Additional value of combining low-dose computed tomography to V/Q SPECT on a hybrid SPECT-CT camera for pulmonary embolism diagnosis

Roux, Pierre‐Yves Le; Robin, Philippe; Delluc, Aurélien; Abgral, Ronan; Palard, Xavier; Tissot, V.; Morel, A.; Rousset, J.; Couturaud, Francis; Gal, Grégoire Le; Salaun, Pierre–Yves

doi:10.1097/mnm.0000000000000351

Cited by 34 publications

(28 citation statements)

References 32 publications

(38 reference statements)

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“…Limitations include lack of available pre-test probability, clinical prediction scores and follow-up clinical data to validate the imaging findings. However, our findings of positive and negative scans are similar to other studies 7,11 and the low rates of CTPA following V/Q SPECT (2.8%) with only 1/118 negative scans progressing to a CTPA, suggesting that our reporting was reliable and our referrers had confidence in our reports.…”

Section: Discussionsupporting

confidence: 91%

An audit of ventilation and perfusion SPECT reporting for the diagnosis of pulmonary embolism in a tertiary cardiothoracic centre

Kannan

Rose

Lee

et al. 2020

Internal Medicine Journal

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The aim of the study was to identify reporting patterns of ventilation and perfusion single‐photon emission computed tomography (V/Q SPECT) scans done in our department over 3 months in 2016. Factors impacting on reporting and patient groups that would most benefit from the addition of low‐dose computed tomography (CT) to V/Q SPECT were analysed. Among 178 patients, 173 (97.2%) had a definitive (positive/negative) report and 2.8% had an equivocal report. As the majority of the equivocal reports were seen in patients aged ≥70 years, we believe that addition of low‐dose CT with V/Q SPECT to this patient group will reduce the non‐diagnostic rate.

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Section: Discussionsupporting

confidence: 91%

An audit of ventilation and perfusion SPECT reporting for the diagnosis of pulmonary embolism in a tertiary cardiothoracic centre

Kannan

Rose

Lee

et al. 2020

Internal Medicine Journal

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“…The combination of V/Q SPECT with CT has been described to improve the diagnostic performance of V/Q SPECT, especially by improving the specificity of the test. [ 2 ] Another potential advantage of adding ldCT to V/Q SPECT over V/Q SPECT alone is the possibility of providing alternative diagnosis (e.g., pneumothorax, pneumonia) in patients suspected with PE which has been reported as an advantage of CTPA, or the possibility of providing incidental but clinically relevant findings (e.g., breast tumor). [ 9 , 10 ] Moreover, some alternative diagnoses to PE, such as IMH, are life-threatening emergencies that need to be detected as early as possible.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] The addition of low dose CT (ldCT) to V/Q SPECT has been described to improve the diagnostic performance of the test, especially by improving the specificity of the test. [ 2 ] Here we presented a case of an aortic intramural hematoma (IMH) diagnosed on ldCT of a V/Q SPECT/CT.…”

Section: Introductionmentioning

confidence: 99%

An aortic intra mural hematoma in ventilation/perfusion SPECT/CT

Robin¹,

Delcroix²,

Abgral³

et al. 2018

Medicine

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Rationale:Ventilation/perfusion (V/Q) single-photon-emission computed tomography (SPECT) has arisen as an alternative to computed tomography pulmonary angiography (CTPA) in patients with pulmonary embolism (PE) suspicion. The addition of low dose CT (ldCT) to V/Q SPECT improves the specificity of the test, allowing for potential alternative diagnosis.Patient concerns and diagnosis:Here we presented a case of an aortic intramural hematoma (IMH) diagnosed on the ldCT portion of V/Q SPECT combined with CT. A 74-year-old man suffering from sudden-onset chest pain was referred to our nuclear medicine department for PE suspicion.Intervention and outcome:A V/Q SPECT combined with nonenhanced ldCT ruled out PE diagnosis. Nevertheless, ldCT revealed high attenuation aortic wall thickening suggestive of aortic IMH. Chest CT angiography showed mild dilatation and circumferential thickening of aortic wall confirming Stanford type A IMH involving the entire ascending aorta.Lesson:This case illustrates the potential usefulness of combining ldCT to V/Q SPECT in providing alternative diagnosis in suspected PE patients.

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“…All patients treated with anticoagulant therapy, regardless of whether therapy was received based on a true‐positive or a false‐positive diagnosis, were expected to have the same risk of experiencing anticoagulation complications. Only major bleeding events were considered, with 10% hypothesized to be fatal 20. All patients who received therapy based on a true‐positive diagnosis were assumed to have a complete resolution of PE symptomatology and were no longer considered to be at any further risk—fatal or otherwise—from recurrent PE in the subsequent model's follow‐up time period of 6 months.…”

Section: Methodsmentioning

confidence: 99%

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

Toney

Kim

Palli

2017

Academic Emergency Medicine

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ObjectiveThe objective was to quantify the potential economic value of single‐photon emission computed tomography (SPECT) with computed tomography (CT; SPECT/CT) versus CT pulmonary angiography (CTPA), ventilation–perfusion (V/Q) planar scintigraphy, and V/Q SPECT imaging modalities for diagnosing suspected pulmonary embolism (PE) patients in an emergency setting.MethodsAn Excel‐based simulation model was developed to compare SPECT/CT versus the alternate scanning technologies from a payer's perspective. Clinical endpoints (diagnosis, treatment, complications, and mortality) and their corresponding cost data (2016 USD) were obtained by performing a best evidence review of the published literature. Studies were pooled and parameters were weighted by sample size. Outcomes measured included differences in 1) excess costs, 2) total costs, and 3) lives lost per annum between SPECT/CT and the other imaging modalities. One‐way (±25%) sensitivity and three scenario analyses were performed to gauge the robustness of the results.ResultsFor every 1,000 suspected PE patients undergoing imaging, expected annual economic burden by modality was found to be 3.2 million (SPECT/CT), 3.8 million (CTPA), 5.8 million (planar), and 3.6 million (SPECT) USD, with a switch to SPECT/CT technology yielding per‐patient‐per‐month cost savings of $51.80 (vs. CTPA), $213.80 (vs. planar), and $36.30 (vs. SPECT), respectively. The model calculated that the incremental number of lives saved with SPECT/CT was six (vs. CTPA) and three (vs. planar). Utilizing SPECT/CT as the initial imaging modality for workup of acute PE was also expected to save $994,777 (vs. CTPA), $2,852,014 (vs. planar), and $435,038 (vs. SPECT) in “potentially avoidable”’ excess costs per annum for a payer or health plan.ConclusionCompared to the currently available scanning technologies for diagnosing suspected PE, SPECT/CT appears to confer superior economic value, primarily via improved sensitivity and specificity and low nondiagnostic rates. In turn, the improved diagnostic accuracy accords this modality the lowest ratio of expenses attributable to potentially avoidable complications, misdiagnosis, and underdiagnosis.

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Additional value of combining low-dose computed tomography to V/Q SPECT on a hybrid SPECT-CT camera for pulmonary embolism diagnosis

Abstract: For PE diagnosis with lung SPECT, the use of ldCT in substitution to ventilation SPECT is associated with a high risk of overdiagnosis. The diagnostic value of ldCT in addition to V/Q SPECT remains unclear. Further studies are needed to determine its potential role in PE diagnosis.

Cited by 34 publications

References 32 publications

An audit of ventilation and perfusion SPECT reporting for the diagnosis of pulmonary embolism in a tertiary cardiothoracic centre

An audit of ventilation and perfusion SPECT reporting for the diagnosis of pulmonary embolism in a tertiary cardiothoracic centre

An aortic intra mural hematoma in ventilation/perfusion SPECT/CT

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

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