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Lee S, Lee HY, Park J, Kim H, Park JY. Assessment of Pulmonary Ventilation Using 3D Ventilation Flow Capacity-Weighted and Ventilation-Weighted Maps From 3D Ultrashort Echo Time (UTE) MRI. J Magn Reson Imaging 2024; 60:483-494. [PMID: 37970646 DOI: 10.1002/jmri.29129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) ventilation flow capacity-weighted (VFCW) maps together with 3D ventilation-weighted (VW) maps may help to better assess pulmonary function. PURPOSE To investigate the use of 3D VFCW and VW maps for evaluating pulmonary ventilation function. STUDY TYPE Prospective. POPULATION Two patients (one male, 85 years old; one female, 64 years old) with chronic obstructive pulmonary disease (COPD) and nine healthy subjects (all male; 23-27 years). FIELD STRENGTH/SEQUENCE 3-T, 3D radial UTE imaging. ASSESSMENT 3D VFCW and VW maps were calculated from 3D UTE MRI by voxel-wise subtraction of respiratory phase images. Their validation was tested in nine healthy volunteers using slow/deep and fast/shallow breathing conditions. Additional validation was performed by comparison with single photon emission computed tomography (SPECT) ventilation maps of one healthy participant. For comparison, gravity dependence of anterior-posterior regional ventilation was assessed by one-dimensional plot of the mean signal intensity for each coronal slice. Structural similarity index measure was also calculated. Finally, VW maps and VFCW maps of two COPD patients were evaluated for emphysema lesions with reference to CT images. STATISTICAL TESTS Wilcoxon sign-rank tests for regional Ventilation and ventilation flow capacity, analysis of variance, post-hoc t-tests and Bonferroni correction, coefficient of variation, Kullback-Liebler divergence. A P-value <0.05 was considered statistically significant. RESULTS The validation of 3D VFCW and VW maps was shown by statistically significant differences in ventilation flow capacity and ventilation between the breathing conditions. Additionally, UTE-MRI and SPECT-based ventilation maps showed gravitational dependence in the anteroposterior direction. When applied to patients with COPD, the use of 3D VFCW and VW maps was able to differentiate between two patients with different phenotypes. DATA CONCLUSION The use of 3D VFCW and VW maps can provide regional information on ventilation function and potentially contribute to assessment of COPD subtypes and disease progression. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Seokwon Lee
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jinil Park
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hyeonha Kim
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Jang-Yeon Park
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
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Le Pennec R, Schaefer W, Tulchinsky M, Lamoureux F, Roach P, Rischpler C, Zukotynski K, O'Brien C, Murphy D, Pascal P, Le Gal G, Salaun PY, Le Roux PY. Performance and Interpretation of Lung Scintigraphy: An Evaluation of Current Practices in Australia, Canada, France, Germany, and United States. Clin Nucl Med 2024:00003072-990000000-01231. [PMID: 39086050 DOI: 10.1097/rlu.0000000000005396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE Although ventilation/perfusion (V/Q) scintigraphy is a widely used imaging test, different options are possible for the acquisition and interpretation of the scan. The aim of this study was to assess current practices regarding the use and interpretation of lung scintigraphy in various clinical indications. PATIENTS AND METHODS An online survey comprising 25 questions was sent to nuclear medicine departments in Australia, Canada, France, Germany, and United States between 2022 and 2023. A single response per department was consolidated. RESULTS Four hundred nineteen responses were collected (Australia: 32, Canada: 58, France: 149, Germany: 92, and United States: 88). For acute pulmonary embolism (PE) diagnosis, 82.8% of centers reported using SPECT acquisitions (Australia: 93.3%, Canada: 91.8%, France: 99.2%, Germany: 96.2%, and United States: 32.1%). Among them, SPECT images were combined with a CT scan in 70.5% of centers. A total of 10.6% of centers reported not using ventilation for acute PE diagnosis. SPECT acquisition was used in 97.8% of centers using 99mTc carbon particles, 97.1% 81mKr gas, 58.7% 99mTc-DTPA, and 19.4% 133Xe gas, respectively. For V/Q SPECT interpretation, the EANM criteria were used in 65.0% of departments. A very wide variety of practices were observed in pregnant women and in COVID-19 patients. SPECT acquisition was widely used in the follow-up of PE and for the screening of chronic thromboembolic pulmonary hypertension (>90% of centers), with inconsistency regarding the interpretation of matched perfusion defects in this setting. CONCLUSIONS This survey shows the strong adoption of SPECT in the various clinical indications of lung scintigraphy, except in the United States, where planar imaging is still mostly used. The survey also shows variability in interpretation criteria both for PE diagnosis and screening for chronic thromboembolic pulmonary hypertension, highlighting the need for further standardizations of practices.
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Affiliation(s)
- Romain Le Pennec
- From the Univ Brest, CHU Brest, Médecine Nucléaire, GETBO, UMR1304, Brest, France
| | - Wolfgang Schaefer
- Department of Nuclear Medicine, Maria Hilf Hospital, Mönchengladbach, Germany
| | - Mark Tulchinsky
- Division of Nuclear Medicine, Department of Radiology, Penn State University, Hershey, PA
| | | | - Paul Roach
- Royal North Shore Hospital, Sydney, Australia
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Katherine Zukotynski
- Departments of Radiology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Pierre-Yves Salaun
- From the Univ Brest, CHU Brest, Médecine Nucléaire, GETBO, UMR1304, Brest, France
| | - Pierre-Yves Le Roux
- From the Univ Brest, CHU Brest, Médecine Nucléaire, GETBO, UMR1304, Brest, France
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Qing K, Altes TA, Mugler JP, Tustison NJ, Mata JF, Ruppert K, Komlosi P, Feng X, Nie K, Zhao L, Wang Z, Hersman FW, Ruset IC, Liu B, Shim YM, Teague WG. Pulmonary MRI with hyperpolarized xenon-129 demonstrates novel alterations in gas transfer across the air-blood barrier in asthma. Med Phys 2024; 51:2413-2423. [PMID: 38431967 PMCID: PMC10994727 DOI: 10.1002/mp.17009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/20/2023] [Accepted: 02/03/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Individuals with asthma can vary widely in clinical presentation, severity, and pathobiology. Hyperpolarized xenon-129 (Xe129) MRI is a novel imaging method to provide 3-D mapping of both ventilation and gas exchange in the human lung. PURPOSE To evaluate the functional changes in adults with asthma as compared to healthy controls using Xe129 MRI. METHODS All subjects (20 controls and 20 asthmatics) underwent lung function measurements and Xe129 MRI on the same day. Outcome measures included the pulmonary ventilation defect and transfer of inspired Xe129 into two soluble compartments: tissue and blood. Ten asthmatics underwent Xe129 MRI before and after bronchodilator to test whether gas transfer measures change with bronchodilator effects. RESULTS Initial analysis of the results revealed striking differences in gas transfer measures based on age, hence we compared outcomes in younger (n = 24, ≤ 35 years) versus older (n = 16, > 45 years) asthmatics and controls. The younger asthmatics exhibited significantly lower Xe129 gas uptake by lung tissue (Asthmatic: 0.98% ± 0.24%, Control: 1.17% ± 0.12%, P = 0.035), and higher Xe129 gas transfer from tissue to the blood (Asthmatic: 0.40 ± 0.10, Control: 0.31% ± 0.03%, P = 0.035) than the younger controls. No significant difference in Xe129 gas transfer was observed in the older group between asthmatics and controls (P > 0.05). No significant change in Xe129 transfer was observed before and after bronchodilator treatment. CONCLUSIONS By using Xe129 MRI, we discovered heterogeneous alterations of gas transfer that have associations with age. This finding suggests a heretofore unrecognized physiological derangement in the gas/tissue/blood interface in young adults with asthma that deserves further study.
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Affiliation(s)
- Kun Qing
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Talissa A. Altes
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - John P. Mugler
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA USA
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA USA
| | - Nicholas J. Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA USA
| | - Jaime F. Mata
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA USA
| | - Kai Ruppert
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Komlosi
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xue Feng
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA USA
| | - Ke Nie
- Department of Radiation Oncology, Rutgers University, New Brunswick, NJ, USA
| | - Li Zhao
- Department of Biomedical Engineering, Zhejiang University, Hangzhou, ZJ, China
| | - Zhixing Wang
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - F. William Hersman
- Department of Physics, University of New Hampshire, Durham, NH, USA
- Xemed LLC, Durham, NH, USA
| | | | - Bo Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Y. Michael Shim
- Department of Medicine, University of Virginia, Charlottesville, VA USA
| | - W. Gerald Teague
- Child Health Research Center and the Division of Respiratory Medicine, Allergy, and Immunology, University of Virginia, School of Medicine, Charlottesville, VA, USA
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4
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Leblanc M, Tessier M, Ollenberger G, O'Brien C, Zuckier LS. Guidelines for ventilation/perfusion (V/P SPECT) in pulmonary embolism. J Med Imaging Radiat Sci 2024; 55:158-162. [PMID: 37996383 DOI: 10.1016/j.jmir.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 11/25/2023]
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5
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Maughan BC, Jarman AF, Redmond A, Geersing GJ, Kline JA. Pulmonary embolism. BMJ 2024; 384:e071662. [PMID: 38331462 DOI: 10.1136/bmj-2022-071662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Brandon C Maughan
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Angela F Jarman
- Department of Emergency Medicine, University of California Davis, Sacramento, CA
| | | | - Geert-Jan Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jeffrey A Kline
- Department of Emergency Medicine, Wayne State School of Medicine, Detroit, MI
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6
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Siora A, Vontetsianos A, Chynkiamis N, Anagnostopoulou C, Bartziokas K, Anagnostopoulos N, Rovina N, Bakakos P, Papaioannou AI. Small airways in asthma: From inflammation and pathophysiology to treatment response. Respir Med 2024; 222:107532. [PMID: 38228215 DOI: 10.1016/j.rmed.2024.107532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/02/2024] [Accepted: 01/13/2024] [Indexed: 01/18/2024]
Abstract
Small airways are characterized as those with an inner diameter less than 2 mm and constitute a major site of pathology and inflammation in asthma disease. It is estimated that small airways dysfunction may occur before the emergence of noticeable symptoms, spirometric abnormalities and imaging findings, thus characterizing them as "the quiet or silent zone" of the lungs. Despite their importance, measuring and quantifying small airways dysfunction presents a considerable challenge due to their inaccessibility in usual functional measurements, primarily due to their size and peripheral localization. Several pulmonary function tests have been proposed for the assessment of the small airways, including impulse oscillometry, nitrogen washout, body plethysmography, as well as imaging methods. Nevertheless, none of these methods has been established as the definitive "gold standard," thus, a combination of them should be used for an effective assessment of the small airways. Widely used asthma treatments seem to also affect several parameters of the small airways. Emerging biologic treatments show promising results in reducing small airways inflammation and remodelling, providing evidence for potential alterations in the disease's progression and outcomes. These novel therapies have implications not only in the clinical aspects of asthma but also in its inflammatory and functional aspects.
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Affiliation(s)
- Anastasia Siora
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Athens, Greece.
| | - Angelos Vontetsianos
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Athens, Greece
| | - Nikolaos Chynkiamis
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Athens, Greece
| | - Christina Anagnostopoulou
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Athens, Greece
| | | | - Nektarios Anagnostopoulos
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Athens, Greece
| | - Nikoletta Rovina
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Athens, Greece
| | - Petros Bakakos
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Athens, Greece
| | - Andriana I Papaioannou
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Athens, Greece
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7
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Zhang Z, Li H, Xiao S, Zhou Q, Liu S, Zhou X, Fan L. Hyperpolarized Gas Imaging in Lung Diseases: Functional and Artificial Intelligence Perspective. Acad Radiol 2024:S1076-6332(24)00014-X. [PMID: 38233260 DOI: 10.1016/j.acra.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
Pathophysiologic changes in lung diseases are often accompanied by changes in ventilation and gas exchange. Comprehensive evaluation of lung function cannot be obtained through chest X-ray and computed tomography. Proton-based lung MRI is particularly challenging due to low proton density within the lung tissue. In this review, we discuss an emerging technology--hyperpolarized gas MRI with inhaled 129Xe, which provides functional and microstructural information and has the potential as a clinical tool for detecting the early stage and progression of certain lung diseases. We review the hyperpolarized 129Xe MRI studies in patients with a range of pulmonary diseases, including chronic obstructive pulmonary disease, asthma, cystic fibrosis, pulmonary hypertension, radiation-induced lung injury and interstitial lung disease, and the applications of artificial intelligence were reviewed as well.
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Affiliation(s)
- Ziwei Zhang
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, People's Republic of China (Z.Z., S.L., L.F.)
| | - Haidong Li
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovative Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430071, China (H.L., S.X., Q.Z., X.Z.); University of Chinese Academy of Sciences, Beijing 100049, China (H.L., S.X., X.Z.)
| | - Sa Xiao
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovative Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430071, China (H.L., S.X., Q.Z., X.Z.); University of Chinese Academy of Sciences, Beijing 100049, China (H.L., S.X., X.Z.)
| | - Qian Zhou
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovative Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430071, China (H.L., S.X., Q.Z., X.Z.)
| | - Shiyuan Liu
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, People's Republic of China (Z.Z., S.L., L.F.)
| | - Xin Zhou
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovative Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430071, China (H.L., S.X., Q.Z., X.Z.); University of Chinese Academy of Sciences, Beijing 100049, China (H.L., S.X., X.Z.)
| | - Li Fan
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, People's Republic of China (Z.Z., S.L., L.F.).
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Larrabee S, Nugen S, Bruhn A, Porter I, Stowe S, Adler A, Martin-Flores M, Araos J. Three-dimensional electrical impedance tomography to study regional ventilation/perfusion ratios in anesthetized pigs. Am J Physiol Lung Cell Mol Physiol 2023; 325:L638-L646. [PMID: 37724348 DOI: 10.1152/ajplung.00180.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
This study aimed to develop a three-dimensional (3-D) method for assessing ventilation/perfusion (V/Q̇) ratios in a pig model of hemodynamic perturbations using electrical impedance tomography (EIT). To evaluate the physiological coherence of changes in EIT-derived V/Q̇ ratios, global EIT-derived V/Q̇ mismatches were compared with global gold standards. The study found regional heterogeneity in the distribution of V/Q̇ ratios in both the ventrodorsal and craniocaudal directions. Although global EIT-derived indices of V/Q̇ mismatch consistently underestimated both low and high V/Q̇ mismatch compared with global gold standards, the direction of the change was similar. We made the software available at no cost for other researchers to use. Future studies should compare regional V/Q̇ ratios determined by our method against other regional, high-resolution methods.NEW & NOTEWORTHY In this study, we introduce a novel 3-D method for assessing ventilation-perfusion (V/Q̇) ratios using electrical impedance tomography (EIT). Heterogeneity in V/Q̇ distribution showcases the significant potential for enhanced understanding of pulmonary conditions. This work signifies a substantial step forward in the application of EIT for monitoring and managing lung diseases.
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Affiliation(s)
- Shannon Larrabee
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Sarah Nugen
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ian Porter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Symon Stowe
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Andy Adler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Manuel Martin-Flores
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Joaquin Araos
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
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9
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Verrecchia-Ramos E, Morel O, Ginet M, Retif P, Ben Mahmoud S. Clinical validation of an AI-based automatic quantification tool for lung lobes in SPECT/CT. EJNMMI Phys 2023; 10:57. [PMID: 37733103 PMCID: PMC10513978 DOI: 10.1186/s40658-023-00578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Lung lobar ventilation and perfusion (V/Q) quantification is generally obtained by generating planar scintigraphy images and then imposing three equally sized regions of interest on the data of each lung. This method is fast but not as accurate as SPECT/CT imaging, which provides three-dimensional data and therefore allows more precise lobar quantification. However, the manual delineation of each lobe is time-consuming, which makes SPECT/CT incompatible with the clinical workflow for V/Q estimation. An alternative may be to use artificial intelligence-based auto-segmentation tools such as AutoLung3D (Siemens Healthineers, Knoxville, USA), which automatically delineate the lung lobes on the CT data acquired with the SPECT data. The present study assessed the clinical validity of this approach relative to planar scintigraphy and manual quantification in SPECT/CT. METHODS The Autolung3D software was tested on the retrospective SPECT/CT data of 43 patients who underwent V/Q scintigraphy with 99mTc-macroaggregated albumin and 99mTc-labeled aerosol. It was compared to planar scintigraphy and SPECT/CT using the manual quantification method in terms of relative lobar V/Q quantification values and interobserver variability. RESULTS The three methods provided similar V/Q estimates for the left lung lobes and total lungs. However, compared to the manual SPECT/CT method, planar scintigraphy yielded significantly higher estimates for the middle right lobe and significantly lower estimates for the superior and inferior right lobes. The estimates of the manual and automated SPECT/CT methods were similar. However, the post-processing time in the automated method was approximately 5 min compared to 2 h for the manual method. Moreover, the automated method associated with a drastic reduction in interobserver variability: Its maximal relative standard deviation was only 5%, compared to 23% for planar scintigraphy and 19% for the manual SPECT/CT method. CONCLUSIONS This study validated the AutoLung3D software for general clinical use since it rapidly provides accurate lobar quantification in V/Q scans with markedly less interobserver variability than planar scintigraphy or the manual SPECT/CT method.
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Affiliation(s)
- Emilie Verrecchia-Ramos
- Department of Medical Physics, Mercy Hospital, CHR Metz-Thionville, 1, Allée du Château, 57530, Ars-Laquenexy, France.
| | - Olivier Morel
- Department of Nuclear Medicine, Mercy Hospital, CHR Metz-Thionville, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Merwan Ginet
- Department of Nuclear Medicine, Mercy Hospital, CHR Metz-Thionville, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Paul Retif
- Department of Medical Physics, Mercy Hospital, CHR Metz-Thionville, 1, Allée du Château, 57530, Ars-Laquenexy, France
- CNRS, CRAN, Université de Lorraine, 54000, Nancy, France
| | - Sinan Ben Mahmoud
- Department of Nuclear Medicine, Mercy Hospital, CHR Metz-Thionville, 1, Allée du Château, 57530, Ars-Laquenexy, France
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10
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Radadia N, Friedlander Y, Priel E, Konyer NB, Huang C, Jamal M, Farncombe T, Marriott C, Finley C, Agzarian J, Dolovich M, Noseworthy MD, Nair P, Shargall Y, Svenningsen S. Comparison of ventilation defects quantified by Technegas SPECT and hyperpolarized 129Xe MRI. Front Physiol 2023; 14:1133334. [PMID: 37234422 PMCID: PMC10206636 DOI: 10.3389/fphys.2023.1133334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/03/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction: The ideal contrast agents for ventilation SPECT and MRI are Technegas and 129Xe gas, respectively. Despite increasing interest in the clinical utility of ventilation imaging, these modalities have not been directly compared. Therefore, our objective was to compare the ventilation defect percent (VDP) assessed by Technegas SPECT and hyperpolarized 129Xe MRI in patients scheduled to undergo lung cancer resection with and without pre-existing obstructive lung disease. Methods: Forty-one adults scheduled to undergo lung cancer resection performed same-day Technegas SPECT, hyperpolarized 129Xe MRI, spirometry, and diffusing capacity of the lung for carbon monoxide (DLCO). Ventilation abnormalities were quantified as the VDP using two different methods: adaptive thresholding (VDPT) and k-means clustering (VDPK). Correlation and agreement between VDP quantified by Technegas SPECT and 129Xe MRI were determined by Spearman correlation and Bland-Altman analysis, respectively. Results: VDP measured by Technegas SPECT and 129Xe MRI were correlated (VDPT: r = 0.48, p = 0.001; VDPK: r = 0.63, p < 0.0001). A 2.0% and 1.6% bias towards higher Technegas SPECT VDP was measured using the adaptive threshold method (VDPT: 23.0% ± 14.0% vs. 21.0% ± 5.2%, p = 0.81) and k-means method (VDPK: 9.4% ± 9.4% vs. 7.8% ± 10.0%, p = 0.02), respectively. For both modalities, higher VDP was correlated with lower FEV1/FVC (SPECT VDPT: r = -0.38, p = 0.01; MRI VDPK: r = -0.46, p = 0.002) and DLCO (SPECT VDPT: r = -0.61, p < 0.0001; MRI VDPK: r = -0.68, p < 0.0001). Subgroup analysis revealed that VDP measured by both modalities was significantly higher for participants with COPD (n = 13) than those with asthma (n = 6; SPECT VDPT: p = 0.007, MRI VDPK: p = 0.006) and those with no history of obstructive lung disease (n = 21; SPECT VDPT: p = 0.0003, MRI VDPK: p = 0.0003). Discussion: The burden of ventilation defects quantified by Technegas SPECT and 129Xe MRI VDP was correlated and greater in participants with COPD when compared to those without. Our observations indicate that, despite substantial differences between the imaging modalities, quantitative assessment of ventilation defects by Technegas SPECT and 129Xe MRI is comparable.
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Affiliation(s)
- Nisarg Radadia
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Yonni Friedlander
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Eldar Priel
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Norman B. Konyer
- Imaging Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Chynna Huang
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Mobin Jamal
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Troy Farncombe
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Department of Nuclear Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Christopher Marriott
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Department of Nuclear Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Christian Finley
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - John Agzarian
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Myrna Dolovich
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Michael D. Noseworthy
- Imaging Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Yaron Shargall
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Sarah Svenningsen
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
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11
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Martins GH, Contardi EB, Lopes DM, de Souza TF, Grangeia TA, Dertkigil SS, Amorim BJ, Ramos CD. Head-to-head comparison of ventilation/perfusion single photon emission computed tomography/computed tomography and multidetector computed tomography angiography for the detection of acute pulmonary embolism in clinical practice. Perfusion 2023; 38:637-644. [PMID: 35225074 DOI: 10.1177/02676591221075934] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Computed tomography angiography (CTA) and ventilation/perfusion (V/Q) single photon emission computed tomography/CT (SPECT/CT) images have been widely used to detect PE, but few studies have performed a direct comparison between them. We aimed to evaluate the performance of these tests in the same group of patients, selected from the routine practice of a general hospital. METHODS Patients with suspected acute PE were prospectively submitted to CTA and V/Q SPECT/CT. General radiologists and nuclear physicians, respectively, interpreted the images. Data regarding age, sex, time between examinations, symptoms, and Wells score were also recorded. The final diagnosis was decided through a consensus among the clinicians, taking into account clinical, laboratory, follow-up, and all imaging procedures data. RESULTS Twenty-eight patients (15 male, 13 female, and median age of 51.5 years) were studied. Median duration of the onset of symptoms was 4 (1-14) days, and the median Wells score was 3.5 (1.5-6). Sensitivity, specificity, positive and negative predictive values, and accuracy were 84.6%, 80.0%, 78.6%, 85.7%, and 82.1% for V/Q SPECT/CT, and 46.1%, 100%, 100%, 68.2%, and 75.0% for CTA. The overall agreement between the methods was 57.1%. Of the 22 patients with negative CTA, 10 (45.4%) had positives V/Q SPECT/CT and seven of them classified as true positives. CONCLUSIONS Our results suggest that V/Q SPECT/CT is more sensitive and accurate than CTA when interpreted by general radiologists and nuclear medicine physicians.
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Affiliation(s)
- Gustavo H Martins
- Division of Nuclear Medicine of the Department of Radiology, 28132University of Campinas (UNICAMP), Campinas, Brazil
| | - Ewandro B Contardi
- Department of Radiology, 28132University of Campinas (UNICAMP), Campinas, Brazil
| | - Djon M Lopes
- Department of Internal Medicine, 28132Campinas State University (UNICAMP), Campinas, Brazil
| | - Thiago F de Souza
- Division of Nuclear Medicine of the Department of Radiology, 28132University of Campinas (UNICAMP), Campinas, Brazil
| | - Tiago Ag Grangeia
- Department of Internal Medicine, 28132Campinas State University (UNICAMP), Campinas, Brazil
| | - Sergio Sj Dertkigil
- Department of Radiology, 28132University of Campinas (UNICAMP), Campinas, Brazil
| | - Bárbara J Amorim
- Division of Nuclear Medicine of the Department of Radiology, 28132University of Campinas (UNICAMP), Campinas, Brazil
| | - Celso D Ramos
- Division of Nuclear Medicine of the Department of Radiology, 28132University of Campinas (UNICAMP), Campinas, Brazil
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12
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Currie GM, Bailey DL. V/Q SPECT and SPECT/CT in Pulmonary Embolism. J Nucl Med Technol 2023; 51:9-15. [PMID: 36599703 DOI: 10.2967/jnmt.122.264880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
Ventilation and perfusion (V/Q) lung scintigraphy has been used in the assessment of patients with suspected pulmonary embolism for more than 50 y. Advances in imaging technology make SPECT and SPECT/CT feasible. This article will examine the application and technical considerations associated with performing 3-dimensional V/Q SPECT and the contribution of a coacquired CT scan. The literature tends to be mixed and contradictory in terms of appropriate investigation algorithms for pulmonary embolism. V/Q SPECT and SPECT/CT offer significant advantages over planar V/Q, with or without the advantages of Technegas ventilation, and if available should be the preferred option in the evaluation of patients with suspected pulmonary embolism.
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Affiliation(s)
- Geoffrey M Currie
- Charles Sturt University, Wagga Wagga, New South Wales, Australia, and Baylor College of Medicine, Houston, Texas; and
| | - Dale L Bailey
- Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia
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13
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Xue P, Fu Y, Zhang J, Ma L, Ren M, Zhang Z, Dong E. Effective lung ventilation estimation based on 4D CT image registration and supervoxels. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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14
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Remillard TC, Kodra A, Kim M. Diagnosis, Diagnostic Tools, and Risk Stratification for Contemporary Treatment of Pulmonary Embolism. Int J Angiol 2022; 31:150-154. [PMID: 36157099 PMCID: PMC9507591 DOI: 10.1055/s-0042-1756177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Pulmonary embolism (PE) is quite common and is associated with significant morbidity and mortality. It is estimated that it is the cause of approximately 100,000 annual deaths in the United States. With great variability in presenting symptoms of PE, poor recognition of PE can be fatal. As such, many risk scores have been created to identify the sickest patients. Choosing the appropriate imaging modality is also critical. Invasive pulmonary angiography was once the gold standard to establish the diagnosis. With the advent of nuclear imaging, V/Q scans, invasive angiography has been phased out for diagnosing acute PE. At present, the standard for diagnosis of acute PE is computed tomography pulmonary angiography. In select patient cohorts, nuclear studies remain the modality of choice. Once the diagnosis of acute PE is established, there is a broad spectrum of severity in outcome which has led to substantial focus and development of risk stratification prediction models. We will discuss making the proper diagnosis with contemporary diagnostic tools and risk stratifying patients with PE to receive the correct treatment.
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Affiliation(s)
- Taylor C. Remillard
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Arber Kodra
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York
- Department of Cardiothoracic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Michael Kim
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York
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15
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Lyhne MD, Witkin AS, Dasegowda G, Tanayan C, Kalra MK, Dudzinski DM. Evaluating cardiopulmonary function following acute pulmonary embolism. Expert Rev Cardiovasc Ther 2022; 20:747-760. [PMID: 35920239 DOI: 10.1080/14779072.2022.2108789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Pulmonary embolism is a common cause of cardiopulmonary mortality and morbidity worldwide. Survivors of acute pulmonary embolism may experience dyspnea, report reduced exercise capacity, or develop overt pulmonary hypertension. Clinicians must be alert for these phenomena and appreciate the modalities and investigations available for evaluation. AREAS COVERED In this review, the current understanding of available contemporary imaging and physiologic modalities is discussed, based on available literature and professional society guidelines. The purpose of the review is to provide clinicians with an overview of these modalities, their strengths and disadvantages, and how and when these investigations can support the clinical work-up of patients post-pulmonary embolism. EXPERT OPINION Echocardiography is a first test in symptomatic patients post-pulmonary embolism, with ventilation/perfusion scanning vital to determination of whether there is chronic residual emboli. The role of computed tomography and magnetic resonance in assessing the pulmonary arterial tree in post-pulmonary embolism patients is evolving. Functional testing, in particular cardiopulmonary exercise testing, is emerging as an important modality to quantify and determine cause of functional limitation. It is possible that future investigations of the post-pulmonary embolism recovery period will better inform treatment decisions for acute pulmonary embolism patients.
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Affiliation(s)
- Mads Dam Lyhne
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Denmark
| | - Alison S Witkin
- Department of Pulmonary Medicine and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Giridhar Dasegowda
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Tanayan
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, USA
| | - Mannudeep K Kalra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - David M Dudzinski
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA.,Echocardiography Laboratory, Massachusetts General Hospital, Boston, MA, USA
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16
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Contemporary use of ventilation-perfusion imaging for pulmonary embolism diagnosis. J Thromb Thrombolysis 2022; 54:500-501. [PMID: 35513632 DOI: 10.1007/s11239-022-02663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
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17
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Kersting D, Settelmeier S, Mavroeidi IA, Herrmann K, Seifert R, Rischpler C. Shining Damaged Hearts: Immunotherapy-Related Cardiotoxicity in the Spotlight of Nuclear Cardiology. Int J Mol Sci 2022; 23:ijms23073802. [PMID: 35409161 PMCID: PMC8998973 DOI: 10.3390/ijms23073802] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
The emerging use of immunotherapies in cancer treatment increases the risk of immunotherapy-related cardiotoxicity. In contrast to conventional chemotherapy, these novel therapies have expanded the forms and presentations of cardiovascular damage to a broad spectrum from asymptomatic changes to fulminant short- and long-term complications in terms of cardiomyopathy, arrythmia, and vascular disease. In cancer patients and, particularly, cancer patients undergoing (immune-)therapy, cardio-oncological monitoring is a complex interplay between pretherapeutic risk assessment, identification of impending cardiotoxicity, and post-therapeutic surveillance. For these purposes, the cardio-oncologist can revert to a broad spectrum of nuclear cardiological diagnostic workup. The most promising commonly used nuclear medicine imaging techniques in relation to immunotherapy will be discussed in this review article with a special focus on the continuous development of highly specific molecular markers and steadily improving methods of image generation. The review closes with an outlook on possible new developments of molecular imaging and advanced image evaluation techniques in this exciting and increasingly growing field of immunotherapy-related cardiotoxicity.
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Affiliation(s)
- David Kersting
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, 45147 Essen, Germany; (K.H.); (R.S.); (C.R.)
- German Cancer Consortium (DKTK, Partner Site Essen/Düsseldorf), 45147 Essen, Germany;
- Correspondence: ; Tel.: +49-201-723-2032
| | - Stephan Settelmeier
- Department of Cardiology and Vascular Medicine, University Hospital Essen, West German Heart and Vascular Center, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Ilektra-Antonia Mavroeidi
- German Cancer Consortium (DKTK, Partner Site Essen/Düsseldorf), 45147 Essen, Germany;
- Clinic for Internal Medicine (Tumor Research), University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, 45147 Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, 45147 Essen, Germany; (K.H.); (R.S.); (C.R.)
- German Cancer Consortium (DKTK, Partner Site Essen/Düsseldorf), 45147 Essen, Germany;
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, 45147 Essen, Germany; (K.H.); (R.S.); (C.R.)
- German Cancer Consortium (DKTK, Partner Site Essen/Düsseldorf), 45147 Essen, Germany;
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, 45147 Essen, Germany; (K.H.); (R.S.); (C.R.)
- German Cancer Consortium (DKTK, Partner Site Essen/Düsseldorf), 45147 Essen, Germany;
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18
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Management of venous thromboembolism in pregnancy. Thromb Res 2022; 211:106-113. [DOI: 10.1016/j.thromres.2022.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/17/2022] [Accepted: 02/02/2022] [Indexed: 11/23/2022]
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19
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Ramirez-Suarez KI, Barrera CA, Otero HJ, Biko DM, States LJ, Servaes S, Zhu X, Davis JC, Piccione J, Rapp JB. Pilot study for comparative assessment of dual-energy computed tomography and single-photon emission computed tomography V/Q scanning for lung perfusion evaluation in infants. Pediatr Pulmonol 2022; 57:702-710. [PMID: 34914194 DOI: 10.1002/ppul.25788] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/05/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate clinical applications of dual-energy computed tomography (DECT) in pediatric-specific lung diseases and compare ventilation and perfusion findings with those from single-photon emission computed tomography (SPECT-CT) V/Q. METHODS All patients at our institution who underwent exams using both techniques within a 3-month period were included in this study. Two readers independently described findings for DECT, and two other readers independently analyzed the SPECT-CT V/Q scan data. All findings were compared between readers and disagreements were reassessed and resolved by consensus. Inter-modality agreements are described throughout this study. RESULTS Eight patients were included for evaluation. The median age for DECT scanning was 3.5 months (IQR = 2). Five of these patients were scanned for both DECT and SPECT-CT V/Q studies the same day, and three had a time gap of 7, 65, and 94 days between studies. The most common indications were chronic lung disease (5/8; 63%) and pulmonary hypertension (6/8; 75%). DECT and SPECT-CT V/Q identified perfusion abnormalities in concordant lobes in most patients (7/8; 88%). In one case, atelectasis limited DECT perfusion assessment. Three patients ultimately underwent lobectomy with corresponding perfusion abnormalities identified by all reviewers on both DECT and SPECT-CT V/Q in all resected lobes. CONCLUSION DECT is a feasible technique that could be considered as an alternative for SPECT-CT V/Q for lung perfusion evaluation in infants.
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Affiliation(s)
- Karen I Ramirez-Suarez
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sabah Servaes
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, West Virginia University Medicine Children's Hospital, Morgantown, West Virginia, USA
| | - Xiaowei Zhu
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James C Davis
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph Piccione
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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Verbelen T, Godinas L, Maleux G, Coolen J, Claessen G, Belge C, Meyns B, Delcroix M. Chronic thromboembolic pulmonary hypertension: diagnosis, operability assessment and patient selection for pulmonary endarterectomy. Ann Cardiothorac Surg 2022; 11:82-97. [PMID: 35433370 PMCID: PMC9012197 DOI: 10.21037/acs-2021-pte-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/08/2021] [Indexed: 07/30/2023]
Abstract
Healthcare providers outside pulmonary hypertension (PH) centers having misinformation or insufficient education, and a general lack of treatment awareness contribute to a massive underdiagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), diagnostic delay and refusal of surgery by patients. Together with the subjective operability assessment, this leads to too few patients undergoing pulmonary endarterectomy (PEA); even though this surgery results in improved survival and exercise capacity. Acute pulmonary embolism (PE) survivors should undergo a CTEPH screening strategy. Patients screened positive and those with CTEPH symptoms (with or without history of PE), should undergo transthoracic echocardiography (TTE) to determine the probability of PH. High PH probability patients should undergo a ventilation/perfusion (V/Q) scan. A negative scan rules out CTEPH. Patients with a positive V/Q scan, but also patients with findings suggestive for CTEPH on computed tomography pulmonary angiography (CTPA) to diagnose acute PE, should be referred to a CTEPH center. Further diagnostic work-up currently consists of catheter based pulmonary angiography, CTPA and right heart catheterization. However, new imaging technologies might replace them in the near future, with one single imaging tool to screen, diagnose and assess operability as the ultimate goal. Operability assessment should be performed by a multidisciplinary CTEPH team. PEA surgery should be organized in a single center per country or for each forty to fifty million inhabitants in order to offer the highest level of expertise. Informing patients about PEA should preferably be done by the treating surgeon. Based on the estimated incidence of CTEPH and with a better education of patients and healthcare providers, despite the advent of new interventional and medical therapies for CTEPH, the number of PEA surgeries performed should still have the potential to grow significantly.
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Affiliation(s)
- Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurent Godinas
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Johan Coolen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Guido Claessen
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Catharina Belge
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marion Delcroix
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
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21
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Suzuki Y, Sekine A, Nishiyama A, Sugiura T, Tanabe N, Isaka Y, Hashimoto Y, Okaya T, Kuriyama A, Nagata J, Shigeta A, Sakao S, Tatsumi K, Suzuki T. A case of pulmonary arterial hypertension with V/Q SPECT/CT that showed localized uptake of 99mTc just below the pleura and a unique distribution. Respirol Case Rep 2021; 9:e0847. [PMID: 34540234 PMCID: PMC8438565 DOI: 10.1002/rcr2.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022] Open
Abstract
Pulmonary hypertension (PH) is a life-threatening disorder, which originates from various aetiologies. Ventilation-perfusion (V/Q) scanning is commonly used to evaluate the differential diagnosis of PH. Meanwhile, previous studies have shown that single-photon emission computed tomography (SPECT)/CT imaging can provide a more detailed analysis for the assessment of pulmonary blood flow. However, there is insufficient evidence supporting the merits of V/Q SPECT/CT image data in detecting pulmonary vascular disease. Here, we report a case of pulmonary arterial hypertension with localized accumulation and peculiar distribution just below the pleura on V/Q SPECT/CT. Our finding is unique, and it suggests that V/Q SPECT/CT image data might be useful to detect blood flow not only in cases of pulmonary embolism, but also in the more commonly encountered PH.
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Affiliation(s)
- Yuri Suzuki
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Ayumi Sekine
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Akira Nishiyama
- Department of Diagnostic Radiology and Radiation OncologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Toshihiko Sugiura
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Nobuhiro Tanabe
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
- Department of Pulmonary Hypertension CenterChibaken Saiseikai Narashino HospitalNarashinoJapan
| | - Yuri Isaka
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Yaeko Hashimoto
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Tadasu Okaya
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Ayaka Kuriyama
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Jun Nagata
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
- Department of Pulmonary Hypertension CenterChibaken Saiseikai Narashino HospitalNarashinoJapan
| | - Ayako Shigeta
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Seiichiro Sakao
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Koichiro Tatsumi
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Takuji Suzuki
- Department of RespirologyGraduate School of Medicine, Chiba UniversityChibaJapan
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22
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Currie GM, Bailey DL. A Technical Overview of Technegas as a Lung Ventilation Agent. J Nucl Med Technol 2021; 49:313-319. [PMID: 34583954 DOI: 10.2967/jnmt.121.262887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Technegas is a carbon-based nanoparticle developed in Australia in 1984 and has been in widespread clinical use, including SPECT imaging, since 1986. Although 81mKr offers the ideal ventilation properties of a true gas, Technegas is considered preferred in more than 60 countries for ventilation imaging yet has limited adoption in the United States. In March 2020, a new U.S. Food and Drug Administration application was lodged for Technegas, and the impending approval warrants a detailed discussion of the technical aspects of the technology for those for whom it is new. Technegas is a simple yet versatile system for producing high-quality 99mTc-based ventilation studies. The design affords safety to patients and staff, including consideration of radiation and biologic risks. Technegas is the gold standard for the ventilation portion of SPECT-based ventilation-perfusion studies in pulmonary embolism and several respiratory pathologies. When approved by the U.S. Food and Drug Administration, Technegas will extend advantages to workflow, safety, and study quality for departments that adopt the technology.
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Affiliation(s)
- Geoffrey M Currie
- Charles Sturt University, Wagga Wagga, Australia; .,Baylor College of Medicine, Houston, Texas
| | - Dale L Bailey
- Royal North Shore Hospital, Sydney, Australia; and.,University of Sydney, Sydney, Australia
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23
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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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24
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Ozguven S, Ones T, Bozkurtlar E, Yanartas M, Tas S, Inanir S, Turoglu HT, Erdil TY, Yildizeli B. Chronic thromboembolic pulmonary hypertension: evaluation of V/Q SPECT/CT and V/Q Quotient SPECT findings with postoperative results of pulmonary endarterectomy. Nucl Med Commun 2021; 42:369-377. [PMID: 33443395 DOI: 10.1097/mnm.0000000000001348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We aimed to perform a comparison between V/Q single-photon emission computed tomography/computed tomography (SPECT/CT) and V/Q Quotient single-photon emission computerized tomography (SPECT) in the detection of chronic thromboembolic pulmonary hypertension (CTEPH) and in depicting the extent of the disease on per-segment basis in patients with CTEPH. METHODS Between January 2015 and November 2019, a total of 412 patients with pulmonary hypertension secondary to CTEPH at the preoperative assessment underwent pulmonary endarterectomy (PEA), of whom 92 consecutive patients with their V/Q SPECT/CT scans have been performed in our institution prior to PEA were included in this study. Histopathological findings and post-PEA fully resected surgical specimens were used as the reference standard. RESULTS On a per-patient basis analysis, V/Q SPECT/CT and V/Q Quotient SPECT both revealed CTEPH in the same 85 of the 92 patients (κ = 1) with a detection rate of 92.4%. In six of these patients, chronic thromboembolic disease could not be reported on both of these two methods due to extensive 'matched' V/Q defects. On a per-segment basis analysis, V/Q SPECT/CT and V/Q Quotient SPECT showed a sensitivity of 75.8 and 73.1%, respectively. Correlation analysis results showed a significant correlation (κ = 0.933) between these two methods on a per-segment basis analysis. CONCLUSION In the light of histopathological findings and post-PEA surgical specimen examinations, the results of the present study indicated that both V/Q SPECT/CT and V/Q Quotient SPECT showed relatively high efficacy for the detection of CTEPH on per-patient and per-segment bases with an excellent agreement.
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Affiliation(s)
| | | | - Emine Bozkurtlar
- Pathology, Marmara University Pendik Training and Research Hospital
| | - Mehmed Yanartas
- Department of Cardiovascular Surgery, Health Sciences University Kartal Koşuyolu Training and Research Hospital
| | - Serpil Tas
- Department of Cardiovascular Surgery, Health Sciences University Kartal Koşuyolu Training and Research Hospital
| | | | | | | | - Bedrettin Yildizeli
- Department of Thoracic Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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25
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Kligerman S, Hsiao A. Optimizing the diagnosis and assessment of chronic thromboembolic pulmonary hypertension with advancing imaging modalities. Pulm Circ 2021; 11:20458940211007375. [PMID: 34104420 PMCID: PMC8150458 DOI: 10.1177/20458940211007375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023] Open
Abstract
Imaging is key to nearly all aspects of chronic thromboembolic pulmonary hypertension including management for screening, assessing eligibility for pulmonary endarterectomy, and post-operative follow-up. While ventilation/perfusion scintigraphy, the gold standard technique for chronic thromboembolic pulmonary hypertension screening, can have excellent sensitivity, it can be confounded by other etiologies of pulmonary malperfusion, and does not provide structural information to guide operability assessment. Conventional computed tomography pulmonary angiography has high specificity, though findings of chronic thromboembolic pulmonary hypertension can be visually subtle and unrecognized. In addition, computed tomography pulmonary angiography can provide morphologic information to aid in pre-operative workup and assessment of other structural abnormalities. Advances in computed tomography imaging techniques, including dual-energy computed tomography and spectral-detector computed tomography, allow for improved sensitivity and specificity in detecting chronic thromboembolic pulmonary hypertension, comparable to that of ventilation/perfusion scans. Furthermore, these advanced computed tomography techniques, compared with conventional computed tomography, provide additional physiologic data from perfused blood volume maps and improved resolution to better visualize distal chronic thromboembolic pulmonary hypertension, an important consideration for balloon pulmonary angioplasty for inoperable patients. Electrocardiogram-synchronized techniques in electrocardiogram-gated computed tomography can also show further information regarding right ventricular function and structure. While the standard of care in the workup of chronic thromboembolic pulmonary hypertension includes a ventilation/perfusion scan, computed tomography pulmonary angiography, direct catheter angiography, echocardiogram, and coronary angiogram, in the future an electrocardiogram-gated dual-energy computed tomography angiography scan may enable a "one-stop" imaging study to guide diagnosis, operability assessment, and treatment decisions with less radiation exposure and cost than traditional chronic thromboembolic pulmonary hypertension imaging modalities.
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Affiliation(s)
- Seth Kligerman
- Cardiothoracic Imaging, University of California San Diego, La Jolla, CA, USA
| | - Albert Hsiao
- Cardiothoracic Imaging, University of California San Diego, La Jolla, CA, USA
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26
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Mohan V, Bruin NM, van de Kamer JB, Sonke JJ, Vogel WV. The increasing potential of nuclear medicine imaging for the evaluation and reduction of normal tissue toxicity from radiation treatments. Eur J Nucl Med Mol Imaging 2021; 48:3762-3775. [PMID: 33687522 PMCID: PMC8484246 DOI: 10.1007/s00259-021-05284-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
Radiation therapy is an effective treatment modality for a variety of cancers. Despite several advances in delivery techniques, its main drawback remains the deposition of dose in normal tissues which can result in toxicity. Common practices of evaluating toxicity, using questionnaires and grading systems, provide little underlying information beyond subjective scores, and this can limit further optimization of treatment strategies. Nuclear medicine imaging techniques can be utilised to directly measure regional baseline function and function loss from internal/external radiation therapy within normal tissues in an in vivo setting with high spatial resolution. This can be correlated with dose delivered by radiotherapy techniques to establish objective dose-effect relationships, and can also be used in the treatment planning step to spare normal tissues more efficiently. Toxicity in radionuclide therapy typically occurs due to undesired off-target uptake in normal tissues. Molecular imaging using diagnostic analogues of therapeutic radionuclides can be used to test various interventional protective strategies that can potentially reduce this normal tissue uptake without compromising tumour uptake. We provide an overview of the existing literature on these applications of nuclear medicine imaging in diverse normal tissue types utilising various tracers, and discuss its future potential.
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Affiliation(s)
- V Mohan
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N M Bruin
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J B van de Kamer
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - J-J Sonke
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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27
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Nyeng TB, Møller DS, Farr K, Kramer S, Khalil AA, Grau C, Hoffmann L. A comparison of two methods for segmentation of functional volumes in radiotherapy planning of lung cancer patients. Acta Oncol 2021; 60:353-360. [PMID: 33522851 DOI: 10.1080/0284186x.2021.1877811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In radiotherapy (RT) of lung cancer, dose to functional lung (FL) volumes segmented with two different methods (perfusion SPECT (Q-SPECT) and 4D-CT (4D) ventilation (V)) have been shown to correlate with the incidence of radiation pneumonitis (RP). This study aims to compare the FL volumes identified by both methods. MATERIAL AND METHODS Thirty lung cancer patients had a 4D and Q-SPECT prior to treatment. Seventeen of these patients also had a ventilation SPECT (V-SPECT). FL sub-volumes were segmented automatically, using cut-off values. The volumes were compared in terms of overlap fraction (OF) relative to the minimal volume, and intersection fraction (IF) of the FL volume relative to the total lung volume (VLung). RESULTS Cut-off values suggested in literature for Q-SPECT and 4D-V resulted in volumes differing in size by a median 18% [6%;31%], and a median OF and IF of 0.48 [0.23;0.70] and 0.09 [0.02;0.25], respectively. Segmenting volumes of comparable size of about 1/3 of VLung (FL-m(1/3), m = method) resulted in a median OF and IF of 0.43 [0.23;0.58] and 0.12 [0.06;0.19], respectively. Twenty-five patients (83%) had a reasonable overlap between FL-Q(1/3) and FL-4D-V(1/3) volumes, with OF values above 0.33. IF increased significantly (p = .036) compared to using fixed cut-off values. Similarly, volumes of comparable size of about 1/3 VLung were produced for V-SPECT, and FL-Q(1/3), FL-V(1/3), and FL-4D-V(1/3) were compared. The overlaps and intersections of FL-V(1/3) with FL-Q(1/3) volumes were significantly (p<.001) larger than the corresponding overlaps and intersections of FL-Q(1/3) with FL-4D(1/3) and FL-V(1/3) with FL-4D(1/3). CONCLUSION The Q-SPECT and 4D-V methods do not segment entirely the same FL volumes. A reasonable overlap of the volumes along with the findings of other studies that both correlate to RP incidence, suggests that a combination of both volumes, e.g. using the IF, may be useful in RT treatment planning.
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Affiliation(s)
- T. B. Nyeng
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - D. S. Møller
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - K. Farr
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - S. Kramer
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - A. A. Khalil
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - C. Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - L. Hoffmann
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
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28
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Remy-Jardin M, Ryerson CJ, Schiebler ML, Leung ANC, Wild JM, Hoeper MM, Alderson PO, Goodman LR, Mayo J, Haramati LB, Ohno Y, Thistlethwaite P, van Beek EJR, Knight SL, Lynch DA, Rubin GD, Humbert M. Imaging of pulmonary hypertension in adults: a position paper from the Fleischner Society. Eur Respir J 2021; 57:57/1/2004455. [PMID: 33402372 DOI: 10.1183/13993003.04455-2020] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/28/2020] [Indexed: 12/22/2022]
Abstract
Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure greater than 20 mmHg and classified into five different groups sharing similar pathophysiologic mechanisms, haemodynamic characteristics, and therapeutic management. Radiologists play a key role in the multidisciplinary assessment and management of PH. A working group was formed from within the Fleischner Society based on expertise in the imaging and/or management of patients with PH, as well as experience with methodologies of systematic reviews. The working group identified key questions focusing on the utility of CT, MRI, and nuclear medicine in the evaluation of PH: a) Is noninvasive imaging capable of identifying PH? b) What is the role of imaging in establishing the cause of PH? c) How does imaging determine the severity and complications of PH? d) How should imaging be used to assess chronic thromboembolic PH before treatment? e) Should imaging be performed after treatment of PH? This systematic review and position paper highlights the key role of imaging in the recognition, work-up, treatment planning, and follow-up of PH.
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Affiliation(s)
- Martine Remy-Jardin
- Dept of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, Lille, France.,Chair of the Fleischner Society writing committee of the position paper for imaging of pulmonary hypertension
| | - Christopher J Ryerson
- Dept of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Mark L Schiebler
- Dept of Radiology, UW-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Ann N C Leung
- Dept of Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - James M Wild
- Division of Imaging, Dept of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Marius M Hoeper
- Dept of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany
| | - Philip O Alderson
- Dept of Radiology, Saint Louis University School of Medicine, St Louis, MO, USA
| | | | - John Mayo
- Dept of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Linda B Haramati
- Dept of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yoshiharu Ohno
- Dept of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | | | - Edwin J R van Beek
- Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Shandra Lee Knight
- Dept of Library and Knowledge Services, National Jewish Health, Denver, CO, USA
| | - David A Lynch
- Dept of Radiology, National Jewish Health, Denver, CO, USA
| | - Geoffrey D Rubin
- Dept of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Marc Humbert
- Université Paris Saclay, Inserm UMR S999, Dept of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.,Co-Chair of the Fleischner Society writing committee of the position paper for imaging of pulmonary hypertension
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29
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Remy-Jardin M, Ryerson CJ, Schiebler ML, Leung ANC, Wild JM, Hoeper MM, Alderson PO, Goodman LR, Mayo J, Haramati LB, Ohno Y, Thistlethwaite P, van Beek EJR, Knight SL, Lynch DA, Rubin GD, Humbert M. Imaging of Pulmonary Hypertension in Adults: A Position Paper from the Fleischner Society. Radiology 2021; 298:531-549. [PMID: 33399507 DOI: 10.1148/radiol.2020203108] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure greater than 20 mm Hg and classified into five different groups sharing similar pathophysiologic mechanisms, hemodynamic characteristics, and therapeutic management. Radiologists play a key role in the multidisciplinary assessment and management of PH. A working group was formed from within the Fleischner Society based on expertise in the imaging and/or management of patients with PH, as well as experience with methodologies of systematic reviews. The working group identified key questions focusing on the utility of CT, MRI, and nuclear medicine in the evaluation of PH: (a) Is noninvasive imaging capable of identifying PH? (b) What is the role of imaging in establishing the cause of PH? (c) How does imaging determine the severity and complications of PH? (d) How should imaging be used to assess chronic thromboembolic PH before treatment? (e) Should imaging be performed after treatment of PH? This systematic review and position paper highlights the key role of imaging in the recognition, work-up, treatment planning, and follow-up of PH. This article is a simultaneous joint publication in Radiology and European Respiratory Journal. The articles are identical except for stylistic changes in keeping with each journal's style. Either version may be used in citing this article. © 2021 RSNA and the European Respiratory Society. Online supplemental material is available for this article.
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Affiliation(s)
- Martine Remy-Jardin
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Christopher J Ryerson
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Mark L Schiebler
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Ann N C Leung
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - James M Wild
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Marius M Hoeper
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Philip O Alderson
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Lawrence R Goodman
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - John Mayo
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Linda B Haramati
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Yoshiharu Ohno
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Patricia Thistlethwaite
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Edwin J R van Beek
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Shandra Lee Knight
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - David A Lynch
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Geoffrey D Rubin
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
| | - Marc Humbert
- From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.)
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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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van Dijk M, Klooster K, Ten Hacken NHT, Sciurba F, Kerstjens HAM, Slebos DJ. The effects of lung volume reduction treatment on diffusing capacity and gas exchange. Eur Respir Rev 2020; 29:29/158/190171. [PMID: 33115787 DOI: 10.1183/16000617.0171-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/19/2020] [Indexed: 11/05/2022] Open
Abstract
Lung volume reduction (LVR) treatment in patients with severe emphysema has been shown to have a positive effect on hyperinflation, expiratory flow, exercise capacity and quality of life. However, the effects on diffusing capacity of the lungs and gas exchange are less clear. In this review, the possible mechanisms by which LVR treatment can affect diffusing capacity of the lung for carbon monoxide (D LCO) and arterial gas parameters are discussed, the use of D LCO in LVR treatment is evaluated and other diagnostic techniques reflecting diffusing capacity and regional ventilation (V')/perfusion (Q') mismatch are considered.A systematic review of the literature was performed for studies reporting on D LCO and arterial blood gas parameters before and after LVR surgery or endoscopic LVR with endobronchial valves (EBV). D LCO after these LVR treatments improved (40 studies, n=1855) and the mean absolute change from baseline in % predicted D LCO was +5.7% (range -4.6% to +29%), with no real change in blood gas parameters. Improvement in V' inhomogeneity and V'/Q' mismatch are plausible explanations for the improvement in D LCO after LVR treatment.
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Affiliation(s)
- Marlies van Dijk
- University of Groningen, Dept of Pulmonary Diseases, University Medical Center Groningen, Research Institute for Asthma and COPD Groningen, Groningen, The Netherlands
| | - Karin Klooster
- University of Groningen, Dept of Pulmonary Diseases, University Medical Center Groningen, Research Institute for Asthma and COPD Groningen, Groningen, The Netherlands
| | - Nick H T Ten Hacken
- University of Groningen, Dept of Pulmonary Diseases, University Medical Center Groningen, Research Institute for Asthma and COPD Groningen, Groningen, The Netherlands
| | - Frank Sciurba
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Huib A M Kerstjens
- University of Groningen, Dept of Pulmonary Diseases, University Medical Center Groningen, Research Institute for Asthma and COPD Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- University of Groningen, Dept of Pulmonary Diseases, University Medical Center Groningen, Research Institute for Asthma and COPD Groningen, Groningen, The Netherlands
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McFarland GA, Johnson SG. Nuclear Medicine Clinical Practice in the United States During the COVID-19 Era and Beyond. J Nucl Med Technol 2020; 48:218-226. [PMID: 32709666 DOI: 10.2967/jnmt.120.253245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/17/2020] [Indexed: 12/27/2022] Open
Abstract
Traditionally, practice in nuclear medicine has involved strong emphasis on radiation safety principles. Nuclear medicine technologists (NMTs) focus on practices that keep patients, the public, and the technologist safe from potentially harmful effects of unnecessary radiation exposure using concepts of time, distance, and shielding as well as ALARA (As low as reasonably achievable) principles. The current COVID-19 pandemic has brought to light the need to apply focus on infection prevention in practice and update knowledge and procedures on such measures. In this article, the authors outline the need for NMTs to develop practices and values focused on infection prevention measures.
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Affiliation(s)
- Gail A McFarland
- Nuclear Medicine Technology Program Bellevue College, Bellevue, Washington; and
| | - Sara G Johnson
- Nuclear Medicine Service, VA San Diego Healthcare System, San Diego, California
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Abstract
Purpose of Review The main goal of the article is to familiarize the reader with commonly and uncommonly used nuclear medicine procedures that can significantly contribute to improved patient care. The article presents examples of specific modality utilization in the chest including assessment of lung ventilation and perfusion, imaging options for broad range of infectious and inflammatory processes, and selected aspects of oncologic imaging. In addition, rapidly developing new techniques utilizing molecular imaging are discussed. Recent Findings The article describes nuclear medicine imaging modalities including gamma camera, SPECT, PET, and hybrid imaging (SPECT/CT, PET/CT, and PET/MR) in the context of established and emerging clinical applications. Areas of potential future development in nuclear medicine are discussed with emphasis on molecular imaging and implementation of new targeted tracers used in diagnostics and therapeutics (theranostics). Summary Nuclear medicine and molecular imaging provide many unique and novel options for the diagnosis and treatment of pulmonary diseases. This article reviews current applications for nuclear medicine and molecular imaging and selected future applications for radiopharmaceuticals and targeted molecular imaging techniques.
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Ratnakanthan PJ, Kavnoudias H, Paul E, Clements WJ. Weight-Adjusted Contrast Administration in the Computed Tomography Evaluation of Pulmonary Embolism. J Med Imaging Radiat Sci 2020; 51:451-461. [PMID: 32620525 DOI: 10.1016/j.jmir.2020.06.002] [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: 01/13/2020] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Computed tomography pulmonary angiogram (CTPA) is widely considered the gold standard for diagnosis of pulmonary embolism (PE) with previous studies demonstrating high sensitivity and specificity. Despite this, nondiagnostic and indeterminate CTPA rates of 5%-26% remain a concern. As part of a continuing quality assurance program, a new weight-adjusted contrast dose and increased administration rate CTPA protocol was studied with an aim to improve diagnostic accuracy of PE evaluation. METHODS A total of 2,398 CTPA examinations were reviewed to assess pulmonary arterial enhancement and PE yield in this retrospective study. Between 1 August 2014 and 1 August 2015, 1,133 patients received a fixed-volume (60 mL) contrast dose technique at 4 mL/s (protocol A). A new protocol was then implemented as part of a continuing quality assurance program. Between 15 September 2015 and 15 September 2016, 1,265 patients received a weight-adjusted contrast dose (1 mL/kg) and increased administration rate (5 mL/s) CTPA technique (protocol B). Studies were classed into categories based on quality of study; diagnostic: HU > 211, nondiagnostic: HU < 211 and PE yield; positive, negative, and indeterminate. These variables were compared with cross-sectional surface area to assess the relationship between patient habitus, CTPA diagnostic quality, and PE yield. RESULTS A weight-adjusted contrast dose and increased administration rate CTPA protocol (protocol B) resulted in a significant increase in mean PA enhancement (P < .0001), 55.23% decrease in nondiagnostic studies and 43.04% decrease in indeterminate studies. Protocol B demonstrated increased positive and negative CTPA rates with decreased indeterminate rates from 12.38% to 7.04%. Comparison with cross-sectional area demonstrated significant increase in proportion of diagnostic studies and reduction in nondiagnostic and indeterminate CTPAs using protocol B in obese patients. CONCLUSIONS A weight-adjusted contrast dose and increased administration rate CTPA protocol can significantly increase PA enhancement, especially in obese patients, resulting in greater high-quality and fewer nondiagnostic and indeterminate CTPA examinations. A CTPA protocol with a higher rate of conclusive examinations can provide greater confidence in PE evaluation for reporting radiologists and accurate clinical decision-making pathways for referring physicians.
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Affiliation(s)
| | - Helen Kavnoudias
- Department of Radiology, The Alfred Hospital, Victoria, Australia; Department of Surgery, Monash University, Victoria, Australia; Department of Neuroscience, Monash University, Victoria, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Warren J Clements
- Department of Radiology, The Alfred Hospital, Victoria, Australia; Department of Surgery, Monash University, Victoria, Australia
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Mehdipoor G, Jimenez D, Bertoletti L, Fidalgo Á, Sanchez Muñoz-Torrero JF, Gonzalez-Martinez JP, Blanco-Molina Á, Ángel Aibar M, Bonnefoy PB, Khorasani R, Prince MR, Bikdeli B, Monreal M, Adarraga MD, Agud M, Azcarate-Agüero P, Aibar J, Alfonso J, Amado C, Ignacio Arcelus J, Ballaz A, Barba R, Barrón CBM, Barrón-Andrés B, Camon AM, Cañas I, Criado J, Ancos CD, Miguel JD, del Toro J, Demelo-Rodríguez P, Díaz-Pedroche C, Díaz-Peromingo JA, Díaz-Simón R, Díez-Sierra J, Milagros Domínguez I, Escribano JC, Farfán AI, Fernández-Capitán C, Fernández-Reyes JL, Flores K, Font C, Font L, Francisco I, Gabara C, Galeano-Valle F, Ángeles García M, García-Bragado F, García-García M, García-Raso A, Gavín-Blanco O, Gavín-Sebastián O, Carmen Gayol M, Gil-Díaz A, Gómez-Cuervo C, Grau E, Gutiérrez-Guisado J, Hernández-Blasco L, Iglesias M, Jara-Palomares L, Jesús Jaras M, Joya MD, Jou I, Lacruz B, Lalueza A, Lecumberri R, Lima J, Llamas P, Luis Lobo J, López-Jiménez L, López-Miguel P, José López-Núñez J, López-Reyes R, Bosco López-Sáez J, Alejandro Lorente M, Lorenzo A, Loring M, Lumbierres M, Madridano O, Maestre A, Javier Marchena P, Martín-Fernández M, Miguel Martín-Guerra J, Martín-Martos F, Mellado M, Mercado MI, Moisés J, del Valle Morales M, Muñoz-Blanco A, Muñoz-Guglielmetti D, Antonio Nieto J, Jesús Núñez M, Ortega-Michel MCOC, Dolores Ortega-Recio M, Osorio J, Otero R, Paredes D, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez-Ductor C, Asunción Pérez-Jacoíste M, Pesántez D, Porras JA, Portillo J, Reig L, Riera-Mestre A, Rivas A, Rodríguez-Cobo A, Rodríguez-Galán I, Rodríguez-Matute C, Rosa V, María Rubio C, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Ruiz J, Ruiz-Sada P, Ruiz-Torregrosa P, Carles Sahuquillo J, Salgueiro G, Sampériz Á, Sancho T, Soler S, Suárez S, María Suriñach J, Tiberio G, Isabel Torres M, Tolosa C, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, Ramón Vela J, Vidal G, Villares P, Zamora C, Gutiérrez P, Javier Vázquez F, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bura-Riviere A, Crichi B, Debourdeau P, Farge-Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Ciammaichella M, Colaizzo D, Dentali F, Micco PD, Giammarino E, Grandone E, Maggi F, Mangiacapra S, Mastroiacovo D, Maida R, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tiraferri E, Tufano A, Visonà A, Hong NV, Zalunardo B, Kalejs RV, Kigitovica D, Skride A, Ferreira M, Meireles J, Reis A, Bosevski M, Krstevski G, Zdraveska M, Bounameaux H, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, My Bui H. Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism. Circ Cardiovasc Imaging 2020; 13:e010651. [PMID: 32418452 DOI: 10.1161/circimaging.120.010651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE.
Methods:
Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging.
Results:
Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%,
P
<0.001). The use of computed tomography pulmonary angiography varied between 13.3% and 98.3% across the countries, and its use increased over time (46.5% in 2002 to 91.7% in 2018,
P
<0.001).
Conclusions:
In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation.
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Affiliation(s)
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain (D.J.)
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de Saint-Etienne and INSERM U1059 SAINBIOSE - CIC 1408, Université Jean-Monnet, Saint-Etienne, France (L.B.)
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Spain (A.F.)
| | | | - José Pedro Gonzalez-Martinez
- Department of Internal Medicine, Hospital Universitari St Joan de Deu Manresa (Barcelona) Fundació Althaia (J.P.G.-M.)
| | - Ángeles Blanco-Molina
- Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain (A.B.-M.)
| | - Miguel Ángel Aibar
- Internal Medicine Department and IIS Aragón, Hospital Clínico Universitario, Zaragoza, Spain (M.A.A.)
| | - Pierre-Benoît Bonnefoy
- Service de médecine nucléaire, Hôpital Nord, CHU de St-Etienne, Saint-Etienne, France (P.-B.B.)
| | - Ramin Khorasani
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.K.)
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital (M.R.P.)
- Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital (B.B.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (B.B.)
- Cardiovascular Research Foundation (CRF), New York, NY (B.B.)
| | - Manuel Monreal
- Department of Internal Medicine, Hospital de Badalona Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain (M.M.)
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Tromeur C, Le Mao R, Leven C, Couturaud F, Théreaux J, Lacut K. [Diagnostic and therapeutic management of venous thromboembolic disease in obese patients]. Rev Mal Respir 2020; 37:328-340. [PMID: 32284207 DOI: 10.1016/j.rmr.2020.02.014] [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: 02/20/2019] [Accepted: 08/06/2019] [Indexed: 01/03/2023]
Abstract
Despite the high proportion of obese patients this population remains understudied in the field of venous thromboembolic disease (VTE). Obesity is a risk factor for pulmonary embolism and/or deep vein thrombosis, especially when it is associated with other risk factors for VTE. Currently there is no validated diagnostic algorithm for VTE in the population of obese patients. Moreover, imaging examinations can be of poor quality and inconclusive. In the prevention of VTE, data concerning obese patients are mainly based on low-level studies. Apart from the context of bariatric surgery, an adjustment of heparin doses according to the weight of the patient is proposed only on a case-by-case basis. According to the current guidelines, therapeutic fixed dose oral anticoagulants should not be prescribed for patients with weights exceeding 120kg or a body mass index>40kg/m2. Heparin doses should be weight adjusted and monitored with anti-Xa activity. Anti vitamin K can be prescribed but require INR monitoring. Therefore, new studies specifically dedicated to obese patients are required in the field of VTE for better diagnostic and therapeutic management.
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Affiliation(s)
- C Tromeur
- Département de médecine interne, vasculaire et pneumologie, CHRU, site Cavale-Blanche, Brest, France; EA3878, FCRIN INNOVTE, groupe d'étude thrombose Bretagne Occidentale, Brest, France.
| | - R Le Mao
- Département de médecine interne, vasculaire et pneumologie, CHRU, site Cavale-Blanche, Brest, France; EA3878, FCRIN INNOVTE, groupe d'étude thrombose Bretagne Occidentale, Brest, France
| | - C Leven
- EA3878, FCRIN INNOVTE, groupe d'étude thrombose Bretagne Occidentale, Brest, France; Département de biochimie et pharmaco-toxicologie, CHRU, Brest, France
| | - F Couturaud
- Département de médecine interne, vasculaire et pneumologie, CHRU, site Cavale-Blanche, Brest, France; EA3878, FCRIN INNOVTE, groupe d'étude thrombose Bretagne Occidentale, Brest, France
| | - J Théreaux
- EA3878, FCRIN INNOVTE, groupe d'étude thrombose Bretagne Occidentale, Brest, France; Service de chirurgie viscérale et digestive, CHRU, site Cavale-Blanche, Brest, France
| | - K Lacut
- Département de médecine interne, vasculaire et pneumologie, CHRU, site Cavale-Blanche, Brest, France; EA3878, FCRIN INNOVTE, groupe d'étude thrombose Bretagne Occidentale, Brest, France
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Si-Mohamed S, Moreau-Triby C, Tylski P, Tatard-Leitman V, Wdowik Q, Boccalini S, Dessouky R, Douek P, Boussel L. Head-to-head comparison of lung perfusion with dual-energy CT and SPECT-CT. Diagn Interv Imaging 2020; 101:299-310. [PMID: 32173289 DOI: 10.1016/j.diii.2020.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the quantitative and qualitative lung perfusion data acquired with dual energy CT (DECT) to that acquired with a large field-of-view cadmium-zinc-telluride camera single-photon emission CT coupled to a CT system (SPECT-CT). MATERIALS AND METHODS A total of 53 patients who underwent both dual-layer DECT angiography and perfusion SPECT-CT for pulmonary hypertension or pre-operative lobar resection surgery were retrospectively included. There were 30 men and 23 women with a mean age of 65.4±17.5 (SD)years (range: 18-88years). Relative lobar perfusion was calculated by dividing the amount (of radiotracer or iodinated contrast agent) per lobe by the total amount in both lungs. Linear regression, Bland-Altman analysis, and Pearson's correlation coefficient were also calculated. Kappa test was used to test agreements in morphology and severity of perfusion defects assessed on SPECT-CT and on DECT iodine maps with a one-month interval. Wilcoxon rank sum test was used to compare the sharpness of perfusion defects and radiation dose among modalities. RESULTS Strong correlations for relative lobar perfusion using linear regression analysis and Pearson's correlation coefficient (r=0.93) were found. Bland-Altman analysis revealed a -0.10 bias, with limits of agreement between [-6.01; 5.81]. With respect to SPECT- CT as standard of reference, the sensitivity, specificity, PPV, NPV, accuracy for lobar perfusion defects were 89.4% (95%
CI: 82.6-93.4%), 96.5% (95% CI: 92.1-98.5%), 95.6% (95% CI:
90.9-97.8%), 91.4% (95% CI: 85.6-94.9%) and 93.0% (95% CI:
87.6-96.1%) respectively. High level of agreement was found for morphology and severity of perfusion defects between modalities (Kappa=0.84 and 0.86 respectively) and on DECT images among readers (Kappa=0.94 and 0.89 respectively). A significantly sharper delineation of perfusion defects was found on DECT images (P<0.0001) using a significantly lower equivalent dose of 4.1±2.3 (SD) mSv (range: 1.9-11.85mSv) compared to an equivalent dose of 5.3±1.1 (SD) mSv (range: 2.8-7.3mSv) for SPECT-CT, corresponding to a 21.2% dose reduction (P=0.0004). CONCLUSION DECT imaging shows strong quantitative correlations and qualitative agreements with SPECT-CT for the evaluation of lung perfusion.
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Affiliation(s)
- S Si-Mohamed
- Department of Radiology, Hospices Civils de Lyon, 69500 Bron, France; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France.
| | - C Moreau-Triby
- Department of Nuclear Medicine, Hospices Civils de Lyon, 69500 Bron, France
| | - P Tylski
- Medical Physics and Radioprotection, Hospices Civils de Lyon, 69500 Bron, France
| | - V Tatard-Leitman
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Q Wdowik
- Department of Radiology, Hospices Civils de Lyon, 69500 Bron, France
| | - S Boccalini
- Department of Radiology, Hospices Civils de Lyon, 69500 Bron, France
| | - R Dessouky
- Department of Radiology, Faculty of Medicine, Zagazig University, 44519 Zagazig, Egypt
| | - P Douek
- Department of Radiology, Hospices Civils de Lyon, 69500 Bron, France; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - L Boussel
- Department of Radiology, Hospices Civils de Lyon, 69500 Bron, France; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
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Gharabaghi MA, Sarv F, Farzanehfar S, Abbasi M. The diagnostic accuracy of prospective investigative study of acute pulmonary embolism diagnosis criteria for the detection of acute pulmonary thromboembolism in acutely ill patients. World J Nucl Med 2020; 19:137-140. [PMID: 32939201 PMCID: PMC7478309 DOI: 10.4103/wjnm.wjnm_64_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/15/2019] [Indexed: 11/16/2022] Open
Abstract
The practical diagnostic performance of Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISAPED) criteria for the detection of acute pulmonary thromboembolism (APTE) in hospitalized patients is not yet well determined. This is the report of the initial results of our recently implemented protocol to employ PISAPED. One hundred and forty-seven pulmonary perfusion scans with 1–3 mCi 99mTc-MAA of patients of a single pulmonologist were included. Patients with suspicious perfusion defects underwent single-photon emission computed tomography. Interpretations were done by consensus of two nuclear medicine specialists. Comparisons were done with chest X-ray or chest computed tomography when available. The interpreters had access to the clinical records. The scans were reported based on the PISAPED criteria as negative or positive for APTE or indeterminate. Patients were followed up for 6.2 ± 5.3 months when the final diagnosis confirming or excluding APTE was achieved. Patients aged 55.9 (17.2) years; 78 (53.1%) of them were female and 64 (43.8%) had high Wells’ score. The scans were positive, negative, and indeterminate in 17 (11.6%), 126 (85.7%), and 4 (2.7%) patients, respectively. In 6 out of 147 patients, follow-up was not completed and the final diagnosis was not achieved. APTE was finally diagnosed in 21 (14.3%) patients; 12 (57.1%) of them had positive scans. APTE was excluded in 116 (78.9%) patients; 112 (96.5%) of them had negative scans. The accuracy of the test for the diagnosis of APTE was 87.9%. Lung metastasis was the most frequent reason among false-negative cases. The lung perfusion scan using PISAPED criteria could be used with good accuracy in inpatient settings.
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Affiliation(s)
| | - Fatemeh Sarv
- Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Farzanehfar
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrshad Abbasi
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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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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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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Kim HY, Kim KH, Kim J, Park JC. Multimodality cardiovascular imaging in pulmonary embolism. Cardiol J 2019; 28:150-160. [PMID: 31478557 DOI: 10.5603/cj.a2019.0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022] Open
Abstract
Acute pulmonary embolism (APE) is one of the leading causes of cardiovascular (CV) morbidity and mortality. To select appropriate therapeutic strategy and/or to minimize the mortality and morbidity, rapid and correct identification of life-threatening APE is very important. Also, right ventricular (RV) failure usually precedes acute hemodynamic compromise or death, and thus the identification of RV failure is another important step in risk stratification or treatment of APE. With advances in diagnosis and treatment, the prognosis of APE has been dramatically improving in most cases, but inadequate therapy or recurrent episodes of pulmonary embolism (PE) may result in negative outcomes or, so called, chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a condition characterized by remaining chronic thromboembolic material in the pulmonary vasculature and subsequent chronic pulmonary hypertension. Various imaging modalities include chest computed tomography pulmonary angiography (CTPA), echocardiography, magnetic resonance imaging, and nuclear imaging and each are used for the assessment of varying status of PE. Assessment of thromboembolic burden by chest CTPA is the first step in the diagnosis of PE. Hemodynamic assessment can be achieved by echocardiography and also by chest CTPA. Nuclear imaging is useful in discriminating CTEPH from APE. Better perspectives on diagnosis, risk stratification and decision making in PE can be provided by combining multimodality CV imaging. Here, the advantages or pitfalls of each imaging modality in diagnosis, risk stratification, or management of PE will be discussed.
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Affiliation(s)
- Hyung Yoon Kim
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kye Hun Kim
- Chonnam National University Hospital, Gwangju, Republic of Korea.
| | - Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea, Republic Of
| | - Jong Chun Park
- Chonnam National University Hospital, Gwangju, Republic of Korea
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Israel O, Pellet O, Biassoni L, De Palma D, Estrada-Lobato E, Gnanasegaran G, Kuwert T, la Fougère C, Mariani G, Massalha S, Paez D, Giammarile F. Two decades of SPECT/CT - the coming of age of a technology: An updated review of literature evidence. Eur J Nucl Med Mol Imaging 2019; 46:1990-2012. [PMID: 31273437 PMCID: PMC6667427 DOI: 10.1007/s00259-019-04404-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/14/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) was introduced as a hybrid SPECT/CT imaging modality two decades ago. The main advantage of SPECT/CT is the increased specificity achieved through a more precise localization and characterization of functional findings. The improved diagnostic accuracy is also associated with greater diagnostic confidence and better inter-specialty communication. METHODS This review presents a critical assessment of the relevant literature published so far on the role of SPECT/CT in a variety of clinical conditions. It also includes an update on the established evidence demonstrating both the advantages and limitations of this modality. CONCLUSIONS For the majority of applications, SPECT/CT should be a routine imaging technique, fully integrated into the clinical decision-making process, including oncology, endocrinology, orthopaedics, paediatrics, and cardiology. Large-scale prospective studies are lacking, however, on the use of SPECT/CT in certain clinical domains such as neurology and lung disorders. The review also presents data on the complementary role of SPECT/CT with other imaging modalities and a comparative analysis, where available.
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Affiliation(s)
- Ora Israel
- Rappaport School of Medicine, Israel Institute of Technology, Haifa, Israel.
| | - O Pellet
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - L Biassoni
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D De Palma
- Nuclear Medicine Unit, Circolo Hospital, ASST-Settelaghi, Varese, Italy
| | - E Estrada-Lobato
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - G Gnanasegaran
- Department of Nuclear Medicine, Royal Free NHS Foundation Trust, London, UK
| | - T Kuwert
- Clinic of Nuclear Medicine, University Hospital, Erlangen, Germany
| | - C la Fougère
- Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital, Tubingen, Germany
| | - G Mariani
- Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - S Massalha
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
- Department of Nuclear Medicine, Rambam Healthcare Campus, Haifa, Israel
| | - D Paez
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - F Giammarile
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
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Hegi-Johnson F, de Ruysscher D, Keall P, Hendriks L, Vinogradskiy Y, Yamamoto T, Tahir B, Kipritidis J. Imaging of regional ventilation: Is CT ventilation imaging the answer? A systematic review of the validation data. Radiother Oncol 2019; 137:175-185. [DOI: 10.1016/j.radonc.2019.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 01/08/2023]
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Zinellu E, Piras B, Ruzittu GGM, Fois SS, Fois AG, Pirina P. Recent Advances in Inflammation and Treatment of Small Airways in Asthma. Int J Mol Sci 2019; 20:ijms20112617. [PMID: 31141956 PMCID: PMC6601314 DOI: 10.3390/ijms20112617] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/16/2019] [Accepted: 05/27/2019] [Indexed: 12/14/2022] Open
Abstract
Small airways were historically considered to be almost irrelevant in the development and control of pulmonary chronic diseases but, as a matter of fact, in the past few years we have learned that they are not so "silent". Asthma is still a worldwide health issue due to the great share of patients being far from optimal management. Several studies have shown that the deeper lung inflammation plays a critical role in asthma pathogenesis, mostly in these not well-controlled subjects. Therefore, assessing the degree of small airways inflammation and impairment appears to be a pivotal step in the asthmatic patient's management. It is now possible to evaluate them through direct and indirect measurements, even if some obstacles still affect their clinical application. The success of any treatment obviously depends on several factors but reaching the deeper lung has become a priority and, for inhaled drugs, this is strictly connected to the molecule's size. The aim of the present review is to summarize the recent evidence concerning the small airway involvement in asthma, its physiopathological characteristics and how it can be evaluated in order to undertake a personalized pharmacological treatment and achieve a better disease control.
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Affiliation(s)
- Elisabetta Zinellu
- Respiratory Unit, Azienda Ospedaliero Universitaria (AOU), V.le San Pietro, 07100 Sassari, Italy.
| | - Barbara Piras
- Respiratory Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, V.le San Pietro, 07100 Sassari, Italy.
| | - Giulia G M Ruzittu
- Respiratory Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, V.le San Pietro, 07100 Sassari, Italy.
| | - Sara S Fois
- Respiratory Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, V.le San Pietro, 07100 Sassari, Italy.
| | - Alessandro G Fois
- Respiratory Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, V.le San Pietro, 07100 Sassari, Italy.
| | - Pietro Pirina
- Respiratory Unit, Azienda Ospedaliero Universitaria (AOU), V.le San Pietro, 07100 Sassari, Italy.
- Respiratory Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, V.le San Pietro, 07100 Sassari, Italy.
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Kjellberg M, Sanchez-Crespo A, Jonsson B. Ten-year-old children with a history of bronchopulmonary dysplasia have regional abnormalities in ventilation perfusion matching. Pediatr Pulmonol 2019; 54:602-609. [PMID: 30887678 DOI: 10.1002/ppul.24273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/16/2019] [Indexed: 01/25/2023]
Abstract
AIM The ratio of ventilation to blood flow is an important determinant for regional gas exchange in the lung and hypoxemia is one of the clinical hallmarks in infants with bronchopulmonary dysplasia (BPD). We have previously demonstrated ventilation/perfusion ratio (V/Q) abnormalities in infants with BPD at 36 weekś postconceptional age. The status of V/Q matching in older children with a history of BPD in infancy is unknown. In this study, we examined if 10-year-old children with a history of BPD had V/Q impairments. METHODS Three-dimensional V/Q-scintigraphy (SPECT) was performed in 26 children. RESULTS In the BPD group, lung volume with mismatch, (V>Q) was larger compared to areas with reverse mismatch (Q>V), 26.2% and 11.8%, respectively, implying that perfusion defects contribute more than ventilation defects in the V/Q mismatch. Also, the mean fractional distribution of V and Q to V/Q in children with BPD was reduced compared to healthy children, 31% and 51% compared to 64% and 89%, respectively (P < 0.01). CONCLUSION At 10 years of age children with a history of BPD had ventilation/perfusion abnormalities, with prominent perfusion defects. These V/Q abnormalities suggest the presence of residual alveolar-capillary impairment.
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Affiliation(s)
- Malin Kjellberg
- Institute of Women's and Children's Health, Department of Neonatology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Alejandro Sanchez-Crespo
- Institution of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Department of Medical Radiation Physics and Nuclear Medicine, Karolinska Univeristy Hospital, Stockholm, Sweden
| | - Baldvin Jonsson
- Institute of Women's and Children's Health, Department of Neonatology, Karolinska Institute and University Hospital, Stockholm, Sweden
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Jang B, Chang JH, Park AJ, Wu H. Generation of virtual lung single‐photon emission computed tomography/CT fusion images for functional avoidance radiotherapy planning using machine learning algorithms. J Med Imaging Radiat Oncol 2019; 63:229-235. [DOI: 10.1111/1754-9485.12868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/04/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Bum‐Sup Jang
- Department of Radiation Oncology Seoul National University Hospital Seoul Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology SMG‐SNU Boramae Medical Center Seoul Korea
| | - Andrew J Park
- Artificial Intelligence Research and Development Laboratory SELVAS AI Incorporation Seoul Korea
| | - Hong‐Gyun Wu
- Department of Radiation Oncology Seoul National University Hospital Seoul Korea
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Swan D, Hitchen S, Klok FA, Thachil J. The problem of under-diagnosis and over-diagnosis of pulmonary embolism. Thromb Res 2019; 177:122-129. [PMID: 30889517 DOI: 10.1016/j.thromres.2019.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/02/2019] [Accepted: 03/13/2019] [Indexed: 12/14/2022]
Abstract
Pulmonary embolism (PE) is an increasingly recognised condition which is associated with significant morbidity and mortality. Despite the better awareness of this serious condition, the diagnosis is still overlooked in many cases with sometimes fatal consequences. Under-diagnosis may be due to several reasons including reliance on non-specific 'classic' symptoms, belief that bedside measurements will likely be abnormal in the setting of acute PE, and confounding factors like co-existent cardiorespiratory diseases or being in an intensive care unit, where the diagnosis may not be considered. At the same time, incidental diagnosis of PE is occurring more often due to frequent use of imaging investigations alongside advancements in CT technology, and dilemma exists as to whether the chance finding of PE requires anticoagulation, especially when identified only at the subsegmental level. This article reviews these two issues of under-diagnosis and over-diagnosis of PE in the current era.
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Affiliation(s)
- Dawn Swan
- Department of Haematology, University Hospital Galway, Galway, Ireland.
| | - Sophy Hitchen
- Department of Haematology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Jecko Thachil
- Department of Haematology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Qing K, Tustison NJ, Mugler JP, Mata JF, Lin Z, Zhao L, Wang D, Feng X, Shin JY, Callahan SJ, Bergman MP, Ruppert K, Altes TA, Cassani JM, Shim YM. Probing Changes in Lung Physiology in COPD Using CT, Perfusion MRI, and Hyperpolarized Xenon-129 MRI. Acad Radiol 2019; 26:326-334. [PMID: 30087065 DOI: 10.1016/j.acra.2018.05.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 04/12/2018] [Accepted: 05/16/2018] [Indexed: 12/27/2022]
Abstract
RATIONALE AND OBJECTIVES Chronic obstructive pulmonary disease (COPD) is highly heterogeneous and not well understood. Hyperpolarized xenon-129 (Xe129) magnetic resonance imaging (MRI) provides a unique way to assess important lung functions such as gas uptake. In this pilot study, we exploited multiple imaging modalities, including computed tomography (CT), gadolinium-enhanced perfusion MRI, and Xe129 MRI, to perform a detailed investigation of changes in lung morphology and functions in COPD. Utility and strengths of Xe129 MRI in assessing COPD were also evaluated against the other imaging modalities. MATERIALS AND METHODS Four COPD patients and four age-matched normal subjects participated in this study. Lung tissue density measured by CT, perfusion measures from gadolinium-enhanced MRI, and ventilation and gas uptake measures from Xe129 MRI were calculated for individual lung lobes to assess regional changes in lung morphology and function, and to investigate correlations among the different imaging modalities. RESULTS No significant differences were found for all measures among the five lobes in either the COPD or age-matched normal group. Strong correlations (R > 0.5 or < -0.5, p < 0.001) were found between ventilation and perfusion measures. Also gas uptake by blood as measured by Xe129 MRI showed strong correlations with CT tissue density and ventilation measures (R > 0.5 or < -0.5, p < 0.001) and moderate to strong correlations with perfusion measures (R > 0.4 or < -0.5, p < 0.01). Four distinctive patterns of functional abnormalities were found in patients with COPD. CONCLUSION Xe129 MRI has high potential to uniquely identify multiple changes in lung physiology in COPD using a single breath-hold acquisition.
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Abstract
Pulmonary embolism in pregnancy is a leading cause of maternal mortality. The clinical presentation is often nonspecific, making imaging essential for accurate diagnosis. After reviewing the literature on the radiologic diagnosis of pulmonary embolism in pregnancy, we concluded that both computed tomography pulmonary angiography and lung perfusion scintigraphy are sensitive with high positive predictive values in the presence of high clinical suspicion, but lung perfusion scintigraphy is recommended given lower maternal breast exposure to ionizing radiation and lower fetal contrast exposure. However, if a chest x-ray is abnormal, computed tomography pulmonary angiography is preferred due to high nondiagnostic rates of lung perfusion scintigraphy.
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50
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Le Roux PY, Hicks RJ, Siva S, Hofman MS. PET/CT Lung Ventilation and Perfusion Scanning using Galligas and Gallium-68-MAA. Semin Nucl Med 2019; 49:71-81. [DOI: 10.1053/j.semnuclmed.2018.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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