Improving the diagnostic performance of lung scintigraphy in suspected pulmonary embolic disease

Gleeson, F V; Turner, Stephen; Scarsbrook, Andrew

doi:10.1016/j.crad.2006.05.017

Cited by 13 publications

(5 citation statements)

References 29 publications

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“…For this purpose a single plane radiograph is absolutely sufficient. It has been shown that the presence of any abnormality on the initial chest radiograph decreases the utility of scintigraphy [91, 92]. The approximate fetal dose from a single plane chest radiograph is reported to be <0.01 mGy [21, 29].…”

Section: Discussionmentioning

confidence: 99%

Imaging for suspected pulmonary embolism in pregnancy—what about the fetal dose? A comprehensive review of the literature

et al. 2010

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ObjectiveTo give a comprehensive overview of fetal doses reported in the literature when imaging the pregnant woman with suspected pulmonary embolism (PE).MethodsA comprehensive literature search in the PubMed, MEDLINE and EMBASE databases yielded a total of 1,687 papers that were included in the analysis and have been analysed with regard to fetal dose in suspected PE radiological imaging strategies.ResultsFetal dose in chest computed tomography (CT) ranges between 0.013 and 0.026 mGy in early and 0.06–0.1 mGy in late pregnancy compared with 99mTc-MAA perfusion scintigraphy with a fetal dose of 0.1–0.6 mGy in early and 0.6–0.8 mGy in late pregnancy. 99mTc-aerosol ventilation scintigraphy results in 0.1–0.3 mGy. However, there is concern about female breast irradiation in CT, which is higher than in scintigraphy. CT radiation risks for breast tissue remain unclear.ConclusionKnowledge of dosimetry and radiation risks is crucial in the radiological work-up of suspected PE in pregnancy. It is reasonable to reserve scintigraphy for pregnant patients with normal chest radiography findings and no history of asthma or chronic lung disease. Performing CT applying dose reduction instead of scintigraphy will minimise fetal radiation dose and maximise the diagnostic value.

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Section: Discussionmentioning

confidence: 99%

Imaging for suspected pulmonary embolism in pregnancy—what about the fetal dose? A comprehensive review of the literature

et al. 2010

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“…However, how and when patients admitted to the hospital for an acute COPD exacerbation should be screened for pulmonary embolism remains challenging. Well-established diagnostic management of suspected acute pulmonary embolism in the general population might be ineffective in the setting of COPD exacerbations, particularly when including a ventilation-prefusion lung scan . Furthermore, clinical presentations of acute pulmonary embolism and COPD exacerbation are similar, making it difficult to determine whether pulmonary embolism should be suspected in this context …”

Section: Introductionmentioning

confidence: 99%

“…Well-established diagnostic management of suspected acute pulmonary embolism in the general population might be ineffective in the setting of COPD exacerbations, particularly when including a ventilation-prefusion lung scan. [11][12][13][14] Furthermore, clinical presentations of acute pulmonary embolism and COPD exacerbation are similar, making it difficult to determine whether pulmonary embolism should be suspected in this context. 15 In the present multicenter cross-sectional study with prospective follow-up, the main objective was to determine the prevalence of pulmonary embolism in patients with COPD admitted to the hospital for acutely worsening respiratory symptoms.…”

mentioning

confidence: 99%

Prevalence of Pulmonary Embolism Among Patients With COPD Hospitalized With Acutely Worsening Respiratory Symptoms

Couturaud

Bertoletti

Pastré

et al. 2021

JAMA

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IMPORTANCEThe prevalence of pulmonary embolism in patients with chronic obstructive pulmonary disease (COPD) and acutely worsening respiratory symptoms remains uncertain.OBJECTIVE To determine the prevalence of pulmonary embolism in patients with COPD admitted to the hospital for acutely worsening respiratory symptoms. DESIGN, SETTING, AND PARTICIPANTSMulticenter cross-sectional study with prospective follow-up conducted in 7 French hospitals. A predefined pulmonary embolism diagnostic algorithm based on Geneva score, D-dimer levels, and spiral computed tomographic pulmonary angiography plus leg compression ultrasound was applied within 48 hours of admission; all patients had 3-month follow-up. Patients were recruited from January 2014 to May 2017 and the final date of follow-up was August 22, 2017.EXPOSURES Acutely worsening respiratory symptoms in patients with COPD. MAIN OUTCOMES AND MEASURESThe primary outcome was pulmonary embolism diagnosed within 48 hours of admission. Key secondary outcome was pulmonary embolism during a 3-month follow-up among patients deemed not to have venous thromboembolism at admission and who did not receive anticoagulant treatment. Other outcomes were venous thromboembolism (pulmonary embolism and/or deep vein thrombosis) at admission and during follow-up, and 3-month mortality, whether venous thromboembolism was clinically suspected or not. RESULTS Among 740 included patients (mean age, 68.2 years [SD, 10.9 years]; 274 women [37.0%]), pulmonary embolism was confirmed within 48 hours of admission in 44 patients (5.9%; 95% CI, 4.5%-7.9%). Among the 670 patients deemed not to have venous thromboembolism at admission and who did not receive anticoagulation, pulmonary embolism occurred in 5 patients (0.7%; 95% CI, 0.3%-1.7%) during follow-up, including 3 deaths related to pulmonary embolism. The overall 3-month mortality rate was 6.8% (50 of 740; 95% CI, 5.2%-8.8%). The proportion of patients who died during follow-up was higher among those with venous thromboembolism at admission than the proportion of those without it at admission (14 [25.9%] of 54 patients vs 36 [5.2%] of 686; risk difference, 20.7%, 95% CI, 10.7%-33.8%; P < .001). The prevalence of venous thromboembolism was 11.7% (95% CI, 8.6%-15.9%) among patients in whom pulmonary embolism was suspected (n = 299) and was 4.3% (95% CI, 2.8%-6.6%) among those in whom pulmonary embolism was not suspected (n = 441).CONCLUSIONS AND RELEVANCE Among patients with chronic obstructive pulmonary disease admitted to the hospital with an acute worsening of respiratory symptoms, pulmonary embolism was detected in 5.9% of patients using a predefined diagnostic algorithm. Further research is needed to understand the possible role of systematic screening for pulmonary embolism in this patient population.

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“…It is reported in the literature that planar VQ lung scanning has a reduced non-diagnostic rate in candidates with a normal chest X-ray. 26 Clinicians generally showed an awareness of concerns related to maternal breast radiation from CTPA scanning and where possible VQ imaging was selected, and in many cases low dose or perfusion-only imaging was used. The non-diagnostic rate for nuclear medicine scanning was low, supporting its use as a first-line investigation 27 subject to local availability and experience.…”

Section: Discussionmentioning

confidence: 99%

Use of imaging for investigation of suspected pulmonary embolism during pregnancy and the postpartum period

et al. 2011

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Summary: Pulmonary embolism (PE) is recognized as a leading cause of maternal mortality in the developed world; however, it is a very difficult diagnosis to make on clinical grounds, and in most cases imaging is required. Pregnancy is a recognized risk factor for venous thromboembolism, and symptoms of normal pregnancy including shortness of breath, tachycardia and leg swelling are included in clinical tools for risk stratification for PE in the non-pregnant population. This results in a very low threshold for imaging, despite concerns regarding the risk of exposure to ionizing radiation both for the fetus and the maternal breast. We reviewed the results of all ventilation/perfusion scans and computed tomography pulmonary angiograms performed in pregnant women at a single institution to identify how many of these tests were positive for PE, and which clinical features may identify a low-risk group. A total of 386 scans were performed to investigate 375 episodes of suspected PE, representing 1.3 -1.5% of pregnant women. Fifteen patients were diagnosed with PE, giving an incidence of one in 2000 maternities. The only statistically significant factors associated with PE were smoking or the presence of multiple risk factors. Clinical features of tachycardia and leg swelling did not provide significant diagnostic value; however, the absence of pleuritic chest pain had a negative predictive value of 97.8%. Arterial blood gas and D-dimer were statistically different between those with and without PE but not to a clinically useful degree. Currently available clinical and laboratory tools are not adequate to exclude a diagnosis of PE in a pregnant patient, thus imaging is justified to exclude PE. Further longitudinal studies to identify a low-risk group who do not require imaging is vital.

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Improving the diagnostic performance of lung scintigraphy in suspected pulmonary embolic disease

Cited by 13 publications

References 29 publications

Imaging for suspected pulmonary embolism in pregnancy—what about the fetal dose? A comprehensive review of the literature

Imaging for suspected pulmonary embolism in pregnancy—what about the fetal dose? A comprehensive review of the literature

Prevalence of Pulmonary Embolism Among Patients With COPD Hospitalized With Acutely Worsening Respiratory Symptoms

Use of imaging for investigation of suspected pulmonary embolism during pregnancy and the postpartum period

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