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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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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.
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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.
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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.)
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Piskac Zivkovic N, Mutvar A, Kuster D, Lucijanic M, Ljilja Posavec A, Cvetkovic Kucic D, Lalic K, Vergles M, Udovicic M, Barsic B, Rudan D, Luksic I, Lang IM, Skoro-Sajer N. Longitudinal analysis of chest Q-SPECT/CT in patients with severe COVID-19. Respir Med 2023; 220:107461. [PMID: 37951314 DOI: 10.1016/j.rmed.2023.107461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 11/04/2023] [Accepted: 11/05/2023] [Indexed: 11/13/2023]
Abstract
INTRODUCTION Patients with COVID-19 have an increased risk for microvascular lung thrombosis. In order to evaluate the type and prevalence of perfusion defects, we performed a longitudinal analysis of combined perfusion single-photon emission and low-dose computed tomography (Q-SPECT/CT scan) in patients with COVID-19 pneumonia. METHODS Consecutive patients with severe COVID-19 (B.1.1.7 variant SARS-CoV-2) and respiratory insufficiency underwent chest Q-SPECT/CT during hospitalization, and 3 months after discharge. At follow-up (FU), Q-SPECT/CT were analyzed and compared with pulmonary function tests (PFT), blood analysis (CRP, D-dimers, ferritin), modified Medical Research Council (mMRC) dyspnea scale, and high-resolution CT scans (HRCT). Patients with one or more segmental perfusion defects outside the area of inflammation (PDOI) were treated with anticoagulation until FU. RESULTS At baseline, PDOI were found in 50 of 105 patients (47.6 %). At FU, Q-SPECT/CT scans had improved significantly (p < 0.001) and PDOI were recorded in 14 of 77 (18.2 %) patients. There was a significant correlation between mMRC score and the number of segmental perfusion defects (r = 0.511, p < 0.001), and a weaker correlation with DLCO (r = -0.333, p = 0.002) and KCO (r = -0.373, p = 0.001) at FU. Neither corticosteroid therapy nor HRCT results showed an influence on Q-SPECT/CT changes (p = 0.94, p = 0.74). CRP, D-Dimers and ferritin improved but did not show any association with the FU Q-SPECT/CT results (p = 0.08). CONCLUSION Segmental mismatched perfusion defects are common in severe COVID-19 and are correlated with the degree of dyspnea. Longitudinal analyses of Q-SPECT/CT scans in severe COVID-19 may help understand possible mechanisms of long COVID and prolonged dyspnea.
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Affiliation(s)
| | - Andrea Mutvar
- Primary Respiratory-Intensive Care Center, Dubrava University Hospital, Zagreb, Croatia
| | - Dinka Kuster
- Primary Respiratory-Intensive Care Center, Dubrava University Hospital, Zagreb, Croatia
| | - Marko Lucijanic
- Primary Respiratory-Intensive Care Center, Dubrava University Hospital, Zagreb, Croatia
| | - Anja Ljilja Posavec
- Primary Respiratory-Intensive Care Center, Dubrava University Hospital, Zagreb, Croatia
| | - Daria Cvetkovic Kucic
- Primary Respiratory-Intensive Care Center, Dubrava University Hospital, Zagreb, Croatia
| | - Kristina Lalic
- Primary Respiratory-Intensive Care Center, Dubrava University Hospital, Zagreb, Croatia
| | - Mirna Vergles
- Primary Respiratory-Intensive Care Center, Dubrava University Hospital, Zagreb, Croatia
| | - Mario Udovicic
- Primary Respiratory-Intensive Care Center, Dubrava University Hospital, Zagreb, Croatia
| | - Bruno Barsic
- Primary Respiratory-Intensive Care Center, Dubrava University Hospital, Zagreb, Croatia
| | - Diana Rudan
- Primary Respiratory-Intensive Care Center, Dubrava University Hospital, Zagreb, Croatia
| | - Ivica Luksic
- Primary Respiratory-Intensive Care Center, Dubrava University Hospital, Zagreb, Croatia
| | - Irene Marthe Lang
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Austria
| | - Nika Skoro-Sajer
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Austria.
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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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Squizzato A, Venturini A, Pelitti V, Bellini B, Bernasconi M, Depalo T, Corso A, Riva N. Diagnostic Accuracy of V/Q and Q SPECT/CT in Patients with Suspected Acute Pulmonary Embolism: A Systematic Review and Meta-analysis. Thromb Haemost 2023. [PMID: 36423623 DOI: 10.1055/a-1986-8878] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Computed tomography (CT) pulmonary angiography has simplified the diagnostic approach to patients with clinically suspected acute pulmonary embolism (PE), but alternative imaging tests are still advocated. We aimed to systematically assess the diagnostic accuracy of ventilation/perfusion (V/Q) and Q single-photon emission CT combined with low-dose CT (SPECT/CT) for PE diagnosis. METHODS Studies evaluating the diagnostic accuracy of SPECT/CT for the diagnosis of acute PE were systematically searched in MEDLINE and EMBASE databases (up to August 2022). The QUADAS-2 tool was used for risk-of-bias assessment of the primary studies. A bivariate random-effects regression approach was used for summary estimates of both sensitivity and specificity. The PROSPERO registration number is CRD42021276538. RESULTS Eight studies, for a total of 1,086 patients, were included. The risk of bias of all included studies was high. The weighted mean prevalence of PE was 27.1% at the random-effects model. The SPECT/CT bivariate weighted mean sensitivity was 96% (95% confidence interval [CI]: 93-98%), with a bivariate weighted mean specificity of 95% (95% CI: 90-97%). At subgroup analysis, for V/Q SPECT/CT bivariate weighted mean sensitivity and specificity were 96% (95% CI: 89-98%) and 96% (95% CI: 91-99%), while for Q SPECT/CT they were 96% (95% CI: 92-98%) and 84% (95% CI: 66-93%), respectively. CONCLUSIONS V/Q SPECT/CT has high sensitivity and specificity for the diagnosis of acute PE, meanwhile Q SPECT/CT has high sensitivity but limited specificity for the diagnosis of PE. Management studies will conclusively ascertain the actual role of SPECT/CT in the diagnostic workup of patients with suspected acute PE.
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Affiliation(s)
- Alessandro Squizzato
- Research Center on Thromboembolic Disorders and Antithrombotic Therapies, ASST Lariana, University of Insubria, Como, Italy
| | - Alice Venturini
- Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese and Como, Italy
| | - Valentina Pelitti
- Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese and Como, Italy
| | - Beatrice Bellini
- Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese and Como, Italy
| | | | - Tommaso Depalo
- Nuclear Medicine Unit, 'Sant'Anna' Hospital, ASST Lariana, Como, Italy
| | - Angelo Corso
- Nuclear Medicine Unit, 'Sant'Anna' Hospital, ASST Lariana, Como, Italy
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Elsakka A, Yeh R, Das J. The Clinical Utility of Molecular Imaging in COVID-19: An Update. Semin Nucl Med 2023; 53:98-106. [PMID: 36243572 PMCID: PMC9492514 DOI: 10.1053/j.semnuclmed.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 01/28/2023]
Abstract
The novel pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first discovered in Wuhan, China in late 2019 with Coronavirus disease 2019 (COVID-19) declared a global pandemic in March 2020. Primarily involving the lungs, conventional imaging with chest radiography and CT can play a complementary role to RT-PCR in the initial diagnosis, and also in follow up of select patients. As a broader understanding of the multi-systemic nature of COVID-19 has evolved, a potential role for molecular imaging has developed, that may detect functional changes in advance of standard cross-sectional imaging. In this review, we highlight the evolving role of molecular imaging such as fluorine-18 (18F) fluorodeoxyglucose (FDG) with PET/CT and PET/MRI in the evaluation of both pulmonary and extra-pulmonary COVID-19, ventilation and perfusion scan with SPECT/CT for thromboembolic disease, long term follow-up of COVID-19 infection, and COVID-19 vaccine-related complications.
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Affiliation(s)
- Ahmed Elsakka
- Molecular Imaging and Therapy Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY,Body Imaging Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY
| | - Randy Yeh
- Molecular Imaging and Therapy Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Jeeban Das
- Molecular Imaging and Therapy Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY,Body Imaging Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY
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Baeza S, Gil D, Garcia-Olivé I, Salcedo-Pujantell M, Deportós J, Sanchez C, Torres G, Moragas G, Rosell A. A novel intelligent radiomic analysis of perfusion SPECT/CT images to optimize pulmonary embolism diagnosis in COVID-19 patients. EJNMMI Phys 2022; 9:84. [PMID: 36469151 PMCID: PMC9905449 DOI: 10.1186/s40658-022-00510-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND COVID-19 infection, especially in cases with pneumonia, is associated with a high rate of pulmonary embolism (PE). In patients with contraindications for CT pulmonary angiography (CTPA) or non-diagnostic CTPA, perfusion single-photon emission computed tomography/computed tomography (Q-SPECT/CT) is a diagnostic alternative. The goal of this study is to develop a radiomic diagnostic system to detect PE based only on the analysis of Q-SPECT/CT scans. METHODS This radiomic diagnostic system is based on a local analysis of Q-SPECT/CT volumes that includes both CT and Q-SPECT values for each volume point. We present a combined approach that uses radiomic features extracted from each scan as input into a fully connected classification neural network that optimizes a weighted cross-entropy loss trained to discriminate between three different types of image patterns (pixel sample level): healthy lungs (control group), PE and pneumonia. Four types of models using different configuration of parameters were tested. RESULTS The proposed radiomic diagnostic system was trained on 20 patients (4,927 sets of samples of three types of image patterns) and validated in a group of 39 patients (4,410 sets of samples of three types of image patterns). In the training group, COVID-19 infection corresponded to 45% of the cases and 51.28% in the test group. In the test group, the best model for determining different types of image patterns with PE presented a sensitivity, specificity, positive predictive value and negative predictive value of 75.1%, 98.2%, 88.9% and 95.4%, respectively. The best model for detecting pneumonia presented a sensitivity, specificity, positive predictive value and negative predictive value of 94.1%, 93.6%, 85.2% and 97.6%, respectively. The area under the curve (AUC) was 0.92 for PE and 0.91 for pneumonia. When the results obtained at the pixel sample level are aggregated into regions of interest, the sensitivity of the PE increases to 85%, and all metrics improve for pneumonia. CONCLUSION This radiomic diagnostic system was able to identify the different lung imaging patterns and is a first step toward a comprehensive intelligent radiomic system to optimize the diagnosis of PE by Q-SPECT/CT. HIGHLIGHTS Artificial intelligence applied to Q-SPECT/CT is a diagnostic option in patients with contraindications to CTPA or a non-diagnostic test in times of COVID-19.
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Affiliation(s)
- Sonia Baeza
- Respiratory Medicine Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain. .,Germans Trias I Pujol Research Institute (IGTP), Badalona, Barcelona, Spain. .,Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Debora Gil
- grid.7080.f0000 0001 2296 0625Computer Vision Center and Computer Science Department, UAB, Barcelona, Spain
| | - Ignasi Garcia-Olivé
- grid.411438.b0000 0004 1767 6330Respiratory Medicine Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona Spain ,grid.429186.00000 0004 1756 6852Germans Trias I Pujol Research Institute (IGTP), Badalona, Barcelona Spain ,grid.7080.f0000 0001 2296 0625Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maite Salcedo-Pujantell
- grid.411438.b0000 0004 1767 6330Nuclear Medicine Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona Spain
| | - Jordi Deportós
- grid.411438.b0000 0004 1767 6330Nuclear Medicine Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona Spain
| | - Carles Sanchez
- grid.7080.f0000 0001 2296 0625Computer Vision Center and Computer Science Department, UAB, Barcelona, Spain
| | - Guillermo Torres
- grid.7080.f0000 0001 2296 0625Computer Vision Center and Computer Science Department, UAB, Barcelona, Spain
| | - Gloria Moragas
- grid.411438.b0000 0004 1767 6330Nuclear Medicine Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona Spain
| | - Antoni Rosell
- grid.411438.b0000 0004 1767 6330Respiratory Medicine Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona Spain ,grid.429186.00000 0004 1756 6852Germans Trias I Pujol Research Institute (IGTP), Badalona, Barcelona Spain ,grid.7080.f0000 0001 2296 0625Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
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Hashimoto H, Soma T, Mizumura S, Kokubo T, Nakanishi R, Ikeda T. Evaluation of lung perfusion by using lung perfusion SPECT and lung CT with breathing synchronization software. Eur J Hybrid Imaging 2022; 6:32. [DOI: 10.1186/s41824-022-00154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/17/2022] [Indexed: 11/26/2022] Open
Abstract
Abstract
Background
Lung perfusion using 99mTc-macroaggregated albumin single-photon emission computed tomography (SPECT) and lung computed tomography (CT) is a useful modality for identifying patients with pulmonary artery embolism. However, conformity between SPECT and CT at the bottom of the lung is generally low. This study aims to investigate the progression of conformity between lung perfusion SPECT and lung CT using a breathing synchronization software.
Methods
Among 95 consecutive patients who underwent lung perfusion SPECT and lung CT within 14 days because of suspected pulmonary embolism between June 2019 and August 2020 in department of cardiovascular medicine, we identified 28 patients (73 ± 10 years) who had normal pulmonary artery on contrast lung CT. We compared lung volumes calculated using lung perfusion SPECT and lung CT as gold standard. Visual conformity between lung SPECT and lung CT was scored 0–4 (0: 0–25%, 1: 25–50%, 2: 50–75%, 3: 75–90%, 4: > 90%) by two specialists in nuclear medicine and assessed.
Results
The lung volume calculated from lung CT was 3749 ± 788 ml. The lung volume calculated from lung perfusion SPECT without using the breathing synchronization software was 3091 ± 610 ml. There was a significant difference between the lung volume calculated from CT and SPECT without using the breathing synchronization software (P < 0.01). The lung volume calculated from lung perfusion SPECT using the breathing synchronization software was 3435 ± 686 ml, and there was no significant difference between the lung volume calculated from CT and SPECT using the breathing synchronization software. The visual score improved with the use of breathing synchronization software (without software; 1.9 ± 0.6 vs. with software; 3.4 ± 0.7, P < 0.001).
Conclusion
This study demonstrated that the breathing synchronization software could improve conformity between lung perfusion SPECT and lung CT.
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Investigation of the ongoing pulmonary defects with perfusion-single photon emission computed tomography/computed tomography in patients under anticoagulant therapy for coronavirus disease 2019–induced pulmonary embolism. Nucl Med Commun 2022; 43:978-986. [DOI: 10.1097/mnm.0000000000001595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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
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PET imaging in renal and bladder cancers. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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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.
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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
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14
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Porter EM, Myziuk NK, Quinn TJ, Lozano D, Peterson AB, Quach DM, Siddiqui ZA, Guerrero TM. Synthetic pulmonary perfusion images from 4DCT for functional avoidance using deep learning. Phys Med Biol 2021; 66. [PMID: 34293726 DOI: 10.1088/1361-6560/ac16ec] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/22/2021] [Indexed: 01/14/2023]
Abstract
Purpose.To develop and evaluate the performance of a deep learning model to generate synthetic pulmonary perfusion images from clinical 4DCT images for patients undergoing radiotherapy for lung cancer.Methods. A clinical data set of 58 pre- and post-radiotherapy99mTc-labeled MAA-SPECT perfusion studies (32 patients) each with contemporaneous 4DCT studies was collected. Using the inhale and exhale phases of the 4DCT, a 3D-residual network was trained to create synthetic perfusion images utilizing the MAA-SPECT as ground truth. The training process was repeated for a 50-imaging study, five-fold validation with twenty model instances trained per fold. The highest performing model instance from each fold was selected for inference upon the eight-study test set. A manual lung segmentation was used to compute correlation metrics constrained to the voxels within the lungs. From the pre-treatment test cases (N = 5), 50th percentile contours of well-perfused lung were generated from both the clinical and synthetic perfusion images and the agreement was quantified.Results. Across the hold-out test set, our deep learning model predicted perfusion with a Spearman correlation coefficient of 0.70 (IQR: 0.61-0.76) and a Pearson correlation coefficient of 0.66 (IQR: 0.49-0.73). The agreement of the functional avoidance contour pairs was Dice of 0.803 (IQR: 0.750-0.810) and average surface distance of 5.92 mm (IQR: 5.68-7.55).Conclusion. We demonstrate that from 4DCT alone, a deep learning model can generate synthetic perfusion images with potential application in functional avoidance treatment planning.
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Affiliation(s)
- Evan M Porter
- Department of Medical Physics, Wayne State University, Detroit, MI, United States of America.,Beaumont Artificial Intelligence Research Laboratory, Beaumont Health, Royal Oak, MI, United States of America.,Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Nicholas K Myziuk
- Beaumont Artificial Intelligence Research Laboratory, Beaumont Health, Royal Oak, MI, United States of America.,Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, United States of America
| | - Thomas J Quinn
- Beaumont Artificial Intelligence Research Laboratory, Beaumont Health, Royal Oak, MI, United States of America.,Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, United States of America
| | - Daniela Lozano
- Beaumont Artificial Intelligence Research Laboratory, Beaumont Health, Royal Oak, MI, United States of America.,Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, United States of America
| | - Avery B Peterson
- Department of Medical Physics, Wayne State University, Detroit, MI, United States of America.,Beaumont Artificial Intelligence Research Laboratory, Beaumont Health, Royal Oak, MI, United States of America
| | - Duyen M Quach
- Beaumont Artificial Intelligence Research Laboratory, Beaumont Health, Royal Oak, MI, United States of America.,Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, United States of America
| | - Zaid A Siddiqui
- Beaumont Artificial Intelligence Research Laboratory, Beaumont Health, Royal Oak, MI, United States of America.,Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Thomas M Guerrero
- Beaumont Artificial Intelligence Research Laboratory, Beaumont Health, Royal Oak, MI, United States of America.,Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, United States of America.,Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, United States of America
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15
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Sideris GA, Nikolakea M, Karanikola AE, Konstantinopoulou S, Giannis D, Modahl L. Imaging in the COVID-19 era: Lessons learned during a pandemic. World J Radiol 2021. [DOI: 10.4329/wjr.v13.i6.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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16
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Sideris GA, Nikolakea M, Karanikola AE, Konstantinopoulou S, Giannis D, Modahl L. Imaging in the COVID-19 era: Lessons learned during a pandemic. World J Radiol 2021; 13:192-222. [PMID: 34249239 PMCID: PMC8245753 DOI: 10.4329/wjr.v13.i6.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/02/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
The first year of the coronavirus disease 2019 (COVID-19) pandemic has been a year of unprecedented changes, scientific breakthroughs, and controversies. The radiology community has not been spared from the challenges imposed on global healthcare systems. Radiology has played a crucial part in tackling this pandemic, either by demonstrating the manifestations of the virus and guiding patient management, or by safely handling the patients and mitigating transmission within the hospital. Major modifications involving all aspects of daily radiology practice have occurred as a result of the pandemic, including workflow alterations, volume reductions, and strict infection control strategies. Despite the ongoing challenges, considerable knowledge has been gained that will guide future innovations. The aim of this review is to provide the latest evidence on the role of imaging in the diagnosis of the multifaceted manifestations of COVID-19, and to discuss the implications of the pandemic on radiology departments globally, including infection control strategies and delays in cancer screening. Lastly, the promising contribution of artificial intelligence in the COVID-19 pandemic is explored.
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Affiliation(s)
- Georgios Antonios Sideris
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, United States
- Radiology Working Group, Society of Junior Doctors, Athens 11527, Greece
| | - Melina Nikolakea
- Radiology Working Group, Society of Junior Doctors, Athens 11527, Greece
| | | | - Sofia Konstantinopoulou
- Division of Pulmonary Medicine, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi W13-01, United Arab Emirates
| | - Dimitrios Giannis
- Institute of Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Lucy Modahl
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, United States
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Investigation of perfusion defects by Q-SPECT/CT in patients with mild-to-moderate course of COVID-19 and low clinical probability for pulmonary embolism. Ann Nucl Med 2021; 35:1117-1125. [PMID: 34173212 PMCID: PMC8231747 DOI: 10.1007/s12149-021-01647-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/17/2021] [Indexed: 01/21/2023]
Abstract
Objective Pulmonary embolism is a severe source of mortality and morbidity in patients with severe and critical coronavirus disease 2019. It is not yet clear whether the tendency to thrombosis is increased in the mild-to-moderate course of COVID-19. Our research aims to show the clinical benefit of Q-SPECT/CT in diagnosing PD in outpatients treated with mild-to-moderate course of COVID-19 and to determine the frequency of perfusion defects in these patients having relatively lower risk. Methods All patients who underwent Q-SPECT/CT with suspicion of embolism were examined retrospectively. Only patients with low clinical probability and mild-to-moderate course of COVID-19 for PE were included in the study. The patients were evaluated comparatively as those with and without perfusion defects. Patients were divided into laboratory suspicion, clinical suspicion, or clinical and laboratory suspicion. Results In outpatients with mild-to-moderate COVID-19 with low clinical probability for PE, PD without CT abnormality was detected with a rate of 36.6% with Q-SPECT/CT performed for complaints of high d-dimer and/or dyspnea. None of the patients had PD at more proximal level than the segment level. PD with no concomitant CT abnormality was observed with a rate of 56.5% in patients with both clinical and laboratory suspicion. For d-dimer = 0.5 mg/dL cut-off sensitivity is 85%, for d-dimer = 1.5 mg/dL cut-off specificity 81%. Conclusion Thrombosis tendency is also present in outpatients with mild-to-moderate COVID-19, and these patients should also be offered anticoagulant prophylaxis during the COVID-19 period.
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Ventilation-Perfusion Scans After the COVID-19 Pandemic: Point-Ventilation Studies Are Dispensable. AJR Am J Roentgenol 2021; 218:29-30. [PMID: 34161131 DOI: 10.2214/ajr.21.26409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Evbuomwan O, Engelbrecht G, Bergman MV, Mokwena S, Ayeni OA. Lung perfusion findings on perfusion SPECT/CT imaging in non-hospitalized de-isolated patients diagnosed with mild COVID-19 infection. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC8188766 DOI: 10.1186/s43055-021-00521-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
Background
The aim of this retrospective study is to assess the incidence and type of lung perfusion abnormalities in non-hospitalized patients diagnosed with mild COVID-19 infection after de-isolation. Data from 56 non-hospitalized patients diagnosed with COVID-19 infection referred to our nuclear medicine department from July–December 2020 for a perfusion only SPECT/CT study or a ventilation perfusion SPECT/CT study were collected. Images were assessed for the presence and type of perfusion defects. The CT component of the study was also assessed for the presence of mosaic attenuation and COVID pneumonia changes.
Results
Thirty-two (57.1%) cases had perfusion defects. There were 20 (35.7%) cases with defects in keeping with pulmonary embolism, 17 (30.4%) cases with defects associated with mosaic attenuation but not due to pulmonary embolism, and 6 (10.7%) of cases with defects due to pulmonary infiltrates from COVID pneumonia. A total of 24 (42.9%) cases had mosaic attenuation on CT, with 10 (17.9%) of them showing a pattern likely consistent with shunting on the perfusion images.
Conclusion
Lung perfusion abnormalities are a common finding in non-hospitalized COVID-19 patients with mild disease. They are usually either due to pulmonary embolism, parenchymal infiltrates, or other causes of mosaic attenuation related to, but not specific to the pathophysiology of COVID-19 infection. The value of VQ SPECT/CT imaging is also shown in this study, in detecting and differentiating the various types of perfusion abnormalities.
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20
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Zuckier LS. To everything there is a season: taxonomy of approaches to the performance of lung scintigraphy in the era of COVID-19. Eur J Nucl Med Mol Imaging 2021; 48:666-669. [PMID: 33159223 PMCID: PMC7647190 DOI: 10.1007/s00259-020-05100-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lionel S Zuckier
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center and the Albert Einstein College of Medicine, 1695A Eastchester Road, Bronx, NY, 10461, USA.
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21
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Pulmonary tumor thrombotic microangiopathy: the role of a lung perfusion SPECT-CT study. Eur J Nucl Med Mol Imaging 2021; 48:3340-3342. [PMID: 33772333 DOI: 10.1007/s00259-021-05323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
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22
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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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23
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Das JP, Yeh R, Schöder H. Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE. Eur J Nucl Med Mol Imaging 2020; 48:794-799. [PMID: 32959115 PMCID: PMC7505736 DOI: 10.1007/s00259-020-05043-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE We reviewed the clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). METHODS Following the World Health Organization's declaration of a global pandemic, our department policy recommended Q-only SPECT/CT for all patients undergoing nuclear medicine evaluation for suspected PE to reduce the risk of aerosolization of respiratory droplets. We performed a retrospective review of sequential patients admitted with COVID-19 imaged with Q-SPECT/CT between March 17, 2020, and June 30, 2020, at Memorial Sloan Kettering Cancer Center. We recorded patient demographics, clinical symptoms, Wells score (to stratify patients according to pre-test probability for PE prior to Q-SPECT/CT), and noted ancillary imaging findings on CT. RESULTS Of the 33 patients imaged with Q-SPECT/CT, 6 patients (3 men, 3 women) had a laboratory confirmed diagnosis of COVID-19 (mean age, 55, ± 11.4 years, range 33-68). All patients had a current diagnosis of malignancy and had a moderate or high pre-test probability for PE (mean Wells score 2.8, range 2-4). Q-SPECT/CT was positive in 4/6 (67%) of patients. Distribution of pulmonary emboli was bilateral and segmental in 75% of patients. Ancillary acute findings on SPECT/CT included bilateral parenchymal ground glass opacities (n = 5), pleural effusions (n = 2), and pneumomediastinum (n = 1). CONCLUSION Q-SPECT/CT has clinical utility for diagnosing PE in patients with COVID-19 where there is a contraindication for iodinated contrast media and a moderate or high pre-test probability for PE.
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Affiliation(s)
- Jeeban P Das
- Department of Radiology/Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Randy Yeh
- Department of Radiology/Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heiko Schöder
- Department of Radiology/Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Wang L, Wang M, Yang T, Wu D, Xiong C, Fang W. A Prospective, Comparative Study of Ventilation–Perfusion Planar Imaging and Ventilation–Perfusion SPECT for Chronic Thromboembolic Pulmonary Hypertension. J Nucl Med 2020; 61:1832-1838. [DOI: 10.2967/jnumed.120.243188] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/16/2020] [Indexed: 12/28/2022] Open
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Quantitation of Perfused Lung Volume Using Hybrid SPECT/CT Allows Refining the Assessment of Lung Perfusion and Estimating Disease Extent in Chronic Thromboembolic Pulmonary Hypertension. Clin Nucl Med 2018; 43:e170-e177. [PMID: 29688945 DOI: 10.1097/rlu.0000000000002085] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We evaluated the feasibility of perfusion SPECT/CT for providing quantitative data for estimation of perfusion defect extent in chronic thromboembolic pulmonary hypertension (CTEPH). METHODS Thirty patients with CTEPH underwent Tc-human serum albumin lung perfusion SPECT/CT. Perfusion defects were quantified using 3 different methods: (1) visual, semiquantitative scoring of perfusion defect extent in each lung segment, (2) threshold-based segmentation of perfused lung volumes, and (3) threshold-based segmentation of perfused lung volumes divided by segmented lung volumes at CT (perfusion index). Imaging findings were correlated with right-sided heart catheterization results and N-terminal pro-B-type natriuretic peptide. Receiver operating characteristic analysis was performed to identify SPECT thresholds for mean pulmonary arterial pressure (PAPm) greater than 50 mm Hg. RESULTS Assessment of lung perfusion provided similar results using all 3 methods. The perfusion defect score correlated with PAPm (rs = 0.60, P = 0.0005) and was associated with serum levels of N-terminal pro-B-type natriuretic peptide (rs = 0.37, P = 0.04). Perfused lung volume (40% threshold, rs = -0.48, P = 0.007) and perfusion index (40% threshold, rs = -0.50, P = 0.005) decreased as PAPm increased. Receiver operating characteristic analysis showed that perfusion defect score (sensitivity, 88%; specificity, 77%; area under the curve [AUC] = 0.89, P = 0.001), perfused lung volume (sensitivity, 88%; specificity, 64%; AUC = 0.80, P = 0.01), and perfusion index (sensitivity, 88%; specificity, 64%; AUC = 0.82, P = 0.009) could identify patients with PAPm of greater than 50 mm Hg. CONCLUSIONS Quantitative analysis of perfusion defects at SPECT is feasible, provides a measure of disease severity, and correlates with established clinical parameters. Quantitation of perfusion SPECT may refine the diagnostic approach in CTEPH providing a quantitative imaging biomarker, for example, for therapy monitoring.
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Rengier F, Melzig C, Derlin T, Marra AM, Vogel-Claussen J. Advanced imaging in pulmonary hypertension: emerging techniques and applications. Int J Cardiovasc Imaging 2018; 35:1407-1420. [DOI: 10.1007/s10554-018-1448-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/24/2018] [Indexed: 02/07/2023]
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Masy M, Giordano J, Petyt G, Hossein-Foucher C, Duhamel A, Kyheng M, De Groote P, Fertin M, Lamblin N, Bervar JF, Remy J, Remy-Jardin M. Dual-energy CT (DECT) lung perfusion in pulmonary hypertension: concordance rate with V/Q scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). Eur Radiol 2018; 28:5100-5110. [PMID: 29846802 DOI: 10.1007/s00330-018-5467-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 03/29/2018] [Accepted: 04/09/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate the concordance between DECT perfusion and ventilation/perfusion (V/Q) scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). METHODS Eighty patients underwent V/Q scintigraphy and DECT perfusion on a 2nd- and 3rd-generation dual-source CT system. The imaging criteria for diagnosing CTEPH relied on at least one segmental triangular perfusion defect on DECT perfusion studies and V/Q mismatch on scintigraphy examinations. RESULTS Based on multidisciplinary expert decisions that did not include DECT perfusion, 36 patients were diagnosed with CTEPH and 44 patients with other aetiologies of PH. On DECT perfusion studies, there were 35 true positives, 6 false positives and 1 false negative (sensitivity 0.97, specificity 0.86, PPV 0.85, NPV 0.97). On V/Q scans, there were 35 true positives and 1 false negative (sensitivity 0.97, specificity 1, PPV 1, NPV 0.98). There was excellent agreement between CT perfusion and scintigraphy in diagnosing CTEPH (kappa value 0.80). Combined information from DECT perfusion and CT angiographic images enabled correct reclassification of the 6 false positives and the unique false negative case of DECT perfusion. CONCLUSION There is excellent agreement between DECT perfusion and V/Q scintigraphy in diagnosing CTEPH. The diagnostic accuracy of DECT perfusion is reinforced by the morpho-functional analysis of data sets. KEY POINTS • Chronic thromboembolic pulmonary hypertension (CTEPH) is potentially curable by surgery. • The triage of patients with pulmonary hypertension currently relies on scintigraphy. • Dual-energy CT (DECT) can provide standard diagnostic information and lung perfusion from a single acquisition. • There is excellent agreement between DECT perfusion and scintigraphy in separating CTEPH and non-CTEPH patients.
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Affiliation(s)
- Matthieu Masy
- Department of Thoracic Imaging, Calmette Hospital (EA 2694); CHRU et Université de Lille 2 Nord de France, F-59000, Lille, France
| | - Jessica Giordano
- Department of Thoracic Imaging, Calmette Hospital (EA 2694); CHRU et Université de Lille 2 Nord de France, F-59000, Lille, France
| | - Grégory Petyt
- Department of Nuclear Medicine; Salengro Hospital, University of Lille, CHU Lille, F-59000, Lille, France
| | - Claude Hossein-Foucher
- Department of Nuclear Medicine; Salengro Hospital, University of Lille, CHU Lille, F-59000, Lille, France
| | - Alain Duhamel
- Department of Biostatistics (EA 2694), CHRU et Université de Lille 2 Nord de France, F-59000, Lille, France
| | - Maeva Kyheng
- Department of Biostatistics (EA 2694), CHRU et Université de Lille 2 Nord de France, F-59000, Lille, France
| | - Pascal De Groote
- Department of Cardiology; Cardiology Hospital, University of Lille, CHU Lille, F-59000, Lille, France
- INSERM U1167, Institut Pasteur de Lille, F-59000, Lille, France
| | - Marie Fertin
- Department of Cardiology; Cardiology Hospital, University of Lille, CHU Lille, F-59000, Lille, France
- INSERM U1167, Institut Pasteur de Lille, F-59000, Lille, France
| | - Nicolas Lamblin
- Department of Cardiology; Cardiology Hospital, University of Lille, CHU Lille, F-59000, Lille, France
- INSERM U1167, Institut Pasteur de Lille, F-59000, Lille, France
| | - Jean-François Bervar
- Department of Pulmonology, Calmette Hospital; University of Lille, CHU Lille, F-59000, Lille, France
| | - Jacques Remy
- Department of Thoracic Imaging, Calmette Hospital (EA 2694); CHRU et Université de Lille 2 Nord de France, F-59000, Lille, France
| | - Martine Remy-Jardin
- Department of Thoracic Imaging, Calmette Hospital (EA 2694); CHRU et Université de Lille 2 Nord de France, F-59000, Lille, France.
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Milà M, Bechini J, Vázquez A, Vallejos V, Tenesa M, Espinal A, Fraile M, Monreal M. Acute pulmonary embolism detection with ventilation/perfusion SPECT combined with full dose CT: What is the best option? Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Milà M, Bechini J, Vázquez A, Vallejos V, Tenesa M, Espinal A, Fraile M, Monreal M. Acute pulmonary embolism detection with ventilation/perfusion SPECT combined with full dose CT: What is the best option? Rev Esp Med Nucl Imagen Mol 2017; 36:139-145. [PMID: 28185782 DOI: 10.1016/j.remn.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/21/2016] [Accepted: 11/01/2016] [Indexed: 11/16/2022]
Abstract
AIM To compare diagnostic accuracy of Ventilation/Perfusion (V/P) single-photon emission computed tomography (SPECT) combined with simultaneous full-dose CT with a hybrid SPECT/CT scanner versus planar ventilation/perfusion (V/P) SPECT and CT angiography (CTA) in patients suspected with acute pulmonary embolism (PE). METHODS Between 2009 and 2011, consecutive patients suspected of acute PE were referred for V/P SPECT/CT (reviewed board approved study). A contrast agent was administered to patients who had no contraindications. Non-contrast V/P SPECT/CT was performed on the remaining patients. All patients were followed-up for at least 3 months. RESULTS A total of 314 patients were available during the study period, with the diagnosis of PE confirmed in 70 (22.29%) of them. The overall population sensitivity and specificity was 90.91% and 92.44%, respectively for V/P SPECT, 80% and 99.15%, respectively, for CTA, and 95.52% and 97.08% for V/P SPECT/CT. SPECT/CT performed better than V/P SPECT (AUC differences=0.0419, P=0.0043, 95% CI; 0.0131-0.0706) and CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103-0.1259)). Comparing imaging modalities when contrast agent could be administered, sensitivity and specificity increased and V/P SPECT/CT was significantly better than CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103-0.1259) and V/P SPECT (AUC differences=0.0659, P=0.0052, 95% CI; 0.0197-0.1121). In case of non-contrast enhancement, there was non-significant increase of specificity. Secondary findings on CT impacted patient management in 14.65% of cases. CONCLUSION Our study shows that combined V/P SPECT/CT scanning has a higher diagnostic accuracy for detecting acute PE than V/P SPECT and CTA alone. When feasible, V/P SPECT/CT with contrast enhancement is the best option.
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Affiliation(s)
- M Milà
- Department of Nuclear Medicine (ICS-IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
| | - J Bechini
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - A Vázquez
- Applied Statistics Service, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Vallejos
- Department of Nuclear Medicine (ICS-IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - M Tenesa
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - A Espinal
- Applied Statistics Service, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Fraile
- Department of Nuclear Medicine (ICS-IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - M Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Leuschner G, Wenter V, Milger K, Zimmermann GS, Matthes S, Meinel FG, Lehner S, Neurohr C, Behr J, Kneidinger N. Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography. Respirology 2016; 21:1081-7. [PMID: 27061739 DOI: 10.1111/resp.12797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/30/2015] [Accepted: 02/01/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Pulmonary embolism (PE) is a common differential diagnosis in patients with pulmonary fibrosis presenting with a clinical deterioration. Both ventilation/perfusion (V/Q)-single photon emission computed tomography (SPECT) and computed tomographic pulmonary angiography (CTPA) are routinely used to detect PE. However, the value of V/Q-SPECT and CTPA in this scenario has not been studied so far. We aimed to investigate the concordance of V/Q-SPECT and CTPA in patients with pulmonary fibrosis and suspicion of pulmonary embolism. METHODS A total of 22 consecutive patients with pulmonary fibrosis and clinical deterioration who underwent both V/Q-SPECT and CTPA were included in the study and analyzed for the presence of pulmonary embolism. RESULTS Nine of 22 patients (41%) had evidence for pulmonary embolism in V/Q-SPECT, and two of these patients had matching evidence for pulmonary embolism in CTPA. In the other seven patients with positive findings in V/Q-SPECT, no evidence of pulmonary embolism was found in CTPA. None of the 13 patients with a negative V/Q-SPECT had evidence for pulmonary embolism in CTPA. CONCLUSION In patients with pulmonary fibrosis and suspected pulmonary embolism, pulmonary embolism is detected more frequently by V/Q-SPECT than by CTPA. Thromboembolic disease is identified on CTPA only in a minority of patients with positive findings on V/Q-SPECT. When making treatment decisions, clinicians should be aware of the high rate of discordant findings in V/Q-SPECT and CTPA in this specific patient population.
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Affiliation(s)
- Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Vera Wenter
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Gregor S Zimmermann
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Sandhya Matthes
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Felix G Meinel
- Institute for Clinical Radiology, University of Munich, Munich, Germany
| | - Sebastian Lehner
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Claus Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Chronic thromboembolic pulmonary hypertension: Comparison of dual-energy computed tomography and single photon emission computed tomography in canines. Eur J Radiol 2015; 85:498-506. [PMID: 26781157 DOI: 10.1016/j.ejrad.2015.11.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare diagnostic accuracy between dual-energy CT lung perfused blood volume (Lung PBV) imaging and single photon emission computed tomography (SPECT) in detecting chronic thromboembolic pulmonary hypertension (CTEPH) with histopathological results as reference standard in a canine model. MATERIALS AND METHODS Eighteen CTEPH canines were included into this experimental study. All procedures including paracentesis, embolization, scanning, pressure measurement and feeding medicine were repeated each two weeks, until systolic/diastolic pressure in canines was ≥ 30/15 mm Hg or mean pulmonary artery pressure ≥ 20 mm Hg, and then sacrificed for histopathology examination. Two radiologists (readers 1 and 2) and two nuclear radiologists (readers 3 and 4) analyzed images of conventional CT pulmonary angiography in dual-energy CT mode, Lung PBV imaging and SPECT, respectively. The presence, numbers, and locations of pulmonary emboli (PE) were recorded on a per-lobe basis. Pathological examination was served as reference standard. Sensitivity, specificity and accuracy of Lung PBV and SPECT were calculated. Kappa statistics were used to quantify inter-reader agreement. RESULTS With histopathological results as reference standard, the sensitivities of 72.2%, 78.8%, 81.2%, specificities of 75.9%, 87.5%, 84.8%, accuracies of 73.8%, 83.1%, 83.1%, for readers 1, 2 and both with Lung PBV, respectively. Readers 3, 4 and both had sensitivities of 14.3%, 25.7%, 33.3%, specificities of 90.0%, 86.7%, 93.3%, accuracies of 49.2%, 53.8%, 60.0% with SPECT for detecting CTEPH. Inter-reader agreements were good for dual-energy CT (kappa=0.662) and SPECT (k=0.706) for detecting CTEPH. CONCLUSION Dual-energy CT had a higher accuracy to detect CTEPH than SPECT in this canine model study.
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Mazurek A, Dziuk M, Witkowska-Patena E, Piszczek S, Gizewska A. The Utility of Hybrid SPECT/CT Lung Perfusion Scintigraphy in Pulmonary Embolism Diagnosis. Respiration 2015; 90:393-401. [PMID: 26418469 DOI: 10.1159/000439543] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/Q) scintigraphy or pulmonary CT angiography. One of the imaging methods used in nuclear medicine is hybrid SPECT/CT scintigraphy. OBJECTIVES The aim of this study was to evaluate the utility of SPECT/CT(Q) scintigraphy in the diagnosis of PE and to compare SPECT/CT(Q) with planar(Q) and SPECT(Q) methods. METHODS The study group consisted of 109 consecutive patients suspected of having PE referred for performing lung scintigraphy. The inclusion criteria were: performance of perfusion planar, SPECT and SPECT/CT scans; availability of clinical data covering a 6-month follow-up period, and D-dimer level testing. The number of eligible patients was 84. PE was reported in patients with at least 1 segmental or 2 subsegmental perfusion defects without parenchymal abnormalities on CT scans. PE was excluded when there was a normal perfusion pattern or perfusion defects were caused by lung parenchymal abnormalities or were not arranged in accordance with the pulmonary vasculature. RESULTS Twenty-six patients (31%) had a final diagnosis of PE. The sensitivity and specificity values of each method were as follows: planar(Q) 73 and 43%, SPECT(Q) 88 and 47% and SPECT/CT(Q) 100 and 83%. SPECT/CT(Q) yielded a significantly higher diagnostic accuracy than planar(Q) (p < 0.001) and SPECT(Q) (p < 0.001) scans. CONCLUSIONS We conclude that hybrid SPECT/CT(Q) imaging has a high diagnostic efficacy in the diagnosis of PE. Lung perfusion scintigraphy performed with a hybrid SPECT/CT device has a significantly higher sensitivity and specificity than scanning performed with the planar or SPECT technique.
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Affiliation(s)
- Andrzej Mazurek
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
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Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate. Nucl Med Mol Imaging 2015; 49:303-11. [PMID: 26550050 DOI: 10.1007/s13139-015-0359-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/22/2015] [Accepted: 07/28/2015] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To investigate the diagnostic performance of perfusion single-photon emission computed tomography/computed tomography (Q-SPECT/CT) in patients suspected to have pulmonary embolism (PE) but with indeterminate computed tomographic pulmonary angiography (CTPA) or planar ventilation/perfusion (V/Q) scans. METHODS This retrospective study included two groups of patients. Group I consisted of 49 patients with nondiagnostic CTPA. These 49 patients underwent subsequent V/Q scans. Further Q-SPECTs were obtained in patients with indeterminate planar images and fused with existing CTPA. Group II consisted of 182 non-CTPA patients with indeterminate V/Q scans. These 182 patients underwent further Q-SPECT and separate noncontrast low-dose CT chest. Fusion Q-SPECT/CT scans were obtained through FDA-approved software and interpreted according to published criteria as positive, negative, or indeterminate for PE. Upon retrospective analyses, the final diagnosis was made using composite reference standards including all available clinical and imaging information for at least 6-month follow-up. RESULTS In group I patients, 1 was positive, 24 were negative, and another 24 (49 %, 24/49) were indeterminate. In the subsequent 24 Q-SPECT/CTPAs, 4 were positive, 19 were negative, and 1 was indeterminate (4.2 %, 1/24). In group II patients, 9 (4.9 %, 9/182) were indeterminate, 33 were positive, and 140 were negative. The combined nondiagnostic rate for Q-SPECT/CT was only 4.9 % (10/206). There was six false-negative and one false-positive Q-SPECT/CT examinations. The sensitivity, specificity, and positive and negative predictive value of Q-SPECT/CT were 85.7 % (36/42), 99.4 % (153/154), 97.3 % (36/37) and 96.2 % (153/159), respectively. CONCLUSIONS Q-SPECT/CT improves the diagnostic rate with promising accuracy in diagnosing PE that yields a satisfactory clinical verdict, especially when the CTPA and planar V/Q scan are indeterminate.
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Starmans LWE, Moonen RPM, Aussems-Custers E, Daemen MJAP, Strijkers GJ, Nicolay K, Grüll H. Evaluation of iron oxide nanoparticle micelles for magnetic particle imaging (MPI) of thrombosis. PLoS One 2015; 10:e0119257. [PMID: 25746677 PMCID: PMC4352001 DOI: 10.1371/journal.pone.0119257] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/12/2015] [Indexed: 11/19/2022] Open
Abstract
Magnetic particle imaging (MPI) is an emerging medical imaging modality that directly visualizes magnetic particles in a hot-spot like fashion. We recently developed an iron oxide nanoparticle-micelle (ION-Micelle) platform that allows highly sensitive MPI. The goal of this study was to assess the potential of the ION-Micelles for MPI-based detection of thrombi. To this aim, an in vivo carotid artery thrombosis mouse model was employed and ex vivo magnetic particle spectrometer (MPS) measurements of the carotid arteries were performed. In addition, we studied the effect of functionalization of the ION-Micelle nanoplatform with fibrin-binding peptides (FibPeps) with respect to nanoparticle thrombus uptake and hence thrombus detection. In vivo quantitative MR imaging pre- and post-ION-Micelle injection was performed as reference for visualization of ION-micelle uptake. ION-Micelles significantly decreased T2 values in the thrombi with respect to pre-injection T2 values (p < 0.01) and significantly increased ex vivo MPS thrombus signal with respect to the noninjured, contralateral carotid (p < 0.01). Functionalization of the ION-Micelles with the FibPep peptides did not result in an increased MPS thrombus signal with respect to the non-fibrin binding ION-Micelles. The lack of a significant increased thrombus uptake for the FibPep-ION-Micelles indicates that (non-fibrin-specific) entrapment of nanoparticles in the mesh-like thrombi is the key contributor to thrombus nanoparticle uptake. Therefore, (nontargeted) ION-Micelles might be of value for noninvasive MPI-based diagnosis, characterization and treatment monitoring of thrombosis.
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Affiliation(s)
- Lucas W. E. Starmans
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Rik P. M. Moonen
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | - Mat J. A. P. Daemen
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | - Gustav J. Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Holger Grüll
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Oncology Solutions, Philips Research, Eindhoven, the Netherlands
- * E-mail:
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Ziessman HA. Ventilation–Perfusion Scanning: Stuck in a Rut, Perhaps, but the Road Ahead Is Not So Clear. J Nucl Med 2014; 55:2079-80. [DOI: 10.2967/jnumed.114.149203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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