Diagnostic evaluation of planar and tomographic ventilation/perfusion lung images in patients with suspected pulmonary emboli

Bajc, Marika; Olsson, Carl; Olsson, Berit; Palmer, John; Jonson, B.

doi:10.1111/j.1475-097x.2004.00546.x

Cited by 109 publications

(105 citation statements)

References 17 publications

(15 reference statements)

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“…Corresponding sagittal, coronal and transverse slices were displayed using Hybrid Viewer ™ (Hermes Medical Solutions AB, Stockholm, Sweden). Reporting criteria were those first proposed by Bajc et al 22 and subsequently incorporated into EANM guidelines. 17,18 CT pulmonary angiography Images were acquired using a Lightspeed® VCT XTe CT scanner (GE Healthcare, Little Chalfont, Buckinghamshire, UK).…”

Section: Patientsmentioning

confidence: 99%

Diagnosing venous thromboembolism in pregnancy

Grüning

Mingo

Gosling

et al. 2016

BJR

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Objective: We report the imaging outcomes of all pregnant patients referred for suspected thromboembolism over a 43-month period. Methods: We identified 168 patients who underwent ventilation/perfusion (VQ) single-photon emission CT (SPECT), CT pulmonary angiography (CTPA) or a Doppler ultrasound scan of the lower legs, as well as a control group of 89 non-pregnant age-and sex-matched patients who underwent VQ SPECT during the same period. Imaging outcomes were recorded, and radiation doses were calculated for individual patients. Results: VQ SPECT and CTPA were equally likely to diagnose pulmonary embolism (PE) in about one patient out of every seven patients investigated. One in three CTPA scans was of suboptimal quality. A Doppler ultrasound examination of the legs will find deep venous thrombosis much less often, in about 1 patient out of every 15 patients investigated. The prevalence of PE in pregnant patients (as diagnosed by VQ SPECT) was similar to that in the non-pregnant, age-and sex-matched control group. The effective dose and the absorbed radiation dose to the maternal breast were lower with VQ SPECT. The foetal dose is comparable for both VQ SPECT and CTPA. Conclusion: VQ SPECT and CTPA provide a similar diagnostic yield for diagnosing PE during pregnancy, but VQ SPECT does so with a lower radiation dose to the mother (effective dose and breast dose). Advances in knowledge: Ours is the first report of the diagnostic performance of VQ SPECT, rather than planar VQ scans, in pregnancy in a routine clinical setting.

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Section: Patientsmentioning

confidence: 99%

Diagnosing venous thromboembolism in pregnancy

Grüning

Mingo

Gosling

et al. 2016

BJR

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“…Early cardiac failure, identification of a large area of reverse mismatch and underestimation of the severity of COPD constitute the most frequent alternative explanations for the symptoms that are not apparent on a standard chest x-ray. Such alternate findings are frequent, occurring in nearly 40% of patients in one study (Bajc, Olsson et al 2004). However, COPD in often known beforehand and the scope of potential diagnosis is narrower than with CTPA.…”

Section: Alternate Diagnosismentioning

confidence: 99%

“…However, even if proof of superiority of V/Q SPECT to planar imaging seems redundant, it has been proven clinically, with V/Q SPECT having an edge in sensitivity of more than 20% while still maintaining better specificity (Gutte, Mortensen et al 2010;Bajc, Olsson et al 2004). The negative predictive value of V/Q SPECT (the ability to reliably exclude PE) has been validated and is excellent, in the order of 98-99%, even in the presence of abnormal perfusion with a nonvascular pattern (Leblanc, Leveillee et al 2007).…”

Section: Clinical Studiesmentioning

confidence: 99%

Ventilation Perfusion Single Photon Emission Tomography (V/Q SPECT) in the Diagnosis of Pulmonary Embolism

Leblanc¹

2012

Pulmonary Embolism

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“…Across all investigations, the sensitivity of V/Q SPECT ranged from 55 to 100 % [21,22,[24][25][26][27][28][29][30][31][32][33][34][35][36] (Table 1). The specificity ranged from 71 to 100 % [21,22,24,[26][27][28][29][30][31][32][33][34][35][36] except in a single investigation of six patients without PE, in which the specificity was 0 out of 6 (0 %) [25].…”

Section: Non-diagnosticmentioning

confidence: 99%

“…The study design contributed to the low specificity. When comparing individual lung segments, the sensitivity of SPECT was 56 out of 62 (90 %) and the specificity 75 out of 118 (64 %) ( Table 1) V/Q SPECT using composite reference standards Most investigations of the sensitivity and specificity of V/Q SPECT included the index test (SPECT) or planar V/Q results in the composite reference standard [21,22,[24][25][26][27][28][29][30][31][32][33][34][35][36] ( Table 1). This would introduce incorporation bias [18,37], which can be expected to result in an overestimation of the diagnostic accuracy [18,38].…”

Section: Non-diagnosticmentioning

confidence: 99%

Critical review of SPECT imaging in pulmonary embolism

Stein

Sostman

Matta

2014

Clin Transl Imaging

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Outcome studies have shown that pulmonary embolism can be safely excluded in patients with negative ventilation/perfusion (V/Q) single-photon emission computed tomography (SPECT). The effective radiation dose of V/Q SPECT is much less than with computed tomographic (CT) pulmonary angiography, which would make it preferable to CT angiography in many young female patients. The accuracy of V/Q SPECT, however, is difficult to assess, because most published investigations are limited by incorporation bias or partial verification bias, as well as other limitations in study design and reporting. Consequently, the accuracy of V/Q SPECT relative to planar V/Q scintigraphy or CT angiography has not been definitively determined. There is need for a prospective investigation of the accuracy of V/Q SPECT with consecutive patients, blinded interpretations, and an independent reference standard, or independent composite reference standard.Keywords Pulmonary embolism Á Venous thromboembolism Á Single-photon emission computed tomography Since the publication of the prospective investigation of pulmonary embolism diagnosis (PIOPED) in 1990 [1], there has been a decline in the use of ventilation/perfusion (V/Q) planar scintigraphy [2] and widespread adoption of computed tomographic (CT) pulmonary angiography for the diagnosis of acute pulmonary embolism (PE) [2]. The development of tomographic radionuclide imaging presents diagnostic possibilities that were not available at the time of publication of the PIOPED. In 2009, together with colleagues, we reviewed the use of single-photon emission computed tomography (SPECT) in acute PE [3]. Numerous observations with SPECT in the 5 years since then prompted us to conduct the present review of its potential role in evaluating patients with PE. One aim of this review is to present data that will allow physicians to make informed choices regarding the use of SPECT in patients with suspected PE.We searched PubMed using the following search terms: SPECT PE matched with accuracy (20 results), sensitivity (34 results), specificity (39 results); SPECT pulmonary embolism matched with accuracy (35 results), sensitivity (78 results), specificity (80 results); single-photon emission computed tomography pulmonary embolism matched with accuracy (30 results), sensitivity (71 results), specificity (72 results); single-photon emission computed tomography pulmonary embolism (174 results); SPECT pulmonary embolism (197 results). We also checked the references of relevant studies to identify additional investigations. The inclusion criteria were: studies in all languages related to the accuracy of SPECT that included [10 patients suspected of having acute PE and showed or allowed the reader to calculate sensitivity, specificity, and results of clinical follow-up. We identified 21 such articles and 2 preliminary articles with fewer patients that were of interest. Some addressed more than one topic.

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Diagnostic evaluation of planar and tomographic ventilation/perfusion lung images in patients with suspected pulmonary emboli

Cited by 109 publications

References 17 publications

Diagnosing venous thromboembolism in pregnancy

Diagnosing venous thromboembolism in pregnancy

Ventilation Perfusion Single Photon Emission Tomography (V/Q SPECT) in the Diagnosis of Pulmonary Embolism

Critical review of SPECT imaging in pulmonary embolism

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