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Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography.
Respirology 2016; 21(6):1081-7R

Abstract

BACKGROUND AND OBJECTIVE

Pulmonary embolism (PE) is a common differential diagnosis in patients with pulmonary fibrosis presenting with a clinical deterioration. Both ventilation/perfusion (V/Q)-single photon emission computed tomography (SPECT) and computed tomographic pulmonary angiography (CTPA) are routinely used to detect PE. However, the value of V/Q-SPECT and CTPA in this scenario has not been studied so far. We aimed to investigate the concordance of V/Q-SPECT and CTPA in patients with pulmonary fibrosis and suspicion of pulmonary embolism.

METHODS

A total of 22 consecutive patients with pulmonary fibrosis and clinical deterioration who underwent both V/Q-SPECT and CTPA were included in the study and analyzed for the presence of pulmonary embolism.

RESULTS

Nine of 22 patients (41%) had evidence for pulmonary embolism in V/Q-SPECT, and two of these patients had matching evidence for pulmonary embolism in CTPA. In the other seven patients with positive findings in V/Q-SPECT, no evidence of pulmonary embolism was found in CTPA. None of the 13 patients with a negative V/Q-SPECT had evidence for pulmonary embolism in CTPA.

CONCLUSION

In patients with pulmonary fibrosis and suspected pulmonary embolism, pulmonary embolism is detected more frequently by V/Q-SPECT than by CTPA. Thromboembolic disease is identified on CTPA only in a minority of patients with positive findings on V/Q-SPECT. When making treatment decisions, clinicians should be aware of the high rate of discordant findings in V/Q-SPECT and CTPA in this specific patient population.

Authors+Show Affiliations

Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.Department of Nuclear Medicine, University of Munich, Munich, Germany.Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.Institute for Clinical Radiology, University of Munich, Munich, Germany.Department of Nuclear Medicine, University of Munich, Munich, Germany.Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27061739

Citation

Leuschner, Gabriela, et al. "Suspected Pulmonary Embolism in Patients With Pulmonary Fibrosis: Discordance Between Ventilation/perfusion SPECT and CT Pulmonary Angiography." Respirology (Carlton, Vic.), vol. 21, no. 6, 2016, pp. 1081-7.
Leuschner G, Wenter V, Milger K, et al. Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography. Respirology. 2016;21(6):1081-7.
Leuschner, G., Wenter, V., Milger, K., Zimmermann, G. S., Matthes, S., Meinel, F. G., ... Kneidinger, N. (2016). Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography. Respirology (Carlton, Vic.), 21(6), pp. 1081-7. doi:10.1111/resp.12797.
Leuschner G, et al. Suspected Pulmonary Embolism in Patients With Pulmonary Fibrosis: Discordance Between Ventilation/perfusion SPECT and CT Pulmonary Angiography. Respirology. 2016;21(6):1081-7. PubMed PMID: 27061739.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography. AU - Leuschner,Gabriela, AU - Wenter,Vera, AU - Milger,Katrin, AU - Zimmermann,Gregor S, AU - Matthes,Sandhya, AU - Meinel,Felix G, AU - Lehner,Sebastian, AU - Neurohr,Claus, AU - Behr,Jürgen, AU - Kneidinger,Nikolaus, Y1 - 2016/04/07/ PY - 2015/08/11/received PY - 2015/12/30/revised PY - 2015/02/01/accepted PY - 2016/4/11/entrez PY - 2016/4/12/pubmed PY - 2017/12/19/medline KW - lung disease KW - multidetector computed tomography KW - pulmonary embolism KW - pulmonary fibrosis KW - radionuclide imaging SP - 1081 EP - 7 JF - Respirology (Carlton, Vic.) JO - Respirology VL - 21 IS - 6 N2 - BACKGROUND AND OBJECTIVE: Pulmonary embolism (PE) is a common differential diagnosis in patients with pulmonary fibrosis presenting with a clinical deterioration. Both ventilation/perfusion (V/Q)-single photon emission computed tomography (SPECT) and computed tomographic pulmonary angiography (CTPA) are routinely used to detect PE. However, the value of V/Q-SPECT and CTPA in this scenario has not been studied so far. We aimed to investigate the concordance of V/Q-SPECT and CTPA in patients with pulmonary fibrosis and suspicion of pulmonary embolism. METHODS: A total of 22 consecutive patients with pulmonary fibrosis and clinical deterioration who underwent both V/Q-SPECT and CTPA were included in the study and analyzed for the presence of pulmonary embolism. RESULTS: Nine of 22 patients (41%) had evidence for pulmonary embolism in V/Q-SPECT, and two of these patients had matching evidence for pulmonary embolism in CTPA. In the other seven patients with positive findings in V/Q-SPECT, no evidence of pulmonary embolism was found in CTPA. None of the 13 patients with a negative V/Q-SPECT had evidence for pulmonary embolism in CTPA. CONCLUSION: In patients with pulmonary fibrosis and suspected pulmonary embolism, pulmonary embolism is detected more frequently by V/Q-SPECT than by CTPA. Thromboembolic disease is identified on CTPA only in a minority of patients with positive findings on V/Q-SPECT. When making treatment decisions, clinicians should be aware of the high rate of discordant findings in V/Q-SPECT and CTPA in this specific patient population. SN - 1440-1843 UR - https://www.unboundmedicine.com/medline/citation/27061739/Suspected_pulmonary_embolism_in_patients_with_pulmonary_fibrosis:_Discordance_between_ventilation/perfusion_SPECT_and_CT_pulmonary_angiography_ L2 - https://doi.org/10.1111/resp.12797 DB - PRIME DP - Unbound Medicine ER -