State-of-the-Art Imaging in Pulmonary Embolism: Ventilation/Perfusion Single-Photon Emission Computed Tomography versus Computed Tomography Angiography — Controversies, Results, and Recommendations from a Systematic Review

Hess, Søren; Frary, Evan C.; Gerke, Oke; Madsen, Poul Thøis

doi:10.1055/s-0036-1593376

Cited by 39 publications

(13 citation statements)

References 62 publications

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“…Similarly, CTA and V/Q scans may have excellent sensitivity and specificity when employed in the proper clinical setting, but CTA may miss peripheral PE and contrast media precludes the use in up to 25% of patients. Whereas the V/Q scan has a high number of inconclusive results if not performed with state-of-the-art SPECT/CT technique, which is not generally abundant [8].…”

Section: Discussionmentioning

confidence: 99%

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FDG-PET/CT in venous thromboembolism

Hess

Frary

Gerke

et al. 2018

Clin Transl Imaging

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Purpose: Venous thromboembolism (VTE) is common; deep venous thrombosis (DVT) and pulmonary embolism (PE) are the most common presentations. VTE may arise in the entire venous bed and the diagnosis may be difficult. VTE is a dynamic disease, inflammation is key, and FDG-PET/CT has been proposed, e.g. to detect thrombi in any anatomic location, to differentiate acute from chronic VTE, and to differentiate bland VTE from tumor thrombosis. The aim of this systematic review was to assess if the potential uses of 18 F-Fluorodeoxyglucose positron emission tomography/computer tomography (FDG-PET/CT) in VTE are described and documented in the literature. Methods: PubMed and Embase databases were searched. Duplicates and papers in other languages than English and Scandinavian were removed. Remaining papers were screened by title and abstract. Eligible papers were assessed in full-text. Results: The master search yielded 3,897 hits, 316 papers were eligible for full-text assessment. Ten papers were included; six on diagnostic performance of PET/CT in VTE, and four on the ability of PET/CT to differentiate bland VTE from tumor thrombosis. Three papers were prospective, seven were retrospective. Conclusion: If applied early, FDG-PET/CT may have a role in diagnosing DVT, but not PE, to discriminate acute from chronic VTE, and to demonstrate recurrent VTE. FDG-PET/CT is by some considered adept in differentiating bland VTE from tumor thrombosis, but we find this controversial due to FDG avidity in bland VTE. FDG-PET/CT may be feasible when screening for occult malignancy. However, in all mentioned areas, available literature is too sparse and too heterogeneous to allow firm conclusions.

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Section: Discussionmentioning

confidence: 99%

“…¼ of patients and implies considerable radiation exposure, while ventilation/perfusion scintigraphy cannot assess the venous system [8,9].…”

Section: Vte Is a Common Disease With About 1 Million Reported Cases mentioning

confidence: 99%

FDG-PET/CT in venous thromboembolism

Hess

Frary

Gerke

et al. 2018

Clin Transl Imaging

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“…V/Q SPECT is also used as a second line investigation when a CTPA study is non‐diagnostic or has equivocal findings. Recently, a few systematic reviews and meta‐analyses have been published which concluded that V/Q SPECT was superior or equal to CTPA in most clinical settings with better overall diagnostic performance …”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] For young women, pregnant patients, those with impaired renal function and previous contrast reactions, V/Q SPECT is the modality of choice to define or exclude acute pulmonary emboli. [6][7][8] Choosing Wisely clinical decision rules recommend V/Q scans as the first line investigation for acute PE during pregnancy and for women under the age of 55, due to the well documented reduced radiation dose to sensitive breast tissue when compared with CTPA studies. 9,10 V/Q SPECT is also used as a second line investigation when a CTPA study is nondiagnostic or has equivocal findings.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, a few systematic reviews and meta-analyses have been published which concluded that V/Q SPECT was superior or equal to CTPA in most clinical settings with better overall diagnostic performance. 2,7 It is proposed that V/Q SPECT can provide a definitive report in greater than 98% of investigations of acute PE, dispelling the myth of high rates of indeterminate findings. It is hoped that a low rate of inconclusive findings will encourage physicians to consider V/Q SPECT as the first line investigation of suspected acute PE in pregnant patients and females under the age of 55.…”

Section: Introductionmentioning

confidence: 99%

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Ventilation perfusion single photon emission computed tomography: Referral practices and diagnosis of acute pulmonary embolism in the quaternary clinical setting

Lawrence

Kyle

2018

J Med Imag Rad Onc

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Introduction Ventilation perfusion single photon emission computed tomography (V/Q SPECT) and CTPA are the two leading imaging studies used to investigate acute pulmonary embolism. V/Q SPECT is often the first line investigation for pregnant patients and young females. Historically, V/Q Planar studies have high rates of indeterminate findings resulting in a preference for CTPA studies. The purpose of this research is to examine current V/Q SPECT referral practices in the quaternary clinical setting and to confirm V/Q SPECT studies have low rates of equivocal findings. Methods Retrospective study of a 6‐month period of all completed V/Q SPECT studies (± LDCT) indicated for investigation of acute PE. V/Q SPECT studies were reported using the European Association of Nuclear Medicine guidelines. Patient demographic data and V/Q SPECT findings were recorded. CTPA and Doppler Ultrasound report findings were included if performed 48 hours prior to, or following V/Q SPECT study. Standard descriptive statistical analysis was undertaken. Results Ninety‐nine percent of V/Q SPECT studies had reports positive or negative for acute PE, with 1% inconclusive. Twenty‐two percent of patients had either CTPA or Doppler Ultrasound studies within a 48‐ hour period prior to, or following V/Q SPECT, with the majority having a negative Doppler ultrasound prior to negative V/Q SPECT. Sixty‐eight percent of patients referred for V/Q SPECT were females under the age of 55, 40% of whom were pregnant. Conclusions Ventilation perfusion single photon emission computed tomography has low rates of equivocal findings with referral practices indicating pregnant patients and young women are considered to most benefit from V/Q SPECT as a first line investigation for acute PE.

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