<scp>SPECT</scp>‐<scp>CT</scp>/<scp>VQ</scp> versus <scp>CTPA</scp> for diagnosing pulmonary embolus and other lung pathology: Pre‐existing lung disease should not be a contraindication

Bhatia, Kartik; Ambati, Chaitanya; Dhaliwal, Rajiv; Paschkewitz, Royce; Hsu, Eugene; Ho, Bao; Young, Andy; Emmett, Louise

doi:10.1111/1754-9485.12471

Cited by 21 publications

(49 citation statements)

References 16 publications

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“…In routine V/Q SPECT imaging studies, the ventilation component may improve the specificity of the perfusion study and there is already data showing that the addition of low-dose CT to the SPECT images, the corroborated reporting of the scans with the structural information leads to a higher sensitivity, comparable with that of CTPA [ 20 , 21 ]. Cobes et al retrospectively analyzed V/Q SPECT/CTs in 5 patients hospitalized with COVID-19 and determined that V/Q SPECT/CT could play a role diagnosing embolic complications while following meticulous hygiene [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE

Das

Yeh

Schöder

2020

Eur J Nucl Med Mol Imaging

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Purpose We reviewed the clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Methods Following the World Health Organization’s declaration of a global pandemic, our department policy recommended Q-only SPECT/CT for all patients undergoing nuclear medicine evaluation for suspected PE to reduce the risk of aerosolization of respiratory droplets. We performed a retrospective review of sequential patients admitted with COVID-19 imaged with Q-SPECT/CT between March 17, 2020, and June 30, 2020, at Memorial Sloan Kettering Cancer Center. We recorded patient demographics, clinical symptoms, Wells score (to stratify patients according to pre-test probability for PE prior to Q-SPECT/CT), and noted ancillary imaging findings on CT. Results Of the 33 patients imaged with Q-SPECT/CT, 6 patients (3 men, 3 women) had a laboratory confirmed diagnosis of COVID-19 (mean age, 55, ± 11.4 years, range 33–68). All patients had a current diagnosis of malignancy and had a moderate or high pre-test probability for PE (mean Wells score 2.8, range 2–4). Q-SPECT/CT was positive in 4/6 (67%) of patients. Distribution of pulmonary emboli was bilateral and segmental in 75% of patients. Ancillary acute findings on SPECT/CT included bilateral parenchymal ground glass opacities ( n = 5), pleural effusions ( n = 2), and pneumomediastinum ( n = 1). Conclusion Q-SPECT/CT has clinical utility for diagnosing PE in patients with COVID-19 where there is a contraindication for iodinated contrast media and a moderate or high pre-test probability for PE.

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Section: Discussionmentioning

confidence: 99%

Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE

Das

Yeh

Schöder

2020

Eur J Nucl Med Mol Imaging

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“…Thirteen diagnostic accuracy studies met the inclusion criteria. [26][27][28][29][30][31][32][33][34][35][36][37][38] Study characteristics are depicted in Table S1. Twelve (92%) were single-institution studies.…”

Section: Diagnostic Accuracy Studiesmentioning

confidence: 99%

“…The risk of bias in patient selection was judged as low, high, and unclear in three, 30,34,36 eight, 26,27,29,[31][32][33]37,38 and two 28,35 studies, respectively. Of the eight studies at high risk of bias, three did not enroll a consecutive or random sample of patients, 26,27,37 three had > 10% of the source population that was not analyzed, 29,33,38 and two excluded patients in whom tests were of poor quality or without final diagnosis. 31,32 In two studies, insufficient data were reported to permit a judgment and the risk of bias was judged as "unclear."…”

Section: Risk Of Biasmentioning

confidence: 99%

“…28,35 Domain 2: index test. The risk of bias in the conduct or the interpretation of SPECT was judged as low, high, and unclear in eight, 26,27,[30][31][32][33][34]38 two, 28,29 and three [35][36][37] studies, respectively.…”

Section: Risk Of Biasmentioning

confidence: 99%

“…28,29 In three studies, the risk of bias was judged as "unclear" because insufficient data were reported to permit a judgment. [35][36][37] Domain 3: reference standard. The risk of bias in the conduct or the interpretation of the reference standard was judged as low, high, and unclear in two, 30,34 10, [26][27][28][29][31][32][33]35,36,38 and one 37 studies, respectively.…”

Section: Risk Of Biasmentioning

confidence: 99%

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Ventilation/perfusion SPECT for the diagnosis of pulmonary embolism: A systematic review

Roux

Robin

Tromeur

et al. 2020

Journal of Thrombosis and Haemostasis

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Background: Ventilation/perfusion (V/Q) single-photon emission computed tomography (SPECT) has largely replaced conventional planar V/Q scan in nuclear medicine departments for pulmonary embolism (PE) diagnosis. However, the diagnostic performance of the test and its role in the diagnostic management of acute PE are still a matter of debate. Objective: The primary aim was to establish the diagnostic accuracy (sensitivity, specificity) of V/Q SPECT for PE diagnosis. The secondary aim was to review the clinical outcomes of patients investigated for PE suspicion with a standardized algorithm based on V/Q SPECT. Methods: We conducted a systematic review of diagnostic accuracy and management outcome studies involving patients evaluated with V/Q SPECT for suspected acute PE. We searched from inception to June 23, 2020, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for diagnostic accuracy studies, randomized controlled trials, and observational cohort studies. The methodological quality and risk of bias of eligible studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and the Risk of Bias in Nonrandomized Studies of Interventions tools. Results: We identified 13 accuracy studies and one prospective outcome study. Eleven diagnostic accuracy studies were deemed at high risk of bias in at least two of the four domains of QUADAS-2 evaluation and a further two studies raised concerns regarding the applicability of results, precluding the meta-analysis for accuracy indices. The only prospective cohort study demonstrated critical risk of bias. Conclusions: Although V/Q SPECT has been widely implemented in daily clinical practice, the exact diagnostic performance of V/Q SPECT for PE is still unknown. This systematic review clearly identifies knowledge gaps and sets the agenda for future research.

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Pulmonary Hypertension Association's 2022 International Conference Scientific Sessions Overview

et al. 2023

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The considerable progress made in recent years in the diagnosis, risk stratification, and treatment of pulmonary hypertension was highlighted during the most recent edition of the Pulmonary Hypertension Association Scientific Sessions, which was held in Atlanta, Georgia from June 9 to 11, 2022, with the theme: Vision for the PHuture: The Evolving Science and Management of PH. Content presented over the 3‐day conference focused on scientific and management updates since the last sessions were held in 2018 and included didactic talks, debates, and roundtable discussions across a broad spectrum of topics related to pulmonary hypertension. This article aims to summarize the key messages from each of the session talks.

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SPECT‐CT/VQ versus CTPA for diagnosing pulmonary embolus and other lung pathology: Pre‐existing lung disease should not be a contraindication

Abstract: SPECT-CT/VQ has high sensitivity and specificity for diagnosing PE compared with CTPA, even among patients with pre-existing lung disease, with lower radiation doses.

Cited by 21 publications

References 16 publications

Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE

Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE

Ventilation/perfusion SPECT for the diagnosis of pulmonary embolism: A systematic review

Pulmonary Hypertension Association's 2022 International Conference Scientific Sessions Overview

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