Relation between lung perfusion defects and intravascular clots in acute pulmonary thromboembolism: Assessment with breath-hold SPECT–CT pulmonary angiography fusion images

Suga, Kazuyoshi; Kawakami, Yoshiyuki; Iwanaga, Hideyuki; Tokuda, Osamu; Matsunaga, Naofumi

doi:10.1016/j.ejrad.2007.08.023

Cited by 15 publications

(15 citation statements)

References 17 publications

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“…Fusion images provided information about the effects of PE on peripheral perfusion (49). In 4 of 34 patients (12%), perfusion defects were absent from lung territories with PE (1 lobar branch and 3 segmental branches) (50). Conversely, in 4 other patients who did not have PE in vessels in the lung territory, perfusion defects were observed in the territory despite the absence of PE from the branches (50).…”

Section: Technical Studiesmentioning

confidence: 99%

SPECT in Acute Pulmonary Embolism

Stein¹,

Freeman²,

Sostman³

et al. 2009

J Nucl Med

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The purpose of this review was to evaluate the accuracy of SPECT in acute pulmonary embolism. Sparse data are available on the accuracy of SPECT based on an objective reference test. Several investigations were reported in which the reference standard for the diagnosis of pulmonary embolism was based in part on the results of SPECT or planar ventilation-perfusion (V/Q) imaging. The sensitivity of SPECT in all but one investigation was at least 90%, and specificity also was generally at least 90%. The sensitivity of SPECT in 4 of 5 investigations was higher than that of planar V/Q imaging. The specificity of SPECT was generally higher, equal, or only somewhat lower than that of planar V/Q imaging. Most investigators reported nondiagnostic SPECT V/Q scans in no more than 3% of cases. Methods of obtaining SPECT images, methods of obtaining planar V/Q images, and the criteria for interpretation varied. The general impression is that SPECT is more advantageous than planar V/Q imaging.

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Section: Technical Studiesmentioning

confidence: 99%

SPECT in Acute Pulmonary Embolism

Stein¹,

Freeman²,

Sostman³

et al. 2009

J Nucl Med

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“…CT angiography showed intravascular clots in 30 out of 34 (88 %) patients with lobar, segmental, or subsegmental perfusion defects on deep-inspiratory breath-hold perfusion SPECT [42]. In each of the four patients who did not show PE on CT angiography, SPECT showed one segmental and one or two subsegmental perfusion defects.…”

Section: V/q Spect/ct Compared With Multidetector Ct Angiographymentioning

confidence: 96%

“…It has been suggested that in some instances, there may be a dissociation between intraluminal filling defects shown on CT pulmonary angiography and perfusion defects in the same region [42]. CT angiography showed intravascular clots in 30 out of 34 (88 %) patients with lobar, segmental, or subsegmental perfusion defects on deep-inspiratory breath-hold perfusion SPECT [42].…”

Section: V/q Spect/ct Compared With Multidetector Ct Angiographymentioning

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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“…Better images have been confirmed in at least one study. Since the majority of emboli are in the lower lung fields, this enhancement may be significant for some patients (Suga, Yasuhiko et al 2008). In recent years, hybrid machines, called SPECT-CT, that combine a nuclear camera with a standard CT have become available.…”

Section: Future Directionsmentioning

confidence: 99%

“…A detailed discussion on each of the available studies can be found elsewhere (Leblanc and Paul 2010). However, all published studies have demonstrated that V/Q SPECT performs at least as well as CTPA for the diagnosis of pulmonary embolism (Reinartz, Wildberger et al 2004;Suga, Yasuhiko et al 2008;Gutte, Mortensen et al 2009;Miles, Rogers et al 2009). …”

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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Relation between lung perfusion defects and intravascular clots in acute pulmonary thromboembolism: Assessment with breath-hold SPECT–CT pulmonary angiography fusion images

Cited by 15 publications

References 17 publications

SPECT in Acute Pulmonary Embolism

SPECT in Acute Pulmonary Embolism

Critical review of SPECT imaging in pulmonary embolism

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

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