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Chest. 2014 May;145(5):1079-1088. doi: 10.1378/chest.13-2090.

Noncontrast perfusion single-photon emission CT/CT scanning: a new test for the expedited, high-accuracy diagnosis of acute pulmonary embolism.

Author information

1
Molecular Imaging and Therapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
2
Body Imaging Section, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
3
Department of Radiology and Pulmonary Disease Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
4
Molecular Imaging and Therapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY. Electronic address: schoderh@mskcc.org.

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.

PMID:
24798835
DOI:
10.1378/chest.13-2090
[Indexed for MEDLINE]

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