Advertisement

Three-year clinical experience with VQ SPECT for diagnosing pulmonary embolism: diagnostic performance

      Abstract

      Ventilation–perfusion (VQ) single-photon emission computed tomography (SPECT) comprised the administration of SmartVent (n=386) or Technegas (n=1564) and 200 MBq 99mTc-MAA. 1406 scans were normal, 462 showed PE, 61 showed a singular subsegmental mismatched defect, 21 scans were non-diagnostic. 26% of scans performed with Technegas showed PE, compared to 15% with SmartVent. VQ SPECT had a sensitivity of 95.7%, specificity 98.6%, positive predictive value 95.7%, negative predictive value 98.6%. A normal VQ SPECT scan implied a more than ten-fold lower cause-specific mortality (1 in 1406) than a scan showing PE (1 in 116). NPV of a negative D-dimer was 94.3%.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Goldhaber SZ
        Pulmonary embolism.
        Lancet. 2004; 363: 1295-1305
        • Wells PS
        • Anderson DR
        • Rodger M
        • Ginsberg JS
        • Kearon C
        • Gent M
        • Turpie AG
        • Bormanis J
        • Weitz J
        • Chamberlain M
        • Bowie D
        • Barnes D
        • Hirsh J
        Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer.
        Thromb Haemost. 2000; 83: 416-420
        • Corbus HF
        • Seitz JP
        • Larson RK
        • Stobbe DE
        • Wooten W
        • Sayre JW
        • Chavez RD
        • Unguez CE
        Diagnostic usefulness of lung SPET in pulmonary thromboembolism: an outcome study.
        Nucl Med Commun. 1997; 18: 897-906
        • Bajc M
        • Neilly JB
        • Miniati M
        • Schümichen C
        • Meignan M
        • Jonson B
        EANM guidelines for ventilation/perfusion scintigraphy: Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography.
        Eur J Nucl Med Mol Imaging. 2009; 36: 1356-1370
        • Bajc M
        • Neilly JB
        • Miniati M
        • Schümichen C
        • Meignan M
        • Jonson B
        EANM guidelines for ventilation/perfusion scintigraphy: Part 2. Algorithms and clinical considerations for diagnosis of pulmonary emboli with V/P(SPECT) and MDCT.
        Eur J Nucl Med Mol Imaging. 2009; 36: 1528-1538
        • Gottschalk A
        • Sostman HD
        • Coleman RE
        • Juni JE
        • Thrall J
        • McKusick KA
        • Froelich JW
        • Alavi A
        Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations.
        J Nucl Med. 1993; 34: 1119-1126
        • Gray HW
        • Bessent RG
        Pulmonary embolism exclusion: a practical approach to low probability using the PIOPED data. Prospective investigation of pulmonary embolism diagnosis.
        Eur J Nucl Med. 1998; 25: 271-276
        • Stein PD
        • Relyea B
        • Gottschalk A
        Evaluation of individual criteria for low probability interpretation of ventilation-perfusion lung scans.
        J Nucl Med. 1996; 37: 577-581
        • Bajc M
        • Olsson CG
        • Olsson B
        • Palmer J
        • Jonson B
        Diagnostic evaluation of planar and tomographic ventilation/perfusion lung images in patients with suspected pulmonary emboli.
        Clin Physiol Funct Imaging. 2004; 24: 249-256
        • Miles S
        • Rogers KM
        • Thomas P
        • Soans B
        • Attia J
        • Abel C
        • Holt E
        • D'Este CA
        • Hensley MJ
        A comparison of single-photon emission CT lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism.
        Chest. 2009; 136: 1546-1553
        • Leblanc M
        • Leveillee F
        • Turcotte E
        Prospective evaluation of the negative predictive value of V/Q SPECT using 99mTc-Technegas.
        Nucl Med Commun. 2007; 28: 667-672
        • Le Duc-Pennec A
        • Le Roux PY
        • Cornily JC
        • Jaffrelot M
        • Delluc A
        • de Saint-Martin L
        • Guillo P
        • Le GG
        • Salaun PY
        • Leroyer C
        Diagnostic accuracy of single-photon emission tomography ventilation/perfusion lung scan in the diagnosis of pulmonary embolism.
        Chest. 2012; 141: 381-387
        • Bajc M
        • Olsson B
        • Palmer J
        • Jonson B
        Ventilation/Perfusion SPECT for diagnostics of pulmonary embolism in clinical practice.
        J Intern Med. 2008; 264: 379-387
        • Grüning T
        • Khonsari M
        • Vivian GC
        • Nokes T
        Can plasma D-dimer predict the result of a ventilation-perfusion scan?.
        Clin Imaging. 2010; 34: 179-184
        • Reinartz P
        • Wildberger JE
        • Schaefer W
        • Nowak B
        • Mahnken AH
        • Buell U
        Tomographic imaging in the diagnosis of pulmonary embolism: a comparison between V/Q lung scintigraphy in SPECT technique and multislice spiral CT.
        J Nucl Med. 2004; 45: 1501-1508