SPECT in Acute Pulmonary Embolism

Stein, Paul D.; Freeman, Leonărd M.; Sostman, Henry Dirk; Goodman, Lawrence R.; Woodard, Pamela K.; Naidich, David P.; Gottschalk, Alexander; Bailey, Dale L.; Matta, Fadi; Yaekoub, Abdo Y.; Hales, Charles A.; Hull, Russell D.; Leeper, Kenneth V.; Tapson, Victor F.; Weg, John G.

doi:10.2967/jnumed.109.063958

Cited by 83 publications

(61 citation statements)

References 40 publications

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“…These data are concordant with those previously published, reporting sensitivity and specificity of at least 90% in almost all studies (19). The main strength of our study is that we used as a reference standard an independent validated diagnostic strategy whose conclusions were not based on V/Q SPECT results.…”

Section: Discussionsupporting

confidence: 80%

“…There is currently a consensus that V/Q SPECT readings should be binary: positive or negative. However, the diagnostic cutoff varies widely (19). Indeed, PE has been diagnosed according to different criteria in different studies, such as "1 mismatched defect, regardless of size" (9-11), "1 segmental mismatched defect" (12), or "2 mismatched segmental or subsegmental mismatched defects" (7).…”

Section: Discussionmentioning

confidence: 99%

“…However, only sparse data based on an objective reference test are available, and the criteria used for interpretation varied widely (19).…”

Section: Discussionmentioning

confidence: 99%

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V/Q SPECT Interpretation for Pulmonary Embolism Diagnosis: Which Criteria to Use?

et al. 2013

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Ventilation-perfusion (V/Q) SPECT has been reported to improve the diagnostic performance of V/Q imaging for the diagnosis of pulmonary embolism (PE). However, only sparse data based on an objective reference test are available, and the criteria used for interpretation have varied widely. Therefore, the aim of our study was to assess the performance of V/Q SPECT using various criteria for interpretation, in comparison with a validated independent diagnostic strategy. Methods: The SPECT study included patients for whom V/Q SPECT data were compared with the results of an independent and validated diagnostic algorithm for PE. V/Q SPECT scans were performed after intravenous injection of 99m Tc-macroaggregated albumin and simultaneous ventilation with 81m Kr gas. Interpretation was performed independently by 2 nuclear medicine physicians who were not aware of the clinical history, diagnostic strategy conclusion, or patient's outcome. Sensitivity, specificity, and likelihood ratios were evaluated for various combinations of mismatched defect numbers and sizes (segmental or subsegmental). Generation of receiver-operating-characteristic curves was based on the number of mismatch defects and the number of subsegmental mismatch defects or equivalent. Results: Of the 249 patients who were analyzed, the diagnosis of PE was confirmed in 49 and ruled out in 200 according to the previously validated independent strategy. Of all the tested criteria, the best performance was achieved using a diagnostic cutoff of at least 1 segmental or 2 subsegmental mismatches, with sensitivity and specificity of 0.92 (95% confidence interval, 0.84-1) and 0.91 (95% confidence interval, 0.87-0.95), respectively. With a negative V/Q SPECT result, the posttest probability of PE was 0.010, 0.037, and 0.119 for a low, intermediate, and high clinical probability. With a positive V/Q SPECT result, the posttest probability of PE was 0.531, 0.814, and 0.939 for a low, intermediate, and high probability. Conclusion: For V/Q SPECT interpretation, a diagnostic cutoff of 1 segmental or 2 subsegmental mismatches seems best for confirming or excluding acute PE. Pl anar ventilation-perfusion (V/Q) lung scintigraphy was the first validated noninvasive procedure for the diagnosis of pulmonary embolism (PE). In the late 1980s, chest CT overtook V/Q scanning in most institutions as the initial imaging modality for suspected PE, mainly because of the high rate of inconclusive results from planar V/Q scintigraphy using the probabilistic interpretation proposed in the PIOPED study (prospective investigation of pulmonary embolism diagnosis) (1).More recently, there has been a renewed interest in V/Q imaging, primarily in response to concerns about high radiation exposure from CT angiography (2). Indeed, the radiation dose is lower with V/Q scintigraphy than with chest multidetector CT (MDCT), particularly to the female breast (3-5). Another drawback of MDCT is that it cannot be performed in many patients because of contraindications such as renal failure or an allerg...

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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V/Q SPECT Interpretation for Pulmonary Embolism Diagnosis: Which Criteria to Use?

et al. 2013

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“…However, there is currently no information about the comparison of these methods with planar imaging in a multiinstitutional setting (24). The criteria for interpretation of SPECT and SPECT/low-dose CT need to be established.…”

Section: Issues Requiring Further Clarificationmentioning

confidence: 99%

SNM Practice Guideline for Lung Scintigraphy 4.0

Parker¹,

Coleman²,

Grady³

et al. 2012

Journal of Nuclear Medicine Technology

162

116

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“…As a result, work has continued on approaches to improve the accuracy of lung scintigraphy. Two articles in this issue, by Stein et al (1) and Gutte et al (2), highlight some of these advances.…”

mentioning

confidence: 99%

Improving Lung Scintigraphy

Parker

2009

J Nucl Med

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SPECT in Acute Pulmonary Embolism

Cited by 83 publications

References 40 publications

V/Q SPECT Interpretation for Pulmonary Embolism Diagnosis: Which Criteria to Use?

V/Q SPECT Interpretation for Pulmonary Embolism Diagnosis: Which Criteria to Use?

SNM Practice Guideline for Lung Scintigraphy 4.0

Improving Lung Scintigraphy

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