Noncontrast perfusion single-photon emission CT/CT scanning: A new test for the expedited, high-accuracy diagnosis of acute pulmonary embolism Journal Article

Authors: Lu, Y.; Lorenzoni, A.; Fox, J. J.; Rademaker, J.; Els, N. V.; Grewal, R. K.; Strauss, H. W.; Schöder, H.
Article Title: Noncontrast perfusion single-photon emission CT/CT scanning: A new test for the expedited, high-accuracy diagnosis of acute pulmonary embolism
Abstract: Background: Standard ventilation and perfusion (V̇/Q̇) scintigraphy uses planar images for the diagnosis of pulmonary embolism (PE). To evaluate whether tomographic imaging improves the diagnostic accuracy of the procedure, we compared noncontrast perfusion single-photon emission CT ( -SPECT)/CT scans with planar V̇/Q̇ scans in patients at high risk for PE. Methods: Between 2006 and 2010, most patients referred for diagnosis of PE underwent both -SPECT/CT scan and planar V̇/Q̇ scintigraphy. All scans were reviewed retrospectively by four observers; planar scans were read with modifi ed Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II and Prospective Investigative Study of Pulmonary Embolism Diagnosis (PISA-PED) criteria. On -SPECT/CT scan, any wedge-shaped peripheral perfusion defect occupying < 50% of a segment without corresponding pulmonary parenchymal or pleural disease was considered to show PE. The fi nal diagnosis was established with a composite reference standard that included ECG, ultrasound of lower-extremity veins, D-dimer levels, CT pulmonary angiography (when available), and clinical follow-up for at least 3 months. Results: One hundred six patients with cancer and mean Wells score of 4.4 had suffi cient follow-up; 22 patients were given a fi nal diagnosis of PE, and 84 patients were given a fi nal diagnosis of no PE. According to PIOPED II, 13 studies were graded as intermediate probability. Sensitivity and specifi city for PE were 50% and 98%, respectively, based on PIOPED II criteria; 86% and 93%, respectively, based on PISA-PED criteria; and 91% and 94%, respectively, based on Q̇SPECT/CT scan. Seventy-six patients had additional relevant fi ndings on the CT image of the Q̇SPECT/CT scan. Conclusions: Noncontrast Q̇SPECT/CT imaging has a higher accuracy than planar V̇/Q̇ imaging based on PIOPED II criteria in patients with cancer and a high risk for PE. © 2014 American College of Chest Physicians.
Keywords: adult; controlled study; aged; major clinical study; cancer patient; follow up; diagnostic accuracy; sensitivity and specificity; clinical assessment; retrospective study; ultrasound; high risk patient; lung embolism; false negative result; probability; intermethod comparison; single photon emission computer tomography; false positive result; electrocardiogram; predictive value; computed tomographic angiography; d dimer; diagnostic test accuracy study; named inventories, questionnaires and rating scales; scintillation camera; lung scintiscanning; human; male; female; priority journal; article; imaging software; leg vein; prospective investigation of pulmonary embolism diagnosis ii; prospective investigative study of pulmonary embolism diagnosis; well score
Journal Title: Chest
Volume: 145
Issue: 5
ISSN: 0012-3692
Publisher: American College of Chest Physicians  
Date Published: 2014-05-01
Start Page: 1079
End Page: 1088
Language: English
DOI: 10.1378/chest.13-2090
PROVIDER: scopus
PUBMED: 24798835
Notes: Chest -- Export Date: 2 June 2014 -- CODEN: CHETB -- Source: Scopus
Citation Impact
MSK Authors
  1. Josef J Fox
    63 Fox
  2. Ravinder K Grewal
    72 Grewal
  3. Heiko Schoder
    411 Schoder
  4. Harry W Strauss
    156 Strauss
  5. Yang Lu
    11 Lu