Single photon emission computed tomography lung perfusion imaging during the COVID-19 pandemic: does nuclear medicine need to reconsider its guidelines?

Vöö, Stefan; Dizdarevic, Sabina

doi:10.1097/mnm.0000000000001246

Cited by 14 publications

(22 citation statements)

References 21 publications

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“…According to the Memorial Sloan Kettering Cancer Center (MSKCC) Q-SPECT/CT criteria [ 6 , 9 ]. Q-SPECT/CT is recommended as an alternative diagnostic method to CTPA in the pandemic [ 10 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Investigation of perfusion defects by Q-SPECT/CT in patients with mild-to-moderate course of COVID-19 and low clinical probability for pulmonary embolism

et al. 2021

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Objective Pulmonary embolism is a severe source of mortality and morbidity in patients with severe and critical coronavirus disease 2019. It is not yet clear whether the tendency to thrombosis is increased in the mild-to-moderate course of COVID-19. Our research aims to show the clinical benefit of Q-SPECT/CT in diagnosing PD in outpatients treated with mild-to-moderate course of COVID-19 and to determine the frequency of perfusion defects in these patients having relatively lower risk. Methods All patients who underwent Q-SPECT/CT with suspicion of embolism were examined retrospectively. Only patients with low clinical probability and mild-to-moderate course of COVID-19 for PE were included in the study. The patients were evaluated comparatively as those with and without perfusion defects. Patients were divided into laboratory suspicion, clinical suspicion, or clinical and laboratory suspicion. Results In outpatients with mild-to-moderate COVID-19 with low clinical probability for PE, PD without CT abnormality was detected with a rate of 36.6% with Q-SPECT/CT performed for complaints of high d -dimer and/or dyspnea. None of the patients had PD at more proximal level than the segment level. PD with no concomitant CT abnormality was observed with a rate of 56.5% in patients with both clinical and laboratory suspicion. For d -dimer = 0.5 mg/dL cut-off sensitivity is 85%, for d -dimer = 1.5 mg/dL cut-off specificity 81%. Conclusion Thrombosis tendency is also present in outpatients with mild-to-moderate COVID-19, and these patients should also be offered anticoagulant prophylaxis during the COVID-19 period.

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Section: Introductionmentioning

confidence: 99%

Investigation of perfusion defects by Q-SPECT/CT in patients with mild-to-moderate course of COVID-19 and low clinical probability for pulmonary embolism

et al. 2021

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“…The role of Q-SPECT/CT in COVID patients has been raised in several clinical editorials to date [ 11 , 15 – 17 ]. We describe the clinical utility of Q-only SPECT/CT in diagnosing PE in COVID-19-positive patients with a contraindication to iodinated contrast media and a moderate-to-high risk of PE.…”

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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“…After Zuckier ( 34 ). Authors Year Population Modality Concept COVID-19 Application Miniati et al ( 56 ) 1996 General Perfusion Planar Perfusion scintigraphy combined with pretest clinical probability Das et al ( 49 ), Lu et al(50) Bajc et al ( 58 ) 2013 General Perfusion SPECT Sostman et al ( 43 ) 2008 General Perfusion Planar+CXR Radiographic information used to evaluate airspace disease Burger et al ( 47 ), Das et al ( 49 ), Voo et al ( 48 ), Lu et al ( 50 ) Lu et al ( 44 ) 2014 Oncology* Perfusion SPECT-CT Mazurek et al ( 45 ) 2015 Elderly# Perfusion SPECT-CT 2018 Pregnancy∼ Perfusion Planar Perfusion scintigraphy used as an initial screening test Zuckier et al ( 62 ), Lu et al ( 50 ), D.G.N. / B.D.N.…”

Section: A Plethora Of Post-pandemic Proposalsmentioning

confidence: 99%

“…During the COVID-19 pandemic, several groups have reported using perfusion SPECT-CT, without ventilation, as a definitive examination for detection of PE ( 47 , 48 , 49 , 50 ). Of 6 patients with proven diagnosis of PE studied by Das and colleagues, perfusion SPECT-CT was positive in only 4, a surprisingly low fraction ( 49 ).…”

Section: A Plethora Of Post-pandemic Proposalsmentioning

confidence: 99%

Safe Pulmonary Scintigraphy in the Era of COVID-19

Zuckier

2022

Seminars in Nuclear Medicine

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One of the major effects of the COVID-19 pandemic within nuclear medicine was to halt performance of lung ventilation studies, due to concern regarding spread of contaminated secretions into the ambient air. A number of variant protocols for performing lung scintigraphy emerged in the medical literature which minimized or eliminated ventilation scintigraphy, due to the persistent need to provide this critical diagnostic service without compromising the safety of staff and patients. We have summarized and reviewed these protocols, many of which are based on concepts developed earlier in the history of lung scintigraphy. It is possible that some of these interim remedies may gain traction and earn a more permanent place in the ongoing practice of nuclear medicine.

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Single photon emission computed tomography lung perfusion imaging during the COVID-19 pandemic: does nuclear medicine need to reconsider its guidelines?

Cited by 14 publications

References 21 publications

Investigation of perfusion defects by Q-SPECT/CT in patients with mild-to-moderate course of COVID-19 and low clinical probability for pulmonary embolism

Investigation of perfusion defects by Q-SPECT/CT in patients with mild-to-moderate course of COVID-19 and low clinical probability for pulmonary embolism

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

Safe Pulmonary Scintigraphy in the Era of COVID-19

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