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Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate.
Nucl Med Mol Imaging 2015; 49(4):303-11NM

Abstract

PURPOSE

To investigate the diagnostic performance of perfusion single-photon emission computed tomography/computed tomography (Q-SPECT/CT) in patients suspected to have pulmonary embolism (PE) but with indeterminate computed tomographic pulmonary angiography (CTPA) or planar ventilation/perfusion (V/Q) scans.

METHODS

This retrospective study included two groups of patients. Group I consisted of 49 patients with nondiagnostic CTPA. These 49 patients underwent subsequent V/Q scans. Further Q-SPECTs were obtained in patients with indeterminate planar images and fused with existing CTPA. Group II consisted of 182 non-CTPA patients with indeterminate V/Q scans. These 182 patients underwent further Q-SPECT and separate noncontrast low-dose CT chest. Fusion Q-SPECT/CT scans were obtained through FDA-approved software and interpreted according to published criteria as positive, negative, or indeterminate for PE. Upon retrospective analyses, the final diagnosis was made using composite reference standards including all available clinical and imaging information for at least 6-month follow-up.

RESULTS

In group I patients, 1 was positive, 24 were negative, and another 24 (49 %, 24/49) were indeterminate. In the subsequent 24 Q-SPECT/CTPAs, 4 were positive, 19 were negative, and 1 was indeterminate (4.2 %, 1/24). In group II patients, 9 (4.9 %, 9/182) were indeterminate, 33 were positive, and 140 were negative. The combined nondiagnostic rate for Q-SPECT/CT was only 4.9 % (10/206). There was six false-negative and one false-positive Q-SPECT/CT examinations. The sensitivity, specificity, and positive and negative predictive value of Q-SPECT/CT were 85.7 % (36/42), 99.4 % (153/154), 97.3 % (36/37) and 96.2 % (153/159), respectively.

CONCLUSIONS

Q-SPECT/CT improves the diagnostic rate with promising accuracy in diagnosing PE that yields a satisfactory clinical verdict, especially when the CTPA and planar V/Q scan are indeterminate.

Authors+Show Affiliations

Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 W Taylor St. MC 931, Chicago, IL 60612 USA.Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 W Taylor St. MC 931, Chicago, IL 60612 USA.Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 W Taylor St. MC 931, Chicago, IL 60612 USA.Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 W Taylor St. MC 931, Chicago, IL 60612 USA.Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 W Taylor St. MC 931, Chicago, IL 60612 USA.Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 W Taylor St. MC 931, Chicago, IL 60612 USA.Section of Pulmonary section, Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, USA.Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 W Taylor St. MC 931, Chicago, IL 60612 USA.Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 W Taylor St. MC 931, Chicago, IL 60612 USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26550050

Citation

Kumar, Nishant, et al. "Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy when Other Pulmonary Embolism Imaging Is Indeterminate." Nuclear Medicine and Molecular Imaging, vol. 49, no. 4, 2015, pp. 303-11.
Kumar N, Xie K, Mar W, et al. Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate. Nucl Med Mol Imaging. 2015;49(4):303-11.
Kumar, N., Xie, K., Mar, W., Anderson, T. M., Carney, B., Mehta, N., ... Lu, Y. (2015). Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate. Nuclear Medicine and Molecular Imaging, 49(4), pp. 303-11. doi:10.1007/s13139-015-0359-8.
Kumar N, et al. Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy when Other Pulmonary Embolism Imaging Is Indeterminate. Nucl Med Mol Imaging. 2015;49(4):303-11. PubMed PMID: 26550050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate. AU - Kumar,Nishant, AU - Xie,Karen, AU - Mar,Winnie, AU - Anderson,Thomas M, AU - Carney,Benjamin, AU - Mehta,Nikhil, AU - Machado,Roberto, AU - Blend,Michael J, AU - Lu,Yang, Y1 - 2015/08/08/ PY - 2015/06/03/received PY - 2015/07/22/revised PY - 2015/07/28/accepted PY - 2015/11/10/entrez PY - 2015/11/10/pubmed PY - 2015/11/10/medline KW - CTPA KW - Pulmonary Embolism KW - Q-SPECT/CT KW - V/Q SP - 303 EP - 11 JF - Nuclear medicine and molecular imaging JO - Nucl Med Mol Imaging VL - 49 IS - 4 N2 - PURPOSE: To investigate the diagnostic performance of perfusion single-photon emission computed tomography/computed tomography (Q-SPECT/CT) in patients suspected to have pulmonary embolism (PE) but with indeterminate computed tomographic pulmonary angiography (CTPA) or planar ventilation/perfusion (V/Q) scans. METHODS: This retrospective study included two groups of patients. Group I consisted of 49 patients with nondiagnostic CTPA. These 49 patients underwent subsequent V/Q scans. Further Q-SPECTs were obtained in patients with indeterminate planar images and fused with existing CTPA. Group II consisted of 182 non-CTPA patients with indeterminate V/Q scans. These 182 patients underwent further Q-SPECT and separate noncontrast low-dose CT chest. Fusion Q-SPECT/CT scans were obtained through FDA-approved software and interpreted according to published criteria as positive, negative, or indeterminate for PE. Upon retrospective analyses, the final diagnosis was made using composite reference standards including all available clinical and imaging information for at least 6-month follow-up. RESULTS: In group I patients, 1 was positive, 24 were negative, and another 24 (49 %, 24/49) were indeterminate. In the subsequent 24 Q-SPECT/CTPAs, 4 were positive, 19 were negative, and 1 was indeterminate (4.2 %, 1/24). In group II patients, 9 (4.9 %, 9/182) were indeterminate, 33 were positive, and 140 were negative. The combined nondiagnostic rate for Q-SPECT/CT was only 4.9 % (10/206). There was six false-negative and one false-positive Q-SPECT/CT examinations. The sensitivity, specificity, and positive and negative predictive value of Q-SPECT/CT were 85.7 % (36/42), 99.4 % (153/154), 97.3 % (36/37) and 96.2 % (153/159), respectively. CONCLUSIONS: Q-SPECT/CT improves the diagnostic rate with promising accuracy in diagnosing PE that yields a satisfactory clinical verdict, especially when the CTPA and planar V/Q scan are indeterminate. SN - 1869-3474 UR - https://www.unboundmedicine.com/medline/citation/26550050/Software_Based_Hybrid_Perfusion_SPECT/CT_Provides_Diagnostic_Accuracy_When_Other_Pulmonary_Embolism_Imaging_Is_Indeterminate_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/26550050/ DB - PRIME DP - Unbound Medicine ER -