Lung Scintigraphy for Pulmonary Embolism Diagnosis in COVID-19 Patients: A Multicenter Study

Roux, Pierre-Yves Le; Bonnefoy, P.B.; Bahloul, Achraf; Denizot, B.; Barrès, B.; Moreau-Triby, Caroline; Girma, A.; Pallardy, Amandine; Ceyrat, Q.; Sarda‐Mantel, Laure; Razzouk-Cadet, Micheline; Zsigmond, Reka; Cachin, Florent; Karcher, Gilles; Salaün, Pierre-Yves

doi:10.2967/jnumed.121.262955

Cited by 10 publications

(29 citation statements)

References 30 publications

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“…All these techniques rely on the analysis of lung perfusion, without information on ventilation. The need for a ventilation scan is of particular interest with the COVID-19 pandemic as the ventilation procedure increases the potential risk of contamination by the aerosol secretion and the expired air ( 22 ). According to our results, an interpretation only based on perfusion images demonstrated similar high sensitivity but lower specificity: 100% (95%CI 93.6–100) and 81.8% (95%CI 75.3–86.9%) using the same 2.5 segments cut-off.…”

Section: Discussionmentioning

confidence: 99%

Lung Ventilation/Perfusion Scintigraphy for the Screening of Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Which Criteria to Use?

et al. 2022

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ObjectiveThe diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) is a major challenge as it is a curable cause of pulmonary hypertension (PH). Ventilation/Perfusion (V/Q) lung scintigraphy is the imaging modality of choice for the screening of CTEPH. However, there is no consensus on the criteria to use for interpretation. The aim of this study was to assess the accuracy of various interpretation criteria of planar V/Q scintigraphy for the screening of CTEPH in patients with PH.MethodsThe eligible study population consisted of consecutive patients with newly diagnosed PH in the Brest University Hospital, France. Final diagnosis (CTEPH or non-CTEPH) was established in a referential center on the management of PH, based on the ESC/ERS guidelines and a minimum follow-up of 3 years. A retrospective central review of planar V/Q scintigraphy was performed by three nuclear physicians blinded to clinical findings and to final diagnosis. The number, extent (sub-segmental or segmental) and type (matched or mismatched) of perfusion defects were reported. Sensitivity and specificity were evaluated for various criteria based on the number of mismatched perfusion defects and the number of perfusion defects (regardless of ventilation). Receiver operating characteristic (ROC) curves were generated and areas under the curve (AUC) were calculated for both.ResultsA total of 226 patients with newly diagnosed PH were analyzed. Fifty six (24.8%) were diagnosed with CTEPH while 170 patients (75.2%) were diagnosed with non-CTEPH. The optimal threshold was 2.5 segmental mismatched perfusion defects, providing a sensitivity of 100 % (95% CI 93.6–100%) and a specificity of 94.7% (95%CI 90.3–97.2%). Lower diagnostic cut-offs of mismatched perfusion defects provided similar sensitivity but lower specificity. Ninety five percent of patients with CTEPH had more than 4 segmental mismatched defects. An interpretation only based on perfusion provided similar sensitivity but a specificity of 81.8% (95%CI 75.3–86.9%).ConclusionOur study confirmed the high diagnostic performance of planar V/Q scintigraphy for the screening of CTEPH in patients with PH. The optimal diagnostic cut-off for interpretation was 2.5 segmental mismatched perfusion defects. An interpretation only based on perfusion defects provided similar sensitivity but lower specificity.

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Section: Discussionmentioning

confidence: 99%

Lung Ventilation/Perfusion Scintigraphy for the Screening of Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Which Criteria to Use?

et al. 2022

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“…Informed consent was obtained from all participants. Description of the registry and collection of data were detailed in a previous work 13 …”

Section: Methodsmentioning

confidence: 99%

“…Lung perfusion was performed after administration of 99m Tc-labeled human albumin ( 99m Tc-MAA). Ventilation was performed after inhalation 99m Tc-Technegas or krypton gas ( 81m Kr) according to local facilities 13 …”

Section: Methodsmentioning

confidence: 99%

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Functional Alterations Due to COVID-19 Lung Lesions—Lessons From a Multicenter V/Q Scan-Based Registry

et al. 2022

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In coronavirus disease 2019 (COVID-19) patients, clinical manifestations as well as chest CT lesions are variable. Lung scintigraphy allows to assess and compare the regional distribution of ventilation and perfusion throughout the lungs. Our main objective was to describe ventilation and perfusion injury by type of chest CT lesions of COVID-19 infection using V/Q SPECT/CT imaging. Patients and Methods: We explored a national registry including V/Q SPECT/CT performed during a proven acute SARS-CoV-2 infection. Chest CT findings of COVID-19 disease were classified in 3 elementary lesions: ground-glass opacities, crazy-paving (CP), and consolidation. For each type of chest CT lesions, a semiquantitative evaluation of ventilation and perfusion was visually performed using a 5-point scale score (0 = normal to 4 = absent function). Results: V/Q SPECT/CTwas performed in 145 patients recruited in 9 nuclear medicine departments. Parenchymal lesions were visible in 126 patients (86.9%). Ground-glass opacities were visible in 33 patients (22.8%) and were responsible for minimal perfusion impairment (perfusion score [mean ± SD], 0.9 ± 0.6) and moderate ventilation impairment (ventilation score, 1.7 ± 1); CP was visible in 43 patients (29.7%) and caused moderate perfusion impairment (2.1 ± 1.1) and moderate-to-severe ventilation impairment (2.5 ± 1.1); consolidation was visible in 89 patients (61.4%) and was associated with moderate perfusion impairment (2.1 ± 1) and severe ventilation impairment (3.0 ± 0.9). Conclusions: In COVID-19 patients assessed with V/Q SPECT/CT, a large proportion demonstrated parenchymal lung lesions on CT, responsible for ventilation and perfusion injury. COVID-19-related pulmonary lesions were, in order of frequency and functional impairment, consolidations, CP, and ground-glass opacity, with typically a reverse mismatched or matched pattern.

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“…Furthermore, a recent multicenter trial evaluated the role of lung scintigraphy in 145 COVID-19 patients, suspected of pulmonary embolism [13]. Compared with perfusion-only SPECT/CT, when ventilation/perfusion SPECT/CT was performed, an additional 31% of patients were able to rule out pulmonary embolism.…”

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confidence: 99%

In the COVID-19 Era, Is It OK to Perform a Perfusion-Only SPECT/CT for the Diagnosis of Pulmonary Embolism?

Suh

2022

Nucl Med Mol Imaging

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Coronavirus disease 2019 (COVID-19) is a global and international public health emergency. The COVID-19 pandemic is having a profound impact on patient care and nuclear medicine practice, especially lung ventilation scans. There is still a lack of evidence whether the lung ventilation scan should be considered as an aerosol-generating procedure. However, since infection from COVID-19 is mainly transmitted by respiratory droplets and close contact, both test personnel and patients are at risk of transmission of COVID-19 during lung ventilation scans. In the inhalation procedure, the patient releases respiratory fluids in the form of droplets, which may carry the virus and transmit infection. For this reason, several recent papers suggest that a ventilation scan can be omitted and it can be replaced with perfusion-only single-photon emission tomography (SPECT)/computed tomography (CT) for the diagnosis of pulmonary embolism [1][2][3].With the advent of hybrid SPECT/CT, it is possible to evaluate the pulmonary perfusion status in three-dimensional space, and when combined with the segmental anatomical information of each patient determined based on the CT scan, it offers a more accurate diagnosis [4]. Co-registered low-dose CT scans can directly assess the structural abnormality of the airways, lung parenchyma, and pleura, and areas with reduced perfusion without corresponding structural abnormalities are likely indicative of pulmonary embolism. Several studies have reported the diagnostic performance of perfusion-only SPECT/CT in the diagnosis of pulmonary thromboembolic disease [5][6][7][8][9][10][11] (Table 1). In common, perfusion-only SPECT/CT showed high sensitivity ranging from 88 to 100%, and a high negative predictive value of 91-100%. However, the specificity was reported to vary from as low as * Minseok Suh

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Lung Scintigraphy for Pulmonary Embolism Diagnosis in COVID-19 Patients: A Multicenter Study

Cited by 10 publications

References 30 publications

Lung Ventilation/Perfusion Scintigraphy for the Screening of Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Which Criteria to Use?

Lung Ventilation/Perfusion Scintigraphy for the Screening of Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Which Criteria to Use?

Functional Alterations Due to COVID-19 Lung Lesions—Lessons From a Multicenter V/Q Scan-Based Registry

In the COVID-19 Era, Is It OK to Perform a Perfusion-Only SPECT/CT for the Diagnosis of Pulmonary Embolism?

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