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Safety of ventilation/perfusion single photon emission computed tomography for pulmonary embolism diagnosis

  • Pierre-Yves Le Roux
  • Xavier Palard
  • Philippe Robin
  • Aurélien Delluc
  • Ronan Abgral
  • Solène Querellou
  • Francis Couturaud
  • Grégoire Le Gal
  • Pierre-Yves SalaunEmail author
Original Article

Abstract

Purpose

The aim of this management outcome study was to assess the safety of ventilation/perfusion single photon emission computed tomography (V/Q SPECT) for the diagnosis of pulmonary embolism (PE) using for interpretation the criteria proposed in the European Association of Nuclear Medicine (EANM) guidelines for V/Q scintigraphy.

Methods

A total of 393 patients with clinically suspected PE referred to the Nuclear Medicine Department of Brest University Hospital from April 2011 to March 2013, with either a high clinical probability or a low or intermediate clinical probability but positive D-dimer, were retrospectively analysed. V/Q SPECT were interpreted by the attending nuclear medicine physician using a diagnostic cut-off of one segmental or two subsegmental mismatches. The final diagnostic conclusion was established by the physician responsible for patient care, based on clinical symptoms, laboratory test, V/Q SPECT and other imaging procedures performed. Patients in whom PE was deemed absent were not treated with anticoagulants and were followed up for 3 months.

Results

Of the 393 patients, the prevalence of PE was 28 %. V/Q SPECT was positive for PE in 110 patients (28 %) and negative in 283 patients (72 %). Of the 110 patients with a positive V/Q SPECT, 78 (71 %) had at least one additional imaging test (computed tomography pulmonary angiography or ultrasound) and the diagnosis of PE was eventually excluded in one patient. Of the 283 patients with a negative V/Q SPECT, 74 (26 %) patients had another test. The diagnosis of PE was finally retained in one patient and excluded in 282 patients. The 3-month thromboembolic risk in the patients not treated with anticoagulants was 1/262: 0.38 % (95 % confidence interval 0.07–2.13).

Conclusion

A diagnostic management including V/Q SPECT interpreted with a diagnostic cut-off of “one segmental or two subsegmental mismatches” appears safe to exclude PE.

Keywords

V/Q SPECT Pulmonary embolism Criteria Outcome 

Notes

Acknowledgments

We would like to thank Z. Alavi, MSc, INSERM CIC 1412, for proofreading this manuscript.

Conflicts of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Pierre-Yves Le Roux
    • 1
    • 2
    • 3
  • Xavier Palard
    • 1
    • 2
    • 3
  • Philippe Robin
    • 1
    • 2
    • 3
  • Aurélien Delluc
    • 1
    • 2
    • 5
  • Ronan Abgral
    • 1
    • 2
    • 3
  • Solène Querellou
    • 1
    • 2
    • 3
  • Francis Couturaud
    • 1
    • 2
    • 5
  • Grégoire Le Gal
    • 1
    • 4
    • 5
    • 6
  • Pierre-Yves Salaun
    • 1
    • 2
    • 3
    Email author
  1. 1.Université Européenne de BretagneBrestFrance
  2. 2.Université de BrestBrestFrance
  3. 3.CHRU de la Cavale Blanche, Service de médecine nucléaireBrestFrance
  4. 4.Ottawa Hospital Research InstituteUniversity of OttawaOttawaCanada
  5. 5.CHRU de la Cavale Blanche, Département de médecine interne et de pneumologieBrestFrance
  6. 6.Université de BrestBrestFrance

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