Tags

Type your tag names separated by a space and hit enter

Planar and SPECT ventilation/perfusion imaging and computed tomography for the diagnosis of pulmonary embolism: A systematic review and meta-analysis of the literature, and cost and dose comparison.
Eur J Radiol 2015; 84(7):1392-400EJ

Abstract

Diagnosing acute pulmonary embolism (PE) is an indication for scintillation V/Q imaging (planar and SPECT) and/or CTPA. This study reviews, compares and aggregates the published diagnostic performance of each modality and assesses the short-term consequences in terms of diagnostic outcomes, monetary cost, and radiation burden. We performed a formal literature review of available data and aggregated the finding using a summary receiver operating characteristic. A decision tree approach was used to estimate cost and dose per correct diagnosis. The review found 19 studies, which comprised 27 data sets (6393 examinations, from 5923 patients). The results showed that planar V/Q was significantly inferior to both V/Q SPECT and CTPA with no difference between the latter two. CTPA represents best value; £129 per correct diagnosis compared to £243 (SPECT) and £226 (planar). In terms of radiation burden V/Q SPECT was the most effective with a dose of 2.12 mSv per correct diagnosis compared with 3.46 mSv (planar) and 4.96 (CTPA) mSv. These findings show no performance difference between V/Q SPECT and CTPA; planar V/Q is inferior. CTPA is clearly the most cost effective technique. V/Q SPECT should be considered in situations where radiation dose is of concern or CTPA is inappropriate.

Authors+Show Affiliations

Nuclear Medicine, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Road, Aberdeen AB25 2ZN, UK. Electronic address: jimphillips@nhs.net.Radiology, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Road, Aberdeen AB25 2ZN, UK.Nuclear Medicine, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Road, Aberdeen AB25 2ZN, UK.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

25868674

Citation

Phillips, J J., et al. "Planar and SPECT Ventilation/perfusion Imaging and Computed Tomography for the Diagnosis of Pulmonary Embolism: a Systematic Review and Meta-analysis of the Literature, and Cost and Dose Comparison." European Journal of Radiology, vol. 84, no. 7, 2015, pp. 1392-400.
Phillips JJ, Straiton J, Staff RT. Planar and SPECT ventilation/perfusion imaging and computed tomography for the diagnosis of pulmonary embolism: A systematic review and meta-analysis of the literature, and cost and dose comparison. Eur J Radiol. 2015;84(7):1392-400.
Phillips, J. J., Straiton, J., & Staff, R. T. (2015). Planar and SPECT ventilation/perfusion imaging and computed tomography for the diagnosis of pulmonary embolism: A systematic review and meta-analysis of the literature, and cost and dose comparison. European Journal of Radiology, 84(7), pp. 1392-400. doi:10.1016/j.ejrad.2015.03.013.
Phillips JJ, Straiton J, Staff RT. Planar and SPECT Ventilation/perfusion Imaging and Computed Tomography for the Diagnosis of Pulmonary Embolism: a Systematic Review and Meta-analysis of the Literature, and Cost and Dose Comparison. Eur J Radiol. 2015;84(7):1392-400. PubMed PMID: 25868674.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Planar and SPECT ventilation/perfusion imaging and computed tomography for the diagnosis of pulmonary embolism: A systematic review and meta-analysis of the literature, and cost and dose comparison. AU - Phillips,J J, AU - Straiton,J, AU - Staff,R T, Y1 - 2015/03/20/ PY - 2015/01/23/received PY - 2015/03/05/revised PY - 2015/03/08/accepted PY - 2015/4/15/entrez PY - 2015/4/15/pubmed PY - 2016/2/11/medline KW - CTPA KW - Performance KW - Pulmonary embolism KW - SPECT KW - Scintillation KW - V/Q SP - 1392 EP - 400 JF - European journal of radiology JO - Eur J Radiol VL - 84 IS - 7 N2 - Diagnosing acute pulmonary embolism (PE) is an indication for scintillation V/Q imaging (planar and SPECT) and/or CTPA. This study reviews, compares and aggregates the published diagnostic performance of each modality and assesses the short-term consequences in terms of diagnostic outcomes, monetary cost, and radiation burden. We performed a formal literature review of available data and aggregated the finding using a summary receiver operating characteristic. A decision tree approach was used to estimate cost and dose per correct diagnosis. The review found 19 studies, which comprised 27 data sets (6393 examinations, from 5923 patients). The results showed that planar V/Q was significantly inferior to both V/Q SPECT and CTPA with no difference between the latter two. CTPA represents best value; £129 per correct diagnosis compared to £243 (SPECT) and £226 (planar). In terms of radiation burden V/Q SPECT was the most effective with a dose of 2.12 mSv per correct diagnosis compared with 3.46 mSv (planar) and 4.96 (CTPA) mSv. These findings show no performance difference between V/Q SPECT and CTPA; planar V/Q is inferior. CTPA is clearly the most cost effective technique. V/Q SPECT should be considered in situations where radiation dose is of concern or CTPA is inappropriate. SN - 1872-7727 UR - https://www.unboundmedicine.com/medline/citation/25868674/Planar_and_SPECT_ventilation/perfusion_imaging_and_computed_tomography_for_the_diagnosis_of_pulmonary_embolism:_A_systematic_review_and_meta_analysis_of_the_literature_and_cost_and_dose_comparison_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0720-048X(15)00135-7 DB - PRIME DP - Unbound Medicine ER -