Ancillary findings assessed by ventilation/perfusiont omography

Begić, Alden; Opanković, Emina; Čukić, Vesna; Lindqvist, Ari; Miniati, Massimo; Bajc, Marika

doi:10.3413/nukmed-0748-15-06

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…24 ancillary findings has also been used by radiology and imaging specialties. 5 , 6 , 25 - 27 Yet, UW survey and UNC focus group patients participating in our study not only did not prefer any of these terms, but they were strikingly consistent in preferring the term “additional findings.” That is, given an option of four terms, 59% of UW survey respondents ranked the term additional findings above the other terms. Only one-third of survey respondents preferred the term “secondary findings.” Similarly, UNC focus group participants both volunteered and reached a consensus on “additional” as their preferred term.…”

Section: Discussionsupporting

confidence: 54%

Is “incidental finding” the best term?: a study of patients’ preferences

Tan

Amendola

O’Daniel

et al. 2017

Genetics in Medicine

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PurposeThere is debate within the genetics community about the optimal term to describe genetic variants unrelated to the test indication, but potentially important for health. Given the lack of consensus and the importance of adopting terminology that promotes effective clinical communication, we sought the opinion of clinical genetics patients.MethodsSurveys and focus groups with two patient populations were conducted. Eighty-eight survey participants were asked to rank four terms according to how well each describes results unrelated to the test indication: incidental findings, secondary findings, additional findings, and ancillary findings. Participants in six focus groups were guided through a free-thought exercise to describe desired attributes of such a term, and then asked to formulate a best term to represent this concept.ResultsThe term additional findings had the most first choice rankings by survey participants, followed by secondary findings, incidental findings, and ancillary findings. Most focus group participants preferred the term additional findings; they also described reasons why other terms were not optimal.ConclusionAdditional findings was preferred as both more neutral and accessible than other terms currently in use. Patient perceptions and comprehension will be framed by the terminology. Thus, patient opinions should be considered by medical genetics professionals.

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Section: Discussionsupporting

confidence: 54%

Is “incidental finding” the best term?: a study of patients’ preferences

Tan

Amendola

O’Daniel

et al. 2017

Genetics in Medicine

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“…The degree of obstructive small airways disease was visually graded according to a predefined 4-point scale (0–3) based on the ventilatory impairment shown by the penetration grade of Technegas in V SPECT (Vgrade), as described earlier 27. V/P SPECT images were reviewed according to a clinical routine assessing the presence of PE, LHF, emphysema, pneumonia, or suspicion of tumor 15,25,28,29…”

Section: Methodsmentioning

confidence: 99%

Identifying the heterogeneity of COPD by V/P SPECT: a new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease

Bajc¹,

Chen²,

Wang³

et al. 2017

COPD

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IntroductionAirway obstruction and possible concomitant pulmonary diseases in COPD cannot be identified conventionally with any single diagnostic tool. We aimed to diagnose and grade COPD severity and identify pulmonary comorbidities associated with COPD with ventilation/perfusion single-photon emission computed tomography (V/P SPECT) using Technegas as the functional ventilation imaging agent.Methods94 COPD patients (aged 43–86 years, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I–IV) were examined with V/P SPECT and spirometry. Ventilation and perfusion defects were analyzed blindly according to the European guidelines. Penetration grade of Technegas in V SPECT measured the degree of obstructive small airways disease. Total preserved lung function and penetration grade of Technegas in V SPECT were assessed by V/P SPECT and compared to GOLD stages and spirometry.ResultsSigns of small airway obstruction in the ventilation SPECT images were found in 92 patients. Emphysema was identified in 81 patients. Two patients had no signs of COPD, but both of them had a pulmonary embolism, and in one of them we also suspected a lung tumor. The penetration grade of Technegas in V SPECT and total preserved lung function correlated significantly to GOLD stages (r=0.63 and −0.60, respectively, P<0.0001). V/P SPECT identified pulmonary embolism in 30 patients (32%). A pattern typical for heart failure was present in 26 patients (28%). Parenchymal changes typical for pneumonia or lung tumor were present in several cases.ConclusionV/P SPECT, using Technegas as the functional ventilation imaging agent, is a new tool to diagnose COPD and to grade its severity. Additionally, it revealed heterogeneity of COPD caused by pulmonary comorbidities. The characteristics of these comorbidities suggest their significant impact in clarifying symptoms, and also their influence on the prognosis.

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“…A general unevenness of ventilation typical for COPD has been observed in V/P SPECT in patients investigated for PE [68, 120, 146]. Perfusion is usually less affected, which leads to so-called reversed mismatch [62, 93, 119].…”

Section: Additional Diagnostic Contributions Of V/pspectmentioning

confidence: 99%

“…Antigravitational perfusion distribution is typical for pulmonary congestion due to left heart failure. In supine patients, redistribution of perfusion towards anterior regions has been observed in 5–15% of patients with suspected PE [146, 150–152]. Based upon a measured vertical perfusion gradient, a positive predictive value of ≥ 88% to detect pulmonary congestion has been reported [151].…”

Section: Additional Diagnostic Contributions Of V/pspectmentioning

confidence: 99%

“…Figure 5 presents a case with PE and pneumonia. In some patients, V/P defects typical for pneumonia reduce the total lung function in the absence of any structural CT defects [146, 160]. Nevertheless, the potential of V/P SPECT for diagnosis and management of pneumonia has in general not been exploited.

Fig.…”

Section: Additional Diagnostic Contributions Of V/pspectmentioning

confidence: 99%

See 1 more Smart Citation

EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond

Bajc

Schümichen

Grüning

et al. 2019

Eur J Nucl Med Mol Imaging

153

159

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These guidelines update the previous EANM 2009 guidelines on the diagnosis of pulmonary embolism (PE). Relevant new aspects are related to (a) quantification of PE and other ventilation/perfusion defects; (b) follow-up of patients with PE; (c) chronic PE; and (d) description of additional pulmonary physiological changes leading to diagnoses of left ventricular heart failure (HF), chronic obstructive pulmonary disease (COPD) and pneumonia. The diagnosis of PE should be reported when a mismatch of one segment or two subsegments is found. For ventilation, Technegas or krypton gas is preferred over diethylene triamine pentaacetic acid (DTPA) in patients with COPD. Tomographic imaging with V/PSPECT has higher sensitivity and specificity for PE compared with planar imaging. Absence of contraindications makes V/PSPECT an essential method for the diagnosis of PE. When V/PSPECT is combined with a low-dose CT, the specificity of the test can be further improved, especially in patients with other lung diseases. Pitfalls in V/PSPECT interpretation are discussed. In conclusion, V/PSPECT is strongly recommended as it accurately establishes the diagnosis of PE even in the presence of diseases like COPD, HF and pneumonia and has no contraindications.

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Ancillary findings assessed by ventilation/perfusiont omography

Cited by 9 publications

References 28 publications

Is “incidental finding” the best term?: a study of patients’ preferences

Is “incidental finding” the best term?: a study of patients’ preferences

Identifying the heterogeneity of COPD by V/P SPECT: a new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease

EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond

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