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 |
| DOI/URL: | |
| Notes: | Chest -- Export Date: 2 June 2014 -- CODEN: CHETB -- Source: Scopus |
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