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Non-contrast Perfusion SPECT/CT - A New Test for the Expedited, High Accuracy Diagnosis of Acute Pulmonary Embolism.
MedLine Citation:
PMID:  24384579     Owner:  NLM     Status:  Publisher    
ABSTRACT BACKGROUND: Standard ventilation/perfusion (V/Q) scintigraphy employs planar images for the diagnosis of pulmonary embolism (PE). To evaluate whether tomographic imaging improves the diagnostic accuracy of the procedure we compared non-contrast perfusion SPECT/CT (Q-SPECT/CT) with that of planar V/Q scans in patients at high risk for PE.
METHODS: Between 2006 and 2010 most patients referred for diagnosis of PE underwent both Q-SPECT/CT and planar V/Q scintigraphy. All scans were reviewed retrospectively by 4 observers; planar scans were read using modified PIOPED II (PIOPED2) and PISA-PED criteria. On Q-SPECT/CT, any wedge shaped peripheral perfusion defect occupying >50% of a segment without corresponding pulmonary parenchymal or pleural disease was considered positive for PE. The final diagnosis was established with a composite reference standard that included EKG, ultrasound of lower extremity veins, D-dimer levels, CT pulmonary angiography (when available) and clinical follow-up for at least 3 months.
RESULTS: 106 patients with a diagnosis of cancer and mean Wells score of 4.4 had sufficient follow-up; 22 patients had a final diagnosis of PE and 84 patients a final diagnosis of no PE. According to PIOPED2, 13 studies were graded as intermediate probability. Sensitivity and specificity for PE were 50% and 98% using PIOPED2 criteria, 86% and 93% using PISA-PED criteria, and 91% and 94% using Q-SPECT/CT. Seventy-six patients had additional relevant findings on the CT of the Q-SPECT/CT.
CONCLUSIONS: Non-contrast Q-SPECT/CT has higher accuracy than planar V/Q imaging using PIOPED2 criteria in cancer patients with high risk for PE.
Yang Lu; Alice Lorenzoni; Josef J Fox; Jürgen Rademaker; Nicholas Vanderels; Ravinder K Grewal; H William Strauss; Heiko Schöder
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-1-2
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-1-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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