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Independent and incremental value of ventilation/perfusion PET/CT and CT pulmonary angiography for pulmonary embolism diagnosis: results of the PECAN pilot study

European Journal of Nuclear Medicine and Molecular Imaging volume 46, pages 1596–1604 (2019)Cite this article

Abstract

Purpose

This pilot study assessed the independent and incremental value of 68Ga-V/Q PET/CT as compared with CT pulmonary angiography (CTPA) for the management of cancer patients with suspected acute pulmonary embolism (PE).

Methods

All 24 cancer patients with suspected acute PE prospectively recruited underwent both 68Ga-V/Q PET/CT and CTPA within 24 h. PET/CT was acquired after inhalation of Galligas prepared using a Technegas generator and administration of 68Ga-macroaggregated albumin. Initially, PET/CT and CTPA scans were read independently with the reader blinded to the results of the other imaging study. CTPA and PET/CT were then coregistered and reviewed by consensus between a radiologist and nuclear medicine physician. The therapeutic management was established by the managing physician based on all available data.

Results

The diagnostic conclusion was concordantly negative in 18 patients (75%). Of the six discordant diagnoses on independent reading, combined interpretation of V/Q PET/CTPA enabled a consensus conclusion in two patients, excluding PE in one and confirming PE in the other, similar to the initial diagnostic conclusion of the V/Q PET/CT. Of the remaining four patients, three had a single subsegmental thrombus on CTPA but a negative V/Q PET/CT scan, and two of these did not receive long-term anticoagulation and did not have a venous thromboembolic event during a 3-year follow-up period. The third patient, along with a patient with a positive V/Q PET/CT scan but a negative CTPA scan, presented with acute complications preventing any conclusions with regard to the appropriateness of the V/Q PET/CT results in the management of PE. Overall, V/Q PET had an impact on management in four patients (17%).

Conclusion

In this pilot study, we demonstrated the feasibility and potential utility of V/Q PET/CT for the management of patients with suspected PE. V/Q PET/CT may be of particular relevance in patients with equivocal findings or isolated subsegmental findings on CTPA, adding further discriminatory information to allow important decision-making regarding the use or withholding of anticoagulation. Given the other advantages of V/Q PET/CT (reduced acquisition time, low radiation dose), and with the increasing availability of 68Ga generators, PET/CT is a potential replacement for V/Q SPECT/CT imaging.

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Acknowledgments

We acknowledge the doctors, radiopharmacists, technologists, nurses and medical physicists at the Peter MacCallum Cancer Team who enabled this research to occur.

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Affiliations

  1. Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia

    Pierre-Yves Le Roux, Amir Iravani, Jason Callahan, Peter Eu, Eddie Lau, Beverly Woon, Rodney J. Hicks & Michael S. Hofman

  2. Nuclear Medicine, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France

    Pierre-Yves Le Roux & Pierre-Yves Salaun

  3. Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

    Kate Burbury

  4. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia

    Kate Burbury, Rodney J. Hicks & Michael S. Hofman

  5. Respiratory Medicine, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia

    Daniel P. Steinfort

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  1. Pierre-Yves Le Roux
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  2. Amir Iravani
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  3. Jason Callahan
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  11. Michael S. Hofman
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Correspondence to Pierre-Yves Le Roux or Michael S. Hofman.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The protocol was approved by the Ethics Committee of our institution (14/117). The study was registered with the Australian New Zealand Clinical Trial Registry (ACTRN12614001170617).

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Le Roux, PY., Iravani, A., Callahan, J. et al. Independent and incremental value of ventilation/perfusion PET/CT and CT pulmonary angiography for pulmonary embolism diagnosis: results of the PECAN pilot study. Eur J Nucl Med Mol Imaging 46, 1596–1604 (2019). https://doi.org/10.1007/s00259-019-04338-z

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Keywords

  • Pulmonary embolism
  • V/Q PET/CT
  • Gallium-68
  • CT pulmonary angiography