Ventilation / Perfusion SPECT for diagnostics of pulmonary embolism in clinical practice

Abstract

Aim. The aim of this retrospective study is to illustrate clinical utility and impact of pulmonary embolism (PE) diagnostics of up to date Ventilation ⁄ Perfusion SPECT (V ⁄ P SPECT ) applying holistic interpretation criteria.Material and methods. During a 2-year period 2328 consecutive patients referred to V ⁄ P SPECT for clinically suspected PE were examined. Final diagnosis was established by physicians clinically responsible for patient care. To establish the performance of V ⁄ P SPECT negative for PE, patients were followed up by medical records for 6 months.Results. Ventilation ⁄ Perfusion SPECT was feasible in 99% of the patients. Data for follow-up were available in 1785 patients (77%). PE was reported in 607 patients (34%). Normal pattern was described in 420 patients (25%). Pathology other than PE such as a pneumonia, left heart failure, obstructive lung disease, tumour was described in 724 patients (41%). Report was nondiagnostic in 19 patients (1%). Six cases were classified as falsely negative because PE was diagnosed at follow-up and was fatal in one case. Six cases were classified as falsely positive because the clinician decided not to treat. In 608 patients with final PE diagnosis, 601 patients had positive V ⁄ P SPECT (99%). In 1177 patients without final PE diagnosis 1153 patients had negative V ⁄ P SPECT (98%).Conclusions. Holistic interpretation of V ⁄ P SPECT, yields high negative and positive predictive values and only 1% of nondiagnostic findings and was feasible in 99% of patients. It is a responsibility and a challenge of nuclear medicine to provide optimal care of patients with suspected PE by making V ⁄ P SPECT available.

The Economic Value of Hybrid Single‐photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis

“…CTPA may be a financially suboptimal choice if employed as the first‐line imaging choice for the entire imaging population. Furthermore, some studies have estimated that CTPA may be contraindicated in up to 50% of the suspected PE imaging directed population because of an underlying clinical condition including renal insufficiency, recent myocardial infarction, grave arrhythmia, allergy, etc 27. Without this contrast‐related burden, CTPA fares very well against planar and SPECT with incremental PPPM cost savings of $2,587.30 and $456.50, respectively.…”

Good clinical practice in pulmonary embolism diagnosis: where do we stand today?

“…Moreover, V/P SPECT permits one to identify patterns typical of other disorders such as chronic obstructive pulmonary disease (COPD), pneumonia and left heart failure. A broad V/P SPECT study showed that this is possible in the vast majority of cases [10].…”

“…In the PIOPED II study the positive predictive value for a PE within a lobar pulmonary artery was 97 % but fell to 68 % and 25 % at the segmental and subsegmental levels, respectively. Bajc et al and a prospective study by Gutte et al showed that V/P SPECT has higher sensitivity and specificity and less non-diagnostic findings than MDCT [10,14]. A recent study by Mahdavi et al showed that in the presence of an indeterminate CT angiography (CTA) in patients with high clinical suspicion of PE, V/P SPECT often provides a diagnosis [15].…”

Diagnostic Imaging in Acute Pulmonary Embolism

“…Kriterlere göre hastalar normal, düşük, orta ve yüksek olasılıklı olarak sınıflandırılmıştır. Klinisyenler ile iletişimi kolaylaştırmak için, üç katmanlı sınıflandırma tercih edilir: Normal tarama (APE dışlar), yüksek olasılık tarama (çoğu hastada APE olarak kabul edilir) ve tanısal olmayan tarama (15,16). Prospektif klinik çalışmaların sonucunda normal bir perfüzyon sintigrafisi olan hastalarda antikoagülan tedavinin kesilmesinin güvenli olduğunu ileri sürmüş ve V / P sintigrafisi ile BT taramanın karşılaştırıldığı randomize çalışmalar tarafından doğrulanmıştır (15).…”