Automatic delineation and quantification of pulmonary vascular obstruction index in patients with pulmonary embolism using Perfusion SPECT-CT: a simulation study

Abstract

Background In patients with pulmonary embolism (PE), there is a growing interest in quantifying the pulmonary vascular obtruction index (PVOI), which may be an independent risk factor for PE recurrence. Perfusion SPECT/CT is a very attractive tool to provide an accurate quantification of the PVOI. However, there is currently no reliable method to automatically delineate and quantify it. The aim of this phantom study was to assess and compare 3 segmentation methods for PVOI quantification with perfusion SPECT/CT imaging. Methods Three hundred ninety-six SPECT/CT scans, with various PE scenarios (n = 44), anterior to posterior perfusion gradients (n = 3), and lung volumes (n = 3) were simulated using Simind software. Three segmentation methods were assesssed: (1) using an intensity threshold expressed as a percentage of the maximal voxel value (MaxTh), (2) using a Z-score threshold (ZTh) after building a Z-score parametric lung map, and (3) using a relative difference threshold (RelDiffTh) after building a relative difference parametric map. Ninety randomly selected simulations were used to define the optimal threshold, and 306 simulations were used for the complete analysis. Spacial correlation between PE volumes from the phantom data and the delineated PE volumes was assessed by computing DICEPE indices. Bland-Altman statistics were used to calculate agreement for PVOI between the phantom data and the segmentation methods. Results Mean DICEPE index was higher with the RelDiffTh method (0.85 ± 0.08), as compared with the MaxTh method (0.78 ± 0.16) and the ZTh method (0.67 ± 0.15). Using the RelDiffTh method, mean DICEPE index remained high (> 0.81) regardless of the perfusion gradient and the lung volumes. Using the RelDiffTh method, mean relative difference in PVOI was − 12%, and the limits of agreement were − 40% to 16%. Values were 3% (− 75% to 81%) for MaxTh method and 0% (− 120% to 120%) for ZTh method. Graphycal analysis of the Bland-Altman graph for the RelDiffTh method showed very close estimation of the PVOI for small and medium PE, and a trend toward an underestimation of large PE. Conclusion In this phantom study, a delineation method based on a relative difference parametric map provided a good estimation of the PVOI, regardless of the extent of PE, the intensity of the anterior to posterior gradient, and the whole lung volumes.

Quantification of the pulmonary vascular obstruction index on ventilation/perfusion lung scintigraphy: Comparison of a segmental visual scoring to the Meyer score

“…Third, we only focused the analysis on planar lung V/Q scintigraphy. The advent of SPECT/CT imaging offers a great opportunity to improve the accuracy of PVOI quantification ( 21 , 22 ), although there is not a reference method for comparison as the Meyer score has not been validated on SPECT imaging.…”