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Le Pennec R, Tromeur C, Orione C, Robin P, Le Mao R, De Moreuil C, Jevnikar M, Hoffman C, Savale L, Couturaud F, Sitbon O, Montani D, Jaïs X, Le Gal G, Salaün PY, Humbert M, Le Roux PY. Lung Ventilation/Perfusion Scintigraphy for the Screening of Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Which Criteria to Use? Front Med (Lausanne) 2022; 9:851935. [PMID: 35321469 PMCID: PMC8936142 DOI: 10.3389/fmed.2022.851935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) is a major challenge as it is a curable cause of pulmonary hypertension (PH). Ventilation/Perfusion (V/Q) lung scintigraphy is the imaging modality of choice for the screening of CTEPH. However, there is no consensus on the criteria to use for interpretation. The aim of this study was to assess the accuracy of various interpretation criteria of planar V/Q scintigraphy for the screening of CTEPH in patients with PH. Methods The eligible study population consisted of consecutive patients with newly diagnosed PH in the Brest University Hospital, France. Final diagnosis (CTEPH or non-CTEPH) was established in a referential center on the management of PH, based on the ESC/ERS guidelines and a minimum follow-up of 3 years. A retrospective central review of planar V/Q scintigraphy was performed by three nuclear physicians blinded to clinical findings and to final diagnosis. The number, extent (sub-segmental or segmental) and type (matched or mismatched) of perfusion defects were reported. Sensitivity and specificity were evaluated for various criteria based on the number of mismatched perfusion defects and the number of perfusion defects (regardless of ventilation). Receiver operating characteristic (ROC) curves were generated and areas under the curve (AUC) were calculated for both. Results A total of 226 patients with newly diagnosed PH were analyzed. Fifty six (24.8%) were diagnosed with CTEPH while 170 patients (75.2%) were diagnosed with non-CTEPH. The optimal threshold was 2.5 segmental mismatched perfusion defects, providing a sensitivity of 100 % (95% CI 93.6–100%) and a specificity of 94.7% (95%CI 90.3–97.2%). Lower diagnostic cut-offs of mismatched perfusion defects provided similar sensitivity but lower specificity. Ninety five percent of patients with CTEPH had more than 4 segmental mismatched defects. An interpretation only based on perfusion provided similar sensitivity but a specificity of 81.8% (95%CI 75.3–86.9%). Conclusion Our study confirmed the high diagnostic performance of planar V/Q scintigraphy for the screening of CTEPH in patients with PH. The optimal diagnostic cut-off for interpretation was 2.5 segmental mismatched perfusion defects. An interpretation only based on perfusion defects provided similar sensitivity but lower specificity.
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Affiliation(s)
- Romain Le Pennec
- Service de médecine nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Université de Bretagne Occidentale, Brest, France
- *Correspondence: Romain Le Pennec
| | - Cécile Tromeur
- Département de Médecine Interne et Pneumologie, EA 3878 (GETBO), CHRU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Charles Orione
- Département de Médecine Interne et Pneumologie, EA 3878 (GETBO), CHRU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Philippe Robin
- Service de médecine nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Raphaël Le Mao
- Département de Médecine Interne et Pneumologie, EA 3878 (GETBO), CHRU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Claire De Moreuil
- Département de Médecine Interne et Pneumologie, EA 3878 (GETBO), CHRU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Mitja Jevnikar
- AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Université Paris-Sud, Paris, France
| | - Clément Hoffman
- Département de Médecine Interne et Pneumologie, EA 3878 (GETBO), CHRU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Laurent Savale
- AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Université Paris-Sud, Paris, France
| | - Francis Couturaud
- Département de Médecine Interne et Pneumologie, EA 3878 (GETBO), CHRU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Olivier Sitbon
- AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Université Paris-Sud, Paris, France
| | - David Montani
- AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Université Paris-Sud, Paris, France
| | - Xavier Jaïs
- AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Université Paris-Sud, Paris, France
| | - Grégoire Le Gal
- Centre d'Investigation Clinique, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Pierre Yves Salaün
- Service de médecine nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Marc Humbert
- AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Université Paris-Sud, Paris, France
| | - Pierre Yves Le Roux
- Service de médecine nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Université de Bretagne Occidentale, Brest, France
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Derenoncourt PR, Felder GJ, Royal HD, Bhalla S, Lang JA, Matesan MC, Itani M. Ventilation-Perfusion Scan: A Primer for Practicing Radiologists. Radiographics 2021; 41:2047-2070. [PMID: 34678101 DOI: 10.1148/rg.2021210060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lung scintigraphy, or ventilation-perfusion (V/Q) scan, is one of the commonly performed studies in nuclear medicine. Owing to variability in clinical applications and different departmental workflows, many trainees are not comfortable interpreting the results of this study. This article provides a simplified overview of V/Q imaging, including a review of its technique, interpretation methods, and established and emerging clinical applications. The authors review the role of V/Q imaging in evaluation of acute and chronic pulmonary embolism, including the role of SPECT/CT and comparing V/Q scan with CT angiography. In addition, a variety of other applications of pulmonary scintigraphy are discussed, including congenital heart disease, pretreatment planning for lung cancer and emphysema, posttransplant imaging for bronchiolitis obliterans, and less common vascular and nonvascular pathologic conditions that may be detected with V/Q scan. This article will help radiologists and residents interpret the results of V/Q scans and understand the various potential clinical applications of this study. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Paul-Robert Derenoncourt
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Gabriel J Felder
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Henry D Royal
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Jordan A Lang
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Manuela C Matesan
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
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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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The conclusions drawn from ventilation/perfusion single-photon emission computed tomography compared with lung perfusion single-photon emission computed tomography and chest radiography in patients with suspected pulmonary thromboembolism. Nucl Med Commun 2018; 39:908-914. [PMID: 30048378 DOI: 10.1097/mnm.0000000000000886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE There are conflicting results from studies on whether ventilation scintigraphy can be safely omitted or replaced by chest radiography. These studies were based on planar ventilation/perfusion (V/Q) scintigraphy. We evaluated the value of the ventilation single-photon emission computed tomography (SPECT) on the final conclusion drawn from a V/Q SPECT and the possible role of the chest radiography as a surrogate for the ventilation SPECT. PATIENTS AND METHODS Raw data of V/Q SPECT images and chest radiography acquired within 48 h over an 18-month period were retrieved, reprocessed and reviewed in batches. The ventilation SPECT, perfusion SPECT and chest radiography were reviewed separately and in combination. Data on the presence and nature of defects and chest radiography abnormalities were recorded. The V/Q SPECT images were interpreted using the criteria in the EANM guideline and the perfusion SPECT and chest radiography images were interpreted using the PISAPED criteria. Agreement between the diagnosis on the V/Q SPECT review and the perfusion SPECT and chest radiography review was analysed. RESULTS Overall, 21.1% of the patients were classified as 'PE present' on the V/Q SPECT review, whereas 48.9% were classified as 'PE present' on the perfusion SPECT and chest radiography review. Only 5.4% of defects observed on ventilation SPECT had matched chest radiography lung field opacity. CONCLUSION Our study showed that the omission of a ventilation SPECT led to a high rate of false-positive diagnoses and that the ventilation scan cannot be replaced by a chest radiography.
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Pinho DF, Banga A, Torres F, Mathews D. Ventilation perfusion pulmonary scintigraphy in the evaluation of pre-and post-lung transplant patients. Transplant Rev (Orlando) 2018; 33:107-114. [PMID: 30415913 DOI: 10.1016/j.trre.2018.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/04/2018] [Accepted: 10/20/2018] [Indexed: 12/18/2022]
Abstract
Lung transplantation is an established treatment for patients with a variety of advanced lung diseases. Imaging studies play a valuable role not only in evaluation of patients prior to lung transplantation, but also in the follow up of patients after transplantation for detection of complications. After lung transplantation, complications can occur as a result of surgical procedure, pulmonary embolism and ultimately chronic lung allograft dysfunction. Lung scintigraphy, which includes physiologic assessment of lung ventilation and perfusion by imaging, has become an important procedure in the evaluation of these patients, assuming a complementary role to high resolution anatomic imaging (computed tomography [CT]), as well as spirometry. The purpose of this atlas article is to demonstrate the uses of ventilation perfusion scintigraphy in the pre-transplantation setting for surgical planning and in the evaluation of complications post-lung transplantation based upon experience at our institution.
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Affiliation(s)
- Daniella F Pinho
- Department of Radiology, The University of Texas Southwestern Medical Center, United States.
| | - Amit Banga
- Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Texas Southwestern Medical Center, United States
| | - Fernando Torres
- Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Texas Southwestern Medical Center, United States
| | - Dana Mathews
- Department of Radiology, The University of Texas Southwestern Medical Center, United States
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Hunasikatti M. Is Screening for Pulmonary Embolism in Patients With COPD Necessary? Chest 2017; 152:220-221. [DOI: 10.1016/j.chest.2017.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/25/2022] Open
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Response. Chest 2017; 152:221-222. [DOI: 10.1016/j.chest.2017.04.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/17/2022] Open
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