Ventilation/perfusion SPECT for the diagnosis of pulmonary embolism: A systematic review

Roux, Pierre‐Yves Le; Robin, Philippe; Tromeur, Cécile; Davis, Alexandra; Robert‐Ebadi, Helia; Carrier, Marc; Gal, Grégoire Le; Salaun, Pierre–Yves

doi:10.1111/jth.15038

Cited by 16 publications

(19 citation statements)

References 47 publications

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“…Surprisingly, the prevalence of positive scans was low (12%) in this population of COVID-19 patients with suspected PE assessed with V/Q SPECT/CT imaging. This prevalence is much lower than that of PE across studies on V/Q SPECT in non–COVID-19 patients—a prevalence that ranges from 17% to 54% (median, 26%) ( 26 ). This prevalence is also low as compared with studies assessing other imaging tests for PE (e.g., CT pulmonary angiography or planar V/P scanning).…”

Section: Discussionmentioning

confidence: 95%

Lung Scintigraphy for Pulmonary Embolism Diagnosis in COVID-19 Patients: A Multicenter Study

et al. 2021

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In patients with novel coronavirus disease 2019 (COVID-19) referred for lung scintigraphy for suspected pulmonary embolism (PE), there has been an ongoing debate within the nuclear medicine community as to whether and when the ventilation study should be performed. Indeed, while PE diagnosis typically relies on the recognition of ventilation/perfusion (V/P) mismatched defects, the ventilation procedure potentially increases the risk of contamination to the healthcare workers. The primary aim of this study was to assess the role of ventilation imaging when performing lung scintigraphy for suspected PE in COVID-19 patients. The secondary aim was to describe practices and imaging findings in this specific population.Methods: A national registry was created in collaboration with the French Society of Nuclear Medicine to collect lung scans performed in COVID-19 patients for suspected PE. Practices of departments were assessed regarding imaging protocols and aerosol precautions. A retrospective review of V/P SPECT/CT scans was then conducted. Two physicians blinded to clinical information reviewed each case by sequentially using P SPECT, P SPECT/CT and V/P SPECT/CT images. Scans were classified in one of the four following categories: patients for whom PE could reasonably be excluded based on 1) perfusion SPECT only, 2) P SPECT/CT, 3) V/P SPECT/CT; or 4) patients with mismatched defects suggestive of PE according to the EANM criteria.Results: Data from 12 French nuclear medicine departments were collected. Lung scans were performed between 03/2020 and 04/2021. Personal protective equipment and dedicated cleaning procedures were used in all departments. Out of the 145 V/Q SPECT/CT included in the central review, PE could be excluded using only P SPECT, P SPECT/CT and V/P SPECT/CT in 27 (19%), 55 (38%) and 45 (31%) patients, respectively.V/P SPECT/CT was positive for PE in 18 (12%) patients, including 12 (67%) with a low burden of PE (≤10%). Conclusion:In this population of COVID-19 patients assessed with lung scintigraphy, PE could be confidently excluded without ventilation in only 57% of patients. Ventilation imaging was required to confidently rule out PE in 31% of patients. Overall, the prevalence of PE was low (12%).

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Section: Discussionmentioning

confidence: 95%

Lung Scintigraphy for Pulmonary Embolism Diagnosis in COVID-19 Patients: A Multicenter Study

et al. 2021

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“…Based on an expert consensus, the recent ERS statement on CTEPH proposed to perform SPECT imaging and to provide retro-projected planar images from SPECT data. Indeed, SPECT has largely replaced planar lung scintigraphy in nuclear medicine facilities for the diagnostic of PE ( 15 , 23 , 24 ). However, the diagnostic performance of planar images generated from V/Q SPECT is controversial ( 25 ) and data for V/Q SPECT in CTEPH are still sparse.…”

Section: Discussionmentioning

confidence: 99%

Lung Ventilation/Perfusion Scintigraphy for the Screening of Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Which Criteria to Use?

et al. 2022

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ObjectiveThe diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) is a major challenge as it is a curable cause of pulmonary hypertension (PH). Ventilation/Perfusion (V/Q) lung scintigraphy is the imaging modality of choice for the screening of CTEPH. However, there is no consensus on the criteria to use for interpretation. The aim of this study was to assess the accuracy of various interpretation criteria of planar V/Q scintigraphy for the screening of CTEPH in patients with PH.MethodsThe eligible study population consisted of consecutive patients with newly diagnosed PH in the Brest University Hospital, France. Final diagnosis (CTEPH or non-CTEPH) was established in a referential center on the management of PH, based on the ESC/ERS guidelines and a minimum follow-up of 3 years. A retrospective central review of planar V/Q scintigraphy was performed by three nuclear physicians blinded to clinical findings and to final diagnosis. The number, extent (sub-segmental or segmental) and type (matched or mismatched) of perfusion defects were reported. Sensitivity and specificity were evaluated for various criteria based on the number of mismatched perfusion defects and the number of perfusion defects (regardless of ventilation). Receiver operating characteristic (ROC) curves were generated and areas under the curve (AUC) were calculated for both.ResultsA total of 226 patients with newly diagnosed PH were analyzed. Fifty six (24.8%) were diagnosed with CTEPH while 170 patients (75.2%) were diagnosed with non-CTEPH. The optimal threshold was 2.5 segmental mismatched perfusion defects, providing a sensitivity of 100 % (95% CI 93.6–100%) and a specificity of 94.7% (95%CI 90.3–97.2%). Lower diagnostic cut-offs of mismatched perfusion defects provided similar sensitivity but lower specificity. Ninety five percent of patients with CTEPH had more than 4 segmental mismatched defects. An interpretation only based on perfusion provided similar sensitivity but a specificity of 81.8% (95%CI 75.3–86.9%).ConclusionOur study confirmed the high diagnostic performance of planar V/Q scintigraphy for the screening of CTEPH in patients with PH. The optimal diagnostic cut-off for interpretation was 2.5 segmental mismatched perfusion defects. An interpretation only based on perfusion defects provided similar sensitivity but lower specificity.

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“…Q SPECT/CT acquires only perfusion images, while V/Q SPECT/CT acquires both perfusion and ventilation images. The perfusion agent is usually 99m Tc-labeled macroaggregated albumin (MAA); the ventilation agents available in most countries are 99m Tc diethylene triamine pentaacetic acid (DTPA) or Technegas, a radiolabeled carbon mist, administered by aerosol 11,12,13 . Finally, SPECT/CT has almost no contraindications, a lower rate of non-diagnostic tests (<3%) in comparison with CTPA (3-5%) and planar V/Q scintigraphy (50%), and a binary interpretation ('PE' vs. 'no PE').…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Diagnostic Accuracy of V/Q and Q SPECT/CT in Patients with Suspected Acute Pulmonary Embolism: A Systematic Review and Meta-analysis

et al. 2022

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Background: Computed tomography (CT) pulmonary angiography has simplified the diagnostic approach to patients with clinically suspected acute pulmonary embolism (PE), but alternative imaging tests are still advocated. We aimed to systematically assess the diagnostic accuracy of ventilation/perfusion (V/Q) and Q single-photon emission CT combined with low-dose CT (SPECT/CT) for PE diagnosis. Methods: Studies evaluating the diagnostic accuracy of SPECT/CT for the diagnosis of acute PE were systematically searched in MEDLINE and EMBASE databases (up to August 2022). QUADAS-2 tool was used for risk of bias assessment of the primary studies. A bivariate random-effects regression approach was used for summary estimates of both sensitivity and specificity. PROSPERO registration number is CRD42021276538 Results: Eight studies, for a total of 1086 patients, were included. The risk of bias of all included studies was high. Weighted mean prevalence of PE was 27.1% at random-effect model. SPECT/CT bivariate weighted mean sensitivity was 96% (95% confidence interval [CI], 93-98%), with a bivariate weighted mean specificity of 95% (95% CI, 90-97%). At subgroup analysis, for V/Q SPECT/CT bivariate weighted mean sensitivity and specificity were 96% (95% CI, 89-98%) and 96% (95% CI, 91-99%), while for Q SPECT/CT they were 96% (95% CI, 92-98%) and 84% (95% CI, 66-93%), respectively. Conclusions: V/Q SPECT/CT has high sensitivity and specificity for the diagnosis of acute PE, meanwhile Q SPECT/CT has high sensitivity but limited specificity for the diagnosis of PE. Management studies will conclusively ascertain the actual role of SPECT/CT in the diagnostic workup of patients with suspected acute PE.

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Ventilation/perfusion SPECT for the diagnosis of pulmonary embolism: A systematic review

Cited by 16 publications

References 47 publications

Lung Scintigraphy for Pulmonary Embolism Diagnosis in COVID-19 Patients: A Multicenter Study

Lung Scintigraphy for Pulmonary Embolism Diagnosis in COVID-19 Patients: A Multicenter Study

Lung Ventilation/Perfusion Scintigraphy for the Screening of Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Which Criteria to Use?

Diagnostic Accuracy of V/Q and Q SPECT/CT in Patients with Suspected Acute Pulmonary Embolism: A Systematic Review and Meta-analysis

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