hypertension Clinic, Respirology Division, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - John Swiston
- Pulmonary Hypertension Program, Respirology Division, Vancouver General Hospital, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dale Lien
- University of Alberta Pulmonary Hypertension Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Nick H. Kim
- Pulmonary Vascular Medicine, University of California San Diego, California, U.S.A.
| | - Marion Delcroix
- Centre for Pulmonary Vascular Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sanjay Mehta
- Southwest Ontario Pulmonary Hypertension Clinic, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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14
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Liu J, Larcos G. Radionuclide lung scans for suspected acute pulmonary embolism: Single photon emission computed tomography (SPECT) or hybrid SPECT/CT? J Med Imaging Radiat Oncol 2019; 63:731-736. [PMID: 31515905 DOI: 10.1111/1754-9485.12951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Hybrid single photon emission computed tomography (SPECT) with CT (SPECT/CT) may improve diagnostic accuracy in suspected acute pulmonary embolism, but further research is needed. We evaluated whether the use of attenuation correction and/or the depiction of lung pathology with hybrid SPECT/CT could significantly reduce potentially false-positive ventilation-perfusion (VQ) SPECT studies or obviate the need for a ventilation study. METHODS Two specialists (S1 and S2) reviewed prospectively acquired VQ SPECT/CT in 165 patients. Studies were reported using standard criteria and compared to VQ SPECT and Q SPECT/CT. RESULTS S1 and S2 recorded positive VQ SPECT in 54 (32.7%) and 42 (25.6%) cases, respectively. Hybrid SPECT/CT showed non-embolic pathology in 41 (S1) and 46 (S2) patients, but compared to VQ SPECT, neither hybrid SPECT/CT nor attenuation correction SPECT/CT had significantly fewer positive studies. Intra-observer agreement with VQ SPECT/CT was almost perfect (k = 0.91 for S1 and k = 0.95 for S2; P < 0.001), but not with Q SPECT/CT (k = 0.4 for S1 and k = 0.62 for S2; P < 0.001). Inter-observer agreement was moderate for VQ SPECT (k = 0.65) and VQ SPECT/CT (k = 0.63). CONCLUSION In our study, hybrid VQ SPECT/CT did not reduce the number of potentially false-positive VQ SPECT, nor did the CT obviate the need for a ventilation study. Thus, the routine use of hybrid SPECT/CT for suspected pulmonary embolism is not justified.
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Affiliation(s)
- Jui Liu
- Department of Nuclear Medicine and Ultrasound, Westmead Hospital, Sydney, New South Wales, Australia
| | - George Larcos
- Department of Nuclear Medicine and Ultrasound, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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A guide for a brave future for lung ventilation/perfusion tomography: the most important pulmonary nuclear medicine technique. Eur J Nucl Med Mol Imaging 2019; 46:2427-2428. [PMID: 31392369 DOI: 10.1007/s00259-019-04464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
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The conclusions drawn from ventilation/perfusion single-photon emission computed tomography compared with lung perfusion single-photon emission computed tomography and chest radiography in patients with suspected pulmonary thromboembolism. Nucl Med Commun 2018; 39:908-914. [PMID: 30048378 DOI: 10.1097/mnm.0000000000000886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE There are conflicting results from studies on whether ventilation scintigraphy can be safely omitted or replaced by chest radiography. These studies were based on planar ventilation/perfusion (V/Q) scintigraphy. We evaluated the value of the ventilation single-photon emission computed tomography (SPECT) on the final conclusion drawn from a V/Q SPECT and the possible role of the chest radiography as a surrogate for the ventilation SPECT. PATIENTS AND METHODS Raw data of V/Q SPECT images and chest radiography acquired within 48 h over an 18-month period were retrieved, reprocessed and reviewed in batches. The ventilation SPECT, perfusion SPECT and chest radiography were reviewed separately and in combination. Data on the presence and nature of defects and chest radiography abnormalities were recorded. The V/Q SPECT images were interpreted using the criteria in the EANM guideline and the perfusion SPECT and chest radiography images were interpreted using the PISAPED criteria. Agreement between the diagnosis on the V/Q SPECT review and the perfusion SPECT and chest radiography review was analysed. RESULTS Overall, 21.1% of the patients were classified as 'PE present' on the V/Q SPECT review, whereas 48.9% were classified as 'PE present' on the perfusion SPECT and chest radiography review. Only 5.4% of defects observed on ventilation SPECT had matched chest radiography lung field opacity. CONCLUSION Our study showed that the omission of a ventilation SPECT led to a high rate of false-positive diagnoses and that the ventilation scan cannot be replaced by a chest radiography.
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Le Roux PY, Robin P, Tromeur C, Davis A, Robert-Ebadi H, Carrier M, Couturaud F, Le Gal G, Salaun PY. SPECT V/Q for the diagnosis of pulmonary embolism: protocol for a systematic review and meta-analysis of diagnostic accuracy and clinical outcome. BMJ Open 2018; 8:e022024. [PMID: 29680814 PMCID: PMC5914710 DOI: 10.1136/bmjopen-2018-022024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/15/2018] [Accepted: 04/03/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Single photon emission computed tomography ventilation/perfusion (SPECT V/Q) imaging has many proponents within the nuclear medicine community and has already largely replaced planar V/Q scintigraphy in daily practice for the diagnosis of pulmonary embolism (PE). However, the test is still described in clinical guidelines as an experimental test because of insufficient evidence. METHODS AND ANALYSIS We will conduct a systematic review and a meta-analysis of diagnostic accuracy and management outcome studies involving patients evaluated with V/Q SPECT for suspected acute PE. We will search from inception to 19 December 2017 MEDLINE, Embase and the Cochrane Central Register of Controlled Trials for diagnostic accuracy studies, randomised controlled trials and observational cohort studies. Two reviewers will conduct all screening and data collection independently. The methodological quality and risk of bias of eligible studies will be carefully and rigorously assessed using the Quality Assessment of Diagnostic Accuracy Studies-2, the Cochrane Collaboration's tool and the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tools. The primary outcomes will be sensitivity, specificity and likelihood ratios of V/Q SPECT for the diagnosis of acute PE. The secondary outcomes will be the rate of venous thromboembolism during a 3-month follow-up period in patients left untreated after a negative diagnostic work-up based on SPECT V/Q. ETHICS AND DISSEMINATION This study of secondary data does not require ethics approval. It will be presented internationally and published in the peer-reviewed literature. PROSPERO REGISTRATION NUMBER CRD42018084095.
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Affiliation(s)
- Pierre-Yves Le Roux
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
| | - Philippe Robin
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Cécile Tromeur
- Département de Médecine Interne et Pneumologie, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
| | - Alexandra Davis
- Library and Learning Centre, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Francis Couturaud
- Département de Médecine Interne et Pneumologie, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Département de Médecine Interne et Pneumologie, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
| | - Pierre-Yves Salaun
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
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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.
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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
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Cochon L, McIntyre K, Nicolás JM, Baez AA. Incremental diagnostic quality gain of CTA over V/Q scan in the assessment of pulmonary embolism by means of a Wells score Bayesian model: results from the ACDC collaboration. Emerg Radiol 2017; 24:355-359. [DOI: 10.1007/s10140-017-1486-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/03/2017] [Indexed: 11/28/2022]
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20
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Hess S, Madsen PH. Radionuclide Diagnosis of Pulmonary Embolism. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 906:49-65. [DOI: 10.1007/5584_2016_105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Ibáñez-Bravo S, Banzo I, Quirce R, Martínez-Rodríguez I, Jiménez-Bonilla J, Martínez-Amador N, Parra J, González-Macías J, Carril J. Ventilation/Perfusion SPECT lung scintigraphy and computed tomography pulmonary angiography in patients with clinical suspicion of pulmonary embolism. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.remnie.2015.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Bengel FM. Radionuclide imaging. IMAGING 2016. [DOI: 10.1183/2312508x.10002215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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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]
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Ibáñez-Bravo S, Banzo I, Quirce R, Martínez-Rodríguez I, Jiménez-Bonilla J, Martínez-Amador N, Parra JA, González-Macías J, Carril JM. Ventilation/Perfusion SPECT lung scintigraphy and computed tomography pulmonary angiography in patients with clinical suspicion of pulmonary embolism. Rev Esp Med Nucl Imagen Mol 2016; 35:215-20. [PMID: 26838481 DOI: 10.1016/j.remn.2015.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/18/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED The aim was to compare ventilation/perfusion SPECT lung scintigraphy (V/Q-SPECT) and computed tomography pulmonary angiography (CTPA) in patients with suspicion of pulmonary embolism (PE). MATERIAL AND METHODS This prospectively designed study included 53 patients with intermediate or high clinical probability of PE. A V/Q-SPECT and CTPA was performed on all patients. The V/Q-SPECT was interpreted according to the European Association of Nuclear Medicine and Molecular Imaging (EANMMI) guidelines. CTPA was reported as positive, negative, or indeterminate. RESULTS CTPA was positive in 22 cases, negative in 28, and indeterminate in 3. V/Q-SPECT was positive in 27 cases, negative in 24, and non-diagnostic in 2. In the 22 with positive CTPA, V/Q-SPECT was positive in 18, negative in 3, and non-diagnostic in 1. In the 28 with negative CTPA, V/Q-SPECT was positive in 8, negative in 19, and non-diagnostic in 1. In the 3 with indeterminate CTPA, V/Q-SPECT was positive in 1 and negative in 2. In the 2 non-diagnostic cases V/Q-SPECT, CTPA was positive in 1 and negative in one. In the 10 high clinical probabilities, CTPA and V/Q-SPECT were positive in 7, negative in 2, and in 1, CTPA was positive and V/Q-SPECT negative. In the 38 intermediate probability group, CTPA and V/Q-SPECT were positive in 11, negative in 17, with CTPA negative and V/Q-SPECT positive in 8, and in 2 CTPA was positive and V/Q-SPECT negative. The results show that V/Q-SPECT detected PE in 5 patients more than CTPA. CONCLUSION Our results show a 77% concordance of both techniques. Overall V/Q-SPECT detected PE in 18% more patients than CTPA in the intermediate group. Both techniques have a complementary role when a diagnosis cannot be made with one of them.
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Affiliation(s)
- S Ibáñez-Bravo
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain.
| | - I Banzo
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
| | - R Quirce
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
| | - I Martínez-Rodríguez
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
| | - J Jiménez-Bonilla
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
| | - N Martínez-Amador
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
| | - J A Parra
- Radiology Department, University Hospital "Marqués de Valdecilla", Cantabria University, Santander, Spain
| | - J González-Macías
- Internal Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Santander, Spain
| | - J M Carril
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
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Begic A, Opankovic E, Cukic V, Lindqvist A, Miniati M, Bajc M. Ancillary findings assessed by ventilation/perfusion tomography. Impact and clinical outcome in patients with suspected pulmonary embolism. Nuklearmedizin 2015; 54:223-30. [PMID: 26227225 DOI: 10.3413/nukmed-0748-15-06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/20/2015] [Indexed: 11/20/2022]
Abstract
UNLABELLED Ventilation/perfusion tomography (V/P SPECT) is a recommended method for diagnosing and follow-up of pulmonary embolism (PE). Moreover, it is possible to recognize other pathologies in addition to PE, such as pneumonia, COPD and left heart failure (LHF). The objective of this prospective study was to identify frequency of ancillary findings among patients with suspected PE. Patients, material, method: 331 consecutive patients with suspected PE were examined and classified with V/P SPECT. Patients were followed up clinically and by means of other laboratory tests. RESULTS 80 patients had a normal V/P SPECT and no clinical consequences in the follow-up. PE had 104 patients: 23 of them had also additional findings. Among the remaining 147 patients, pneumonias were shown in 82, acute in 75 patients and 7 had chronic post inflammatory state. COPD was present in 42 patients, in 3 combined with pneumonia. Sign of LHF was observed in 10: in 7 the acute LHF diagnosis was established, 3 were classified as having a chronic cardiopulmonary disease. Furthermore, in 16 patients, the V/P pattern was suggestive of a tumour. The clinical outcomes were 6 lung tumours, 3 empyema, one sarcoidosis, 2 were unclarified and 4 were lost in the follow-up. CONCLUSION V/P SPECT identifies a high prevalence of other cardiopulmonary diseases among patients with a clinical suspicion of PE. Ancillary findings with V/P SPECT clarified patients' symptoms and had an impact on the treatment. These findings were verified by a clinical outcome by the follow-up over three months.
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Affiliation(s)
| | | | | | | | | | - M Bajc
- Marika Bajc MD, PhD, Department of clinical sciences Lund, 221 85 Lund, Sweden, Tel. +46/46 17 33 03,
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Jögi J, Markstad H, Tufvesson E, Bjermer L, Bajc M. The added value of hybrid ventilation/perfusion SPECT/CT in patients with stable COPD or apparently healthy smokers. Cancer-suspected CT findings in the lungs are common when hybrid imaging is used. Int J Chron Obstruct Pulmon Dis 2014; 10:25-30. [PMID: 25565797 PMCID: PMC4279608 DOI: 10.2147/copd.s73423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ventilation/perfusion (V/P) single-photon emission computed tomography (SPECT) is recognized as a diagnostic method with potential beyond the diagnosis of pulmonary embolism. V/P SPECT identifies functional impairment in diseases such as heart failure (HF), pneumonia, and chronic obstructive pulmonary disease (COPD). The development of hybrid SPECT/computed tomography (CT) systems, combining functional with morphological imaging through the addition of low-dose CT (LDCT), may be useful in COPD, as these patients are prone to lung cancer and other comorbidities. The aim of this study was to investigate the added value of LDCT among healthy smokers and patients with stable COPD, when examined with V/P SPECT/CT hybrid imaging. Sixty-nine subjects, 55 with COPD (GOLD I-IV) and 14 apparently healthy smokers, were examined with V/P SPECT and LDCT hybrid imaging. Spirometry was used to verify COPD grade. Only one apparently healthy smoker and three COPD patients had a normal or nearly normal V/P SPECT. All other patients showed various degrees of airway obstruction, even when spirometry was normal. The same interpretation was reached on both modalities in 39% of the patients. LDCT made V/P SPECT interpretation more certain in 9% of the patients and, in 52%, LDCT provided additional diagnoses. LDCT better characterized the type of emphysema in 12 patients. In 19 cases, tumor-suspected changes were reported. Three of these 19 patients (ie, 4.3% of all subjects) were in the end confirmed to have lung cancer. The majority of LDCT findings were not regarded as clinically significant. V/P SPECT identified perfusion patterns consistent with decompensated left ventricular HF in 14 COPD patients. In 16 patients (23%), perfusion defects were observed. HF and perfusion defects were not recognized with LDCT. In COPD patients and long-time smokers, hybrid imaging had added value compared to V/P SPECT alone, by identifying patients with lung malignancy and more clearly identifying emphysema. V/P SPECT visualizes comorbidities to COPD not seen with LDCT, such as pulmonary embolism and left ventricular HF.
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Affiliation(s)
- Jonas Jögi
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden
| | - Hanna Markstad
- Department of Radiology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Ellen Tufvesson
- Department of Respiratory Medicine and Allergology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Marika Bajc
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden
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