Diagnosis and management of pulmonary embolism

Lapner, Sarah Takach; Kearon, Clive

doi:10.1136/bmj.f757

Cited by 108 publications

(76 citation statements)

References 39 publications

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“…Although the proportion of nuclear medicine physicians performing SPECT acquisitions for diagnosis of PE is high in the countries surveyed, references to V/Q scanning in the medical literature by nonnuclear medicine specialists frequently refer to planar imaging, often with reference to its high nondiagnostic rates (21,22). In the few publications that reference V/Q SPECT, it is often portrayed as a test with future potential applicability, rather than an examination in routine use today (10).…”

Section: Discussionmentioning

confidence: 99%

“…In a systematic review of the literature published by a group of experts in 2009, the promising results of V/Q SPECT were noted, but the group recommended that a large prospective evaluation was needed (20). Although V/Q SPECT has many proponents within the nuclear medicine community, publications from nonnuclear medicine specialists often still focus on planar imaging, in particular referring to its high rate of nondiagnostic examinations (21,22). Some have described V/Q SPECT as a new technology requiring definitive validation (10,23).…”

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confidence: 99%

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Pulmonary Scintigraphy for the Diagnosis of Acute Pulmonary Embolism: A Survey of Current Practices in Australia, Canada, and France

et al. 2015

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There are currently no data published regarding the proportion of nuclear medicine centers using SPECT or SPECT/CT rather than planar ventilation/perfusion (V/Q) imaging in patients with suspected acute pulmonary embolism (PE). Furthermore, the reporting criteria used for interpretation of both planar and SPECT V/Q scans are variable and data are lacking regarding which criteria are commonly used in various centers. The aim of this study was to assess current practices regarding the performance and interpretation of lung scintigraphy across 3 different countries. Methods: A short online survey composed of simple multiple-choice questions was distributed to nuclear medicine departments in Australia, Canada, and France during the period April to December 2014. The survey covered image acquisition, interpretation criteria for SPECT and planar images, and use of pseudoplanar images and radiopharmaceuticals. Information was initially solicited by 2 sets of e-mails, which pointed to the survey internet link. Departments were subsequently contacted by telephone. A single response per department was consolidated. Results: Three hundred thirty-one responses were collected (Australia, 74; Canada, 48; and France, 209). Twenty-eight percent of centers indicated use of V/Q planar imaging alone whereas 72% of centers included some form of SPECT in their acquisition protocol for evaluation of PE, specifically V/Q SPECT in 36%, V/Q SPECT/CT in 29%, Q SPECT/CT in 2%, and both V/Q planar and SPECT in 5%, with a strong variability among countries. The most commonly used criteria for SPECT interpretation were the those of the European Association of Nuclear Medicine (60%). Criteria used for planar interpretation were heterogeneous (European Association of Nuclear Medicine criteria, 35%; Prospective Investigation of Pulmonary Embolism Diagnosis study, 29%; no standardized criteria, 21%). Sixty-three percent of departments used pseudoplanar images in addition to SPECT images. Conclusion: In the 3 countries surveyed, SPECT has largely replaced planar imaging for evaluation of PE, with almost half of the SPECT studies incorporating a CT acquisition. Criteria used for interpretation are inconsistent, especially for planar imaging. It has been more than 50 y since lung scintigraphy was first described for the diagnosis of pulmonary embolism (PE). Since that time, the examination has evolved greatly with respect to equipment, radiopharmaceuticals, and imaging algorithms, along with perception among nuclear medicine and referring physicians.Although performed 25 y ago, using imaging equipment and ventilation agents that would currently be considered obsolete in most centers, the Prospective Investigation of Pulmonary Embolism Diagnosis study (PIOPED) study remains the landmark accuracy study in the eyes of many clinicians (1). The diagnostic performance of planar ventilation/perfusion (V/Q) scanning was then insufficient to allow a binary reporting approach (PE or no PE). Therefore, probabilistic reporting criteria were proposed, resulting...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Pulmonary Scintigraphy for the Diagnosis of Acute Pulmonary Embolism: A Survey of Current Practices in Australia, Canada, and France

et al. 2015

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“…Plaučių arterijos trombinė embolija (toliau -PATE) -plaučių arterijos arba jos šakų okliuzija trombu, sutrikdanti dalies plaučių parenchimos kraujotaką (1). Tai gyvybei grėsminga patologija, dažniausiai pasireiškianti krūtinės skausmu ir/ar dusuliu, tačiau klinikinė išraiška yra nespecifinė ir gali varijuoti nuo besimptomės iki ryškaus kraujotakos nestabilumo ir mirties (2).…”

Section: įVadasunclassified

Ūminė Plaučių Arterijos Trombinė Embolija: Wells Ir Modifikuotos Geneva Skalių Bei D-Dimerų Koncentracijos Prognostinės Vertės Senyvo Amžiaus Pacientams

et al. 2017

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Raktažodžiai: plaučių arterijos trombinė embolija, Wells skalė, modifikuota Geneva skalė, geriatrija. ĮvadasPlaučių arterijos trombinė embolija (toliau -PATE) -plaučių arterijos arba jos šakų okliuzija trombu, sutrikdanti dalies plaučių parenchimos kraujotaką (1). Tai gyvybei grėsminga patologija, dažniausiai pasireiškianti krūtinės skausmu ir/ar dusuliu, tačiau klinikinė išraiška yra nespecifinė ir gali varijuoti nuo besimptomės iki ryškaus kraujotakos nestabilumo ir mirties (2). PATE diagnostika sudėtinga visų amžiaus grupių pacientams, bet didžiausių diagnostinių sunkumų kelia senyvo amžiaus pacientams (3). Nėra būdingų klinikinių simptomų, fizinio ištyrimo ir laboratorinių tyrimų duomenų, kurie patikimai atmestų plaučių arterijos trombinę emboliją (4). Klinikinį ligonio, kuriam

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“…Pulmonary embolism (PE), as a common type of lifethreatening venous thromboembolism, is the third commonest cause of cardiovascular death after myocardial infarction and stroke with high morbidity and mortality (1,2). Because of its variable manifestation and poor sensitivity as well as specificity of signs and symptoms, rapid and accurate diagnosis of PE remains challenging (3).…”

Section: Introductionmentioning

confidence: 99%

MicroRNAs are novel non-invasive diagnostic biomarkers for pulmonary embolism: a meta-analysis

Deng¹,

Li²,

Luo³

et al. 2016

J. Thorac. Dis.

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Backgrounds: The diagnosis of pulmonary embolism (PE) still remains difficult in clinical practice.MicroRNAs (miRNAs) have been widely investigated as biomarkers for various diseases. However, the diagnostic biomarker value of miRNAs in the diagnosis of PE is unclear. Therefore, we conducted this metaanalysis to establish the diagnostic power of miRNAs for PE diagnosis. Methods: A systematic literature search in PubMed and Embase was conducted to identify relevant studies dated up to July 22, 2016. Data on sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were pooled from those included studies. Summary receiver operating characteristic (SROC) curves were used to summarize overall diagnostic power of miRNAs for PE diagnosis. Results: A total of three studies with five types of miRNAs covering 254 participants were included in our meta-analysis. The overall pooled results for sensitivity, specificity, PLR, NLR, and DOR of miRNAs for PE

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Diagnosis and management of pulmonary embolism

Cited by 108 publications

References 39 publications

Pulmonary Scintigraphy for the Diagnosis of Acute Pulmonary Embolism: A Survey of Current Practices in Australia, Canada, and France

Pulmonary Scintigraphy for the Diagnosis of Acute Pulmonary Embolism: A Survey of Current Practices in Australia, Canada, and France

Ūminė Plaučių Arterijos Trombinė Embolija: Wells Ir Modifikuotos Geneva Skalių Bei D-Dimerų Koncentracijos Prognostinės Vertės Senyvo Amžiaus Pacientams

MicroRNAs are novel non-invasive diagnostic biomarkers for pulmonary embolism: a meta-analysis

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