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Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate

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Abstract

Purpose

To investigate the diagnostic performance of perfusion single-photon emission computed tomography/computed tomography (Q-SPECT/CT) in patients suspected to have pulmonary embolism (PE) but with indeterminate computed tomographic pulmonary angiography (CTPA) or planar ventilation/perfusion (V/Q) scans.

Methods

This retrospective study included two groups of patients. Group I consisted of 49 patients with nondiagnostic CTPA. These 49 patients underwent subsequent V/Q scans. Further Q-SPECTs were obtained in patients with indeterminate planar images and fused with existing CTPA. Group II consisted of 182 non-CTPA patients with indeterminate V/Q scans. These 182 patients underwent further Q-SPECT and separate noncontrast low-dose CT chest. Fusion Q-SPECT/CT scans were obtained through FDA-approved software and interpreted according to published criteria as positive, negative, or indeterminate for PE. Upon retrospective analyses, the final diagnosis was made using composite reference standards including all available clinical and imaging information for at least 6-month follow-up.

Results

In group I patients, 1 was positive, 24 were negative, and another 24 (49 %, 24/49) were indeterminate. In the subsequent 24 Q-SPECT/CTPAs, 4 were positive, 19 were negative, and 1 was indeterminate (4.2 %, 1/24). In group II patients, 9 (4.9 %, 9/182) were indeterminate, 33 were positive, and 140 were negative. The combined nondiagnostic rate for Q-SPECT/CT was only 4.9 % (10/206). There was six false-negative and one false-positive Q-SPECT/CT examinations. The sensitivity, specificity, and positive and negative predictive value of Q-SPECT/CT were 85.7 % (36/42), 99.4 % (153/154), 97.3 % (36/37) and 96.2 % (153/159), respectively.

Conclusions

Q-SPECT/CT improves the diagnostic rate with promising accuracy in diagnosing PE that yields a satisfactory clinical verdict, especially when the CTPA and planar V/Q scan are indeterminate.

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Compliance with Ethical Standards

Conflict of Interest

Nishant Kumar, Karen Xie, Winnie Mar, Thomas M. Anderson, Benjamin Carney, Nikhil Mehta, Roberto Machado, Michael J. Blend, and Yang Lu declare that they have no conflict of interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived at the approval of the IRB for this retrospective study.

The manuscript has not been published before and is not under consideration for publication anywhere else, and it has been approved by all coauthors.

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Authors and Affiliations

  1. Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 W Taylor St. MC 931, Chicago, IL, 60612, USA

    Nishant Kumar, Karen Xie, Winnie Mar, Thomas M. Anderson, Benjamin Carney, Nikhil Mehta, Michael J. Blend & Yang Lu

  2. Section of Pulmonary section, Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, USA

    Roberto Machado

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  1. Nishant Kumar
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Correspondence to Yang Lu.

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Kumar, N., Xie, K., Mar, W. et al. Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate. Nucl Med Mol Imaging 49, 303–311 (2015). https://doi.org/10.1007/s13139-015-0359-8

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  • DOI: https://doi.org/10.1007/s13139-015-0359-8

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