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Chinese multi-center study of lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism

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Abstract

To evaluate diagnostic value of the PISA-PED and PIOPED II criteria for lung scintigraphy and compare it with CT pulmonary angiography (CTPA) for the detection of pulmonary embolism (PE). Five hundred and forty-four consecutive patients with suspected PE were enrolled. All patients underwent lung ventilation/perfusion (V/P) scan, chest radiography, and CTPA. Two readers used the PIOPED II criteria, and 2 used the PISA-PED criteria for the interpretation of lung scintigraphy. CTPA scans were interpreted by two experienced radiologists. Lung scintigraphy and CTPA were categorized as PE present, absent or non-diagnostic. PE was present in 321 of 544 patients. Using PIOPED II criteria, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 85.1, 82.5, 88.1, and 78.4% respectively for V/P scan. Using PISA-PED criteria, sensitivity, specificity, PPV, and NPV were 86.0, 81.2, 86.8, and 80.1% respectively, and none was non-diagnostic. Sensitivity, specificity, PPV, and NPV were 81.7, 93.4, 94.9, and 77.3%, respectively for CTPA. PISA-PED interpretation has similar diagnostic accuracy to PIOPED II interpretation, does not have non-diagnostic scan, with lower cost and radiation, thus should be considered as a choice for patients with suspected PE.

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References

  1. Soudry G, Dibos PE (2000) Gated myocardial perfusion scan leading to diagnosis of unsuspected massive pulmonary embolism. Ann Intern Med 132:845

    PubMed  CAS  Google Scholar 

  2. Dalen JE, Alpert JS (1975) Natural history of pulmonary embolism. Prog Cardiovasc Dis 17:259–270

    Article  PubMed  CAS  Google Scholar 

  3. Carson JL, Kelley MA, Duff A et al (1992) The clinical course of pulmonary embolism. N Engl J Med 326:1240–1245

    Article  PubMed  CAS  Google Scholar 

  4. Barritt DW, Jordan SC (1960) Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. Lancet 1:1309–1312

    Article  PubMed  CAS  Google Scholar 

  5. Stein PD, Fowler SE, Goodman LR et al (2006) Multi-detector computed tomography for acute pulmonary embolism. N Engl J Med 354:2317–2327

    Article  PubMed  CAS  Google Scholar 

  6. Musset D, Parent F, Meyer G et al (2002) Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicentre outcome study. Lancet 360:1914–1920

    Article  PubMed  Google Scholar 

  7. Brenner DJ, Hall EJ (2007) Computed tomography: an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    Article  PubMed  CAS  Google Scholar 

  8. Sostman HD, Stein PD, Gottschalk A et al (2008) Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Radiology 246:941–946

    Article  PubMed  Google Scholar 

  9. Miniati M, Pistolesi M, Marini C et al (1996) 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 154:1387–1393

    PubMed  CAS  Google Scholar 

  10. Sostman HD, Miniati M, Gottschalk A et al (2008) Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med 49:1741–1748

    Article  PubMed  Google Scholar 

  11. McLean RG, Carolan M, Bui C et al (2004) Comparison of new clinical and scintigraphic algorithms for the diagnosis of pulmonary embolism. Br J Radiol 77:372–376

    Article  PubMed  CAS  Google Scholar 

  12. Wells PS, Anderson DR, Rodger M et al (2000) Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 83:416–420

    PubMed  CAS  Google Scholar 

  13. Wang F, Fang W, Lv B et al (2009) Comparison of lung scintigraphy with multi-slice spiral CT in the diagnosis of pulmonary embolism. Clin Nucl Med 34:424–427

    Article  PubMed  Google Scholar 

  14. Reinartz P, Wildberger JE, Schaefer W et al (2004) Tomographic imaging in the diagnosis of pulmonary embolism: a comparison between V/Q lung scintigraphy in SPECT technique and multislice spiral CT. J Nucl Med 45:1501–1508

    PubMed  Google Scholar 

  15. Katsouda E, Mystakidou K, Rapti A et al (2005) Evaluation of spiral computed tomography versus ventilation/perfusion scanning in patients clinically suspected of pulmonary embolism. In Vivo 19:873–878

    PubMed  Google Scholar 

  16. Turkstra F, Kuijer PM, van Beek EJ et al (1997) Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med 126:775–781

    PubMed  CAS  Google Scholar 

  17. Henry JW, Relyea B, Stein PD (1995) Continuing risk of thromboemboli among patients with normal pulmonary angiograms. Chest 107:1375–1378

    Article  PubMed  CAS  Google Scholar 

  18. Kipper MS, Moser KM, Kortman KE et al (1982) Longterm follow-up of patients with suspected pulmonary embolism and a normal lung scan. Perfusion scans in embolic suspects. Chest 82:411–415

    Article  PubMed  CAS  Google Scholar 

  19. Wells PS, Ginsberg JS, Anderson DR et al (1998) Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 129:997–1005

    PubMed  CAS  Google Scholar 

  20. Bajc M, Neilly JB, Miniati M et al (2009) EANM guidelines for ventilation/perfusion scintigraphy: part 2. algorithms and clinical considerations for diagnosis of pulmonary emboli with V/P (SPECT) and MDCT. Eur J Nucl Med Mol Imag 36:1528–1538

    Article  CAS  Google Scholar 

  21. Goldberg SN, Palmer EL, Scott JA et al (1994) Pulmonary embolism: prediction of the usefulness of initial ventilation–perfusion scanning with chest radiographic findings. Radiology. 193:801–805

    PubMed  CAS  Google Scholar 

  22. Stein PD, Terrin ML, Gottschalk A et al (1992) Value of ventilation/perfusion scans compared to perfusion scans alone in acute pulmonary embolism. Am J Cardiol 69:1239–1241

    Article  PubMed  CAS  Google Scholar 

  23. The PIOPED Investigators (1990) Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 263:2753–2759

    Article  Google Scholar 

  24. Perrier A, Roy P-M, Sanchez O et al (2005) Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med 352:1760–1768

    Article  PubMed  CAS  Google Scholar 

  25. The Christopher Study Investigators (2006) Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 295:172–179

    Article  Google Scholar 

  26. Parker MS, Hui FK, Camacho MA (2005) Female breast radiation exposure during CT pulmonary angiography. AJR 185:1228–1233

    Article  PubMed  Google Scholar 

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Acknowledgments

The study was supported by Beijing Municipal Science and Technology Project Y0204004040731 and D101100050010034, National Science and Technology Pillar Program in the Eleventh 5-year Plan Period, People’s Republic of China (2006BAI01A07).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China

    Jia He, Zuo-Xiang He & Wei Fang

  2. Department of Nuclear Medicine, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China

    Feng Wang, Hao-jie Dai & Mei Li

  3. Department of Nuclear Medicine, Beijing An Zhen Hospital, Capital Medical University, Beijing, China

    Qian Wang

  4. Department of Nuclear Medicine, Beijing Hospital, Beijing, China

    Zhiming Yao

  5. Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China

    Bin Lv

  6. Pulmonary Disease Center, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China

    Chang-ming Xiong, Jian-guo He & Zhi-hong Liu

Authors
  1. Jia He
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  2. Feng Wang
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  3. Hao-jie Dai
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  4. Mei Li
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  5. Qian Wang
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  6. Zhiming Yao
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  7. Bin Lv
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  8. Chang-ming Xiong
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  9. Jian-guo He
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  10. Zhi-hong Liu
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  11. Zuo-Xiang He
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  12. Wei Fang
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Correspondence to Wei Fang.

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He, J., Wang, F., Dai, Hj. et al. Chinese multi-center study of lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism. Int J Cardiovasc Imaging 28, 1799–1805 (2012). https://doi.org/10.1007/s10554-012-0013-9

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  • DOI: https://doi.org/10.1007/s10554-012-0013-9

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