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Perfusion SPECT in patients with suspected pulmonary embolism

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Ventilation/perfusion tomography (V/PSPECT), with new interpretation criteria and newer tracers for ventilation imaging, has markedly improved the diagnostic yield in acute pulmonary embolism (PE). Here, we evaluated the diagnostic performance of perfusion SPECT (PSPECT) without ventilation imaging.

Methods

We studied 152 patients with clinically suspected PE who had been examined with both V/PSPECT and multidetector computed tomographic angiography (MD-CTA). The diagnosis or exclusion of PE was decided by the referring clinician based on both the V/PSPECT and/or MD-CTA findings in combination with the clinical findings. PSPECT images were retrospectively examined by a physician with experience in the interpretation of planar perfusion scans who was blinded to clinical, V/PSPECT and MD-CTA data. PSPECT images were interpreted without the aid of chest radiography. All the patients who were deemed to have PE were given anticoagulant therapy.

Results

Of the 152 patients, 59 (39 %) received a final diagnosis of PE, and 19 (32 %) had associated cardiopulmonary diseases such as pneumonia, COPD, or left heart failure. PSPECT correctly identified 53 (90 %) of the 59 patients with PE. The specificity was 88 of 93 (95 %). None of the PSPECT images was rated nondiagnostic. PSPECT yielded an overall diagnostic accuracy of 93 % (95 % confidence interval, CI, 87–96 %). At the observed PE prevalence of 39 %, the positive and negative predictive values of PSPECT were 91 % (95 % CI, 80–97 %) and 94 % (95 % CI, 86–97 %), respectively.

Conclusion

In managing critically ill patients, PSPECT might be a valid alternative to V/PSPECT or MD-CTA since it was able to identify most patients with PE with a low false-positive rate and no inconclusive results.

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References

  1. Stein PD. Prevalence, risks, and prognosis of pulmonary embolism and deep vein thrombosis. In: Stein PD, editor. Pulmonary embolism. 2nd ed. Oxford: Blackwell; 2007. p. 3–15.

    Chapter  Google Scholar 

  2. Stein PD, Willis III PW, Dalen JE. Importance of clinical assessment in selecting patients for pulmonary arteriography. Am J Cardiol. 1979;43:669–71.

    Article  PubMed  CAS  Google Scholar 

  3. Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med. 1999;159:864–71.

    Article  PubMed  CAS  Google Scholar 

  4. Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP. National trends in CT use in the emergency department: 1995–2007. Radiology. 2011;258:164–73.

    Article  PubMed  Google Scholar 

  5. Smith-Bindman R. Is computed tomography safe? N Engl J Med. 2010;363:1–4.

    Article  PubMed  CAS  Google Scholar 

  6. PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA. 1990;263:2753–9.

    Article  Google Scholar 

  7. Bajc M, Olsson B, Palmer J, Jonson B. Ventilation/perfusion SPECT for diagnostics of pulmonary embolism in clinical practice. J Intern Med. 2008;264:379–87.

    Article  PubMed  CAS  Google Scholar 

  8. Miniati M, Pistolesi M, Marini C, Di Ricco G, Formichi B, Prediletto R, et al. Value of perfusion lung scan in the diagnosis of pulmonary embolism. Results of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED). Am J Respir Crit Care Med. 1996;154:1387–93.

    Article  PubMed  CAS  Google Scholar 

  9. Sostman DH, Miniati M, Gottschalk A, Matta S, Stein PD, Pistolesi M. Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med. 2008;49:1741–8.

    Article  PubMed  Google Scholar 

  10. Bajc M, Neilly JB, Miniati M, Schuemichen C, Meignan M, Jonson B, et al. EANM guidelines for ventilation/perfusion scintigraphy: part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging. 2009;36:1356–70.

    Article  PubMed  CAS  Google Scholar 

  11. Bajc M, Neilly JB, Miniati M, Schuemichen, Meignan M, Jonson B, et al. EANM guidelines for ventilation/perfusion scintigraphy: part 2. Algorithms and clinical considerations for diagnosis of pulmonary embolism with V/P (SPECT) and MDCT. Eur J Nucl Med Mol Imaging. 2009;36:1528–38.

    Article  PubMed  CAS  Google Scholar 

  12. Palmer J, Bitzen U, Jonson B, Bajc M. Comprehensive ventilation/perfusion SPECT. J Nucl Med. 2001;42:1288–94.

    PubMed  CAS  Google Scholar 

  13. Olsson CG, Bitzen U, Olsson B, Magnusson P, Carlsson MS, Jonson B, et al. Outpatient tinzaparin therapy in pulmonary embolism quantified with ventilation/perfusion scintigraphy. Med Sci Monit. 2006;12:PI9–13.

    PubMed  Google Scholar 

  14. Mamlouk MD, van Sonnenberg E, Gosalia R, Drachman D, Gridley D, Zamora JG, et al. Pulmonary embolism at CT angiography: implications for appropriateness, cost, and radiation exposure in 2003 patients. Radiology. 2010;256:625–32.

    Article  PubMed  Google Scholar 

  15. Hurwitz LM, Reiman RE, Yoshizumi TT, Goodman PC, Toncheva G, Nguyen G, et al. Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: implications for cancer induction. Radiology. 2007;245:742–50.

    Article  PubMed  Google Scholar 

  16. Gutte H, Mortensen J, Jensen CV, Bardam Johnbeck C, von der Reck P, Petersen CL, et al. Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low dose CT: head-to-head comparison with multidetector CT angiography. J Nucl Med. 2009;50:1987–92.

    Article  PubMed  Google Scholar 

  17. He J, Wang F, Dai HJ, Li M, Wang Q, Yao Z, et al. Chinese multi-center study of lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism. Int J Cardiovasc Imaging. 2012;28:1799–805.

    Article  PubMed  Google Scholar 

  18. Morris TA, Gerometta M, Yusen RD, White RH, Douketis JD, Kaatz S, et al. Detection of pulmonary emboli with 99mTc-labeled anti-D-dimer (DI-80B3) Fab’ fragments (ThromboView). Am J Respir Crit Care Med. 2011;184:708–14.

    Article  PubMed  CAS  Google Scholar 

  19. Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354:2317–27.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We are grateful to Berit Olsson, research technologist, for invaluable technical assistance.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden

    Marika Bajc & Jonas Jögi

  2. Department of Experimental and Clinical Medicine, School of Medicine, University of Florence, Florence, Italy

    Massimo Miniati

  3. Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA

    Paul D. Stein

  4. Department of Research, St Mary Mercy Hospital, Livonia, MI, USA

    Paul D. Stein

Authors
  1. Marika Bajc
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  2. Massimo Miniati
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  3. Jonas Jögi
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  4. Paul D. Stein
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Correspondence to Marika Bajc.

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Bajc, M., Miniati, M., Jögi, J. et al. Perfusion SPECT in patients with suspected pulmonary embolism. Eur J Nucl Med Mol Imaging 40, 1432–1437 (2013). https://doi.org/10.1007/s00259-013-2425-8

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  • DOI: https://doi.org/10.1007/s00259-013-2425-8

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