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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 2004; 45(9):1501-8JN

Abstract

Although ventilation/perfusion (V/Q) lung scintigraphy is a well-accepted and frequently performed procedure in the diagnosis of pulmonary embolism, there is growing controversy about its relevance, particularly due to the increasing competition between scintigraphy and CT. Even though comparative studies between both modalities have already been performed, their results were highly inconsistent. Remarkably, in most of those studies, conventional planar perfusion scans were compared with tomographic images acquired using state-of-the-art CT scanners-a study design that cannot give impartial results. Hence, the aim of our study was a balanced comparison between V/Q lung scintigraphy and CT angiography using advanced imaging techniques for both modalities.

METHODS

A total of 83 patients with suspected pulmonary embolism were examined using V/Q lung scintigraphy in SPECT technique as well as 4-slice spiral CT. Ventilation scans were done using an ultrafine aerosol. Additionally, planar images in 8 views were extracted from the V/Q SPECT datasets. Two experienced referees assessed each of the 3 modalities. The final diagnosis was made at a consensus meeting while taking into account all of the imaging modalities, laboratory tests, clinical data, and evaluation of a follow-up period.

RESULTS

In the course of the consensus conference, pulmonary embolism was diagnosed in 37 of the 83 patients (44.6%). Compared with planar scintigraphy, SPECT raised the number of detectable defects at the segmental level by 12.8% (+11 defects; P = 0.401) and at the subsegmental level by 82.6% (+57 defects; P < 0.01). The sensitivity/specificity/accuracy of planar V/Q scintigraphy and V/Q SPECT was 0.76/0.85/0.81 and 0.97/0.91/0.94, respectively, compared with 0.86/0.98/0.93 for multislice CT.

CONCLUSION

SPECT and ultrafine aerosols are technical advancements that can substantially improve lung scintigraphy. Using advanced imaging techniques, V/Q scintigraphy and multislice spiral CT both yield an excellent and, in all aspects, comparable diagnostic accuracy, with CT leading in specificity while SPECT shows a superior sensitivity. Even though planar lung scintigraphy yields satisfactory results for a nontomographic modality, it does not compare with tomographic imaging.

Authors+Show Affiliations

Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany. preinartz@compuserve.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Controlled Clinical Trial
Journal Article
Validation Study

Language

eng

PubMed ID

15347717

Citation

Reinartz, Patrick, et al. "Tomographic Imaging in the Diagnosis of Pulmonary Embolism: a Comparison Between V/Q Lung Scintigraphy in SPECT Technique and Multislice Spiral CT." Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, vol. 45, no. 9, 2004, pp. 1501-8.
Reinartz P, Wildberger JE, Schaefer W, et al. 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. 2004;45(9):1501-8.
Reinartz, P., Wildberger, J. E., Schaefer, W., Nowak, B., Mahnken, A. H., & Buell, U. (2004). Tomographic imaging in the diagnosis of pulmonary embolism: a comparison between V/Q lung scintigraphy in SPECT technique and multislice spiral CT. Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, 45(9), pp. 1501-8.
Reinartz P, et al. 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. 2004;45(9):1501-8. PubMed PMID: 15347717.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tomographic imaging in the diagnosis of pulmonary embolism: a comparison between V/Q lung scintigraphy in SPECT technique and multislice spiral CT. AU - Reinartz,Patrick, AU - Wildberger,Joachim E, AU - Schaefer,Wolfgang, AU - Nowak,Bernd, AU - Mahnken,Andreas H, AU - Buell,Ulrich, PY - 2004/9/7/pubmed PY - 2004/11/2/medline PY - 2004/9/7/entrez SP - 1501 EP - 8 JF - Journal of nuclear medicine : official publication, Society of Nuclear Medicine JO - J. Nucl. Med. VL - 45 IS - 9 N2 - UNLABELLED: Although ventilation/perfusion (V/Q) lung scintigraphy is a well-accepted and frequently performed procedure in the diagnosis of pulmonary embolism, there is growing controversy about its relevance, particularly due to the increasing competition between scintigraphy and CT. Even though comparative studies between both modalities have already been performed, their results were highly inconsistent. Remarkably, in most of those studies, conventional planar perfusion scans were compared with tomographic images acquired using state-of-the-art CT scanners-a study design that cannot give impartial results. Hence, the aim of our study was a balanced comparison between V/Q lung scintigraphy and CT angiography using advanced imaging techniques for both modalities. METHODS: A total of 83 patients with suspected pulmonary embolism were examined using V/Q lung scintigraphy in SPECT technique as well as 4-slice spiral CT. Ventilation scans were done using an ultrafine aerosol. Additionally, planar images in 8 views were extracted from the V/Q SPECT datasets. Two experienced referees assessed each of the 3 modalities. The final diagnosis was made at a consensus meeting while taking into account all of the imaging modalities, laboratory tests, clinical data, and evaluation of a follow-up period. RESULTS: In the course of the consensus conference, pulmonary embolism was diagnosed in 37 of the 83 patients (44.6%). Compared with planar scintigraphy, SPECT raised the number of detectable defects at the segmental level by 12.8% (+11 defects; P = 0.401) and at the subsegmental level by 82.6% (+57 defects; P < 0.01). The sensitivity/specificity/accuracy of planar V/Q scintigraphy and V/Q SPECT was 0.76/0.85/0.81 and 0.97/0.91/0.94, respectively, compared with 0.86/0.98/0.93 for multislice CT. CONCLUSION: SPECT and ultrafine aerosols are technical advancements that can substantially improve lung scintigraphy. Using advanced imaging techniques, V/Q scintigraphy and multislice spiral CT both yield an excellent and, in all aspects, comparable diagnostic accuracy, with CT leading in specificity while SPECT shows a superior sensitivity. Even though planar lung scintigraphy yields satisfactory results for a nontomographic modality, it does not compare with tomographic imaging. SN - 0161-5505 UR - https://www.unboundmedicine.com/medline/citation/15347717/Tomographic_imaging_in_the_diagnosis_of_pulmonary_embolism:_a_comparison_between_V/Q_lung_scintigraphy_in_SPECT_technique_and_multislice_spiral_CT_ L2 - http://jnm.snmjournals.org/cgi/pmidlookup?view=long&amp;pmid=15347717 DB - PRIME DP - Unbound Medicine ER -