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Noncontrast perfusion single-photon emission CT/CT scanning: a new test for the expedited, high-accuracy diagnosis of acute pulmonary embolism.
Chest 2014; 145(5):1079-1088Chest

Abstract

BACKGROUND

Standard ventilation and perfusion (V˙/Q˙) 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 (Q˙-SPECT)/CT scans with 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 scan and planar V˙/Q˙scintigraphy. All scans were reviewed retrospectively by four observers; planar scans were read with modified Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II and Prospective Investigative Study of Pulmonary Embolism Diagnosis (PISA-PED) criteria. On Q˙-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 final 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 sufficient follow-up; 22 patients were given a final diagnosis of PE, and 84 patients were given a final diagnosis of no PE. According to PIOPED II, 13 studies were graded as intermediate probability. Sensitivity and specificity 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 Q˙-SPECT/CT scan. Seventy-six patients had additional relevant findings on the CT image of the Q˙-SPECT/CT scan.

CONCLUSIONS

Noncontrast Q˙-SPECT/CT imaging has a higher accuracy than planar V˙/Q˙imaging based on PIOPED II criteria in patients with cancer and a high risk for PE.

Authors+Show Affiliations

Molecular Imaging and Therapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.Molecular Imaging and Therapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.Molecular Imaging and Therapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.Body Imaging Section, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.Department of Radiology and Pulmonary Disease Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.Molecular Imaging and Therapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.Molecular Imaging and Therapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.Molecular Imaging and Therapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY. Electronic address: schoderh@mskcc.org.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24798835

Citation

Lu, Yang, et al. "Noncontrast Perfusion Single-photon Emission CT/CT Scanning: a New Test for the Expedited, High-accuracy Diagnosis of Acute Pulmonary Embolism." Chest, vol. 145, no. 5, 2014, pp. 1079-1088.
Lu Y, Lorenzoni A, Fox JJ, et al. Noncontrast perfusion single-photon emission CT/CT scanning: a new test for the expedited, high-accuracy diagnosis of acute pulmonary embolism. Chest. 2014;145(5):1079-1088.
Lu, Y., Lorenzoni, A., Fox, J. J., Rademaker, J., Vander Els, N., Grewal, R. K., ... Schöder, H. (2014). Noncontrast perfusion single-photon emission CT/CT scanning: a new test for the expedited, high-accuracy diagnosis of acute pulmonary embolism. Chest, 145(5), pp. 1079-1088. doi:10.1378/chest.13-2090.
Lu Y, et al. Noncontrast Perfusion Single-photon Emission CT/CT Scanning: a New Test for the Expedited, High-accuracy Diagnosis of Acute Pulmonary Embolism. Chest. 2014;145(5):1079-1088. PubMed PMID: 24798835.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Noncontrast perfusion single-photon emission CT/CT scanning: a new test for the expedited, high-accuracy diagnosis of acute pulmonary embolism. AU - Lu,Yang, AU - Lorenzoni,Alice, AU - Fox,Josef J, AU - Rademaker,Jürgen, AU - Vander Els,Nicholas, AU - Grewal,Ravinder K, AU - Strauss,H William, AU - Schöder,Heiko, PY - 2014/5/7/entrez PY - 2014/5/7/pubmed PY - 2014/6/25/medline SP - 1079 EP - 1088 JF - Chest JO - Chest VL - 145 IS - 5 N2 - BACKGROUND: Standard ventilation and perfusion (V˙/Q˙) 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 (Q˙-SPECT)/CT scans with 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 scan and planar V˙/Q˙scintigraphy. All scans were reviewed retrospectively by four observers; planar scans were read with modified Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II and Prospective Investigative Study of Pulmonary Embolism Diagnosis (PISA-PED) criteria. On Q˙-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 final 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 sufficient follow-up; 22 patients were given a final diagnosis of PE, and 84 patients were given a final diagnosis of no PE. According to PIOPED II, 13 studies were graded as intermediate probability. Sensitivity and specificity 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 Q˙-SPECT/CT scan. Seventy-six patients had additional relevant findings on the CT image of the Q˙-SPECT/CT scan. CONCLUSIONS: Noncontrast Q˙-SPECT/CT imaging has a higher accuracy than planar V˙/Q˙imaging based on PIOPED II criteria in patients with cancer and a high risk for PE. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/24798835/Noncontrast_perfusion_single_photon_emission_CT/CT_scanning:_a_new_test_for_the_expedited_high_accuracy_diagnosis_of_acute_pulmonary_embolism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(15)34601-8 DB - PRIME DP - Unbound Medicine ER -