<scp>SPECT</scp> ventilation perfusion scanning with the addition of low‐dose <scp>CT</scp> for the investigation of suspected pulmonary embolism

Ling, Ivan T; Naqvi, Hanna; Siew, Teck; Loh, Nelson; Ryan, Gerard

doi:10.1111/j.1445-5994.2012.02939.x

Cited by 39 publications

(61 citation statements)

References 23 publications

(35 reference statements)

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“…However, in one-third of patients with unprovoked VTE, the risk of recurrence is so low (< 3% per year) that AC therapy > 3 months may not be necessary. [4,5] Pulmoangiography is the method of choice in pulmonary embolism diagnostics. However, this examination is associated with discomfort, elevated cost, and the risk of serious complications, typical of invasive procedures.…”

Section: [3-5]mentioning

confidence: 99%

Homocysteine and D-dimer levels and multilayer computed tomography for diagnosing pulmonary artery thromboembolism

Todua¹,

Akhvlediani²,

Vorobiova³

et al. 2017

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How to cite this article: Todua F, Akhvlediani M, Vorobiova E, Tsivtsivadze G, Baramidze A. Homocysteine and D-dimer levels and multilayer computed tomography for diagnosing pulmonary artery thromboembolism. Vessel Plus 2017;1:38-42.Aim: D-dimer reportedly plays a leading role in diagnosing pulmonary embolism. Additionally, homocysteine is an established risk factor for atherosclerosis, vascular disease, and thrombosis. Herein, the authors aimed to evaluate the diagnostic significance of D-dimer and homocysteine levels, together with multi-detector computed tomography (CT) in suspected pulmonary embolism. Methods: The authors examined patients suffering from conditions and complaints that are typical of pulmonary artery thromboembolism (PATE), such as chest pain, haemoptysis, dyspnoea, tachycardia, arterial hypotension, and signs of vein thrombosis in the inferior limbs. In these patients, PATE was found in different localizations with varying rates of severity. D-dimer levels were measured in patients with suspected PATE using enzyme-linked immunosorbent assays. Homocysteine levels were determined by an enzymatic method. All patients were examined to evaluate the presence of pulmonary embolism by multi-detector CT angiopulmonography. Results: Changes in homocysteine levels can be considered a separate independent factor for PATE diagnostics. The correlation between multi-detector CT angiopulmonography, elevated D-dimer levels, and concomitant hyperhomocysteinemia can be used not only for diagnostics but also for the assessment of the effectiveness of PATE treatment. Conclusion: Multi-detector CT angiopulmonography, D-dimer levels and related hyperhomocysteinemia can serve as significant laboratory markers in the diagnosis and treatment efficacy of PATE. Key words:Homocysteine, D-dimer, pulmonary embolism ABSTRACTArticle history:

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Section: [3-5]mentioning

confidence: 99%

Homocysteine and D-dimer levels and multilayer computed tomography for diagnosing pulmonary artery thromboembolism

Todua¹,

Akhvlediani²,

Vorobiova³

et al. 2017

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“…Today, single-emission photon CT (SPECT) has replaced planar imaging, providing better sensitivity and/or specificity [7,8,9,10,11], not least as a result of the new interpretation criteria. V/P-SPECT represents a transition from planar scintigraphic to cross-sectional imaging, with data acquired tomographically and analyzed as a 3-dimensional dataset [12,13,14]. A comprehensive study by Bajc et al [15] showed the high diagnostic sensitivity (99%) and specificity (93%) of V/P-SPECT, underlining the reliability of this method.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Pulmonary Embolism: Conventional Ventilation/Perfusion SPECT Is Superior to the Combination of Perfusion SPECT and Nonenhanced CT

et al. 2014

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Background: Ventilation/perfusion single-emission photon CT (V/P-SPECT) is widely used to detect pulmonary embolism (PE). Any pathological deficit on P-SPECT with a corresponding unremarkable V-SPECT is considered an embolism. This means that a deficit on P-SPECT with a corresponding deficit on the ventilation scan correlates with other lung pathologies such as pneumonia, bullous emphysema or tumor. In principle, it is possible to identify any of these lung pathologies on nonenhanced chest CT and so this technique has the potential to replace V-SPECT in the diagnosis of PE. Today, SPECT/CT hybrid imaging systems are increasingly applied in clinical routines. Objectives: We investigated whether embolism can be diagnosed using a combined P-SPECT/CT hybrid imaging approach without V-SPECT. Methods: Ninety-three patients with clinically suspected embolism were investigated with standard V/P-SPECT and a nonenhanced CT scan on a combined SPECT/CT system. A diagnosis of embolism was based on V/P-SPECT (gold standard). P-SPECT/CT datasets were blinded and analyzed without any knowledge of the V-SPECT data. The accuracy of P-SPECT/CT was compared to the gold standard. Results: Embolism was diagnosed in 24/93 patients using V/P-SPECT. In total, 57 lung lobes were affected. P-SPECT/CT significantly (p < 0.01) overdiagnosed embolism in nonaffected patients. In total, 36 cases with 88 affected lung lobes were shown. The sensitivity was 95.8%, the specificity 82.6%, the false-negative rate 4.2% and the false-positive rate 17.3%. Conclusions: Our results demonstrate that a nonenhanced CT scan in a novel hybrid imaging system cannot replace V-SPECT in the scintigraphy-based diagnosis of PE. V-SPECT increases specificity and reduces the number of false-positive results when compared to ‘perfusion-only' SPECT/CT.

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“…Studies have consistently reported a higher specificity of the test (24,33), which may be of relevance in the setting of the increasing concern about a possible overtreatment of PE and a trend toward the use of extended duration of anticoagulation therapy (34). An additional low-dose CT also allows the detection of alternative diagnoses, which has been reported as an advantage of CTPA (35). A limited number of institutions routinely use a low-dose CT in lieu of ventilation imaging (Q SPECT/CT).…”

Section: Discussionmentioning

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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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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SPECT ventilation perfusion scanning with the addition of low‐dose CT for the investigation of suspected pulmonary embolism

Cited by 39 publications

References 23 publications

Homocysteine and D-dimer levels and multilayer computed tomography for diagnosing pulmonary artery thromboembolism

Homocysteine and D-dimer levels and multilayer computed tomography for diagnosing pulmonary artery thromboembolism

Diagnosis of Pulmonary Embolism: Conventional Ventilation/Perfusion SPECT Is Superior to the Combination of Perfusion SPECT and Nonenhanced CT

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

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