Time trend analysis of pulmonary embolism diagnosis with single-photon emission computed tomography ventilation/perfusion imaging

Objective Following the implementation of single-photon emission computed tomography ventilation/perfusion (SPECT V/Q) in our department, we previously carried out an observational study over the period 2011–2013 that showed the safety of SPECT V/Q to rule out pulmonary embolism (PE). However, PE prevalence (28%) was high compared with some studies. Our hypothesis was that the use of SPECT V/Q may be responsible for an overdiagnosis of PE, especially at the implementation phase of the test. The aim was to carry out a time trend analysis of the evolution over the years of PE diagnosis with SPECT V/Q. Patients and methods To evaluate the time trend of SPECT V/Q results, the conclusions of all SPECT V/Q scans performed for a suspected acute PE in our department from April 2011 to December 2016 were collected. To confirm the safety of a diagnostic management on the basis of SPECT V/Q to rule out PE, a retrospective observational study of the outcome of patients assessed with SPECT V/Q for suspected acute PE was carried out during the period 2014–2016. SPECT V/Q was interpreted using a diagnostic cutoff of one segmental or two subsegmental mismatches. The final diagnostic conclusion was established by the physician responsible for patient care. The safety of SPECT V/Q was assessed by monitoring the risk of thromboembolic events during the 3-month follow-up period in patients left untreated on the basis of a negative SPECT V/Q. Results Over the period 2011&ndash...
Source: Nuclear Medicine Communications - Category: Nuclear Medicine Tags: ORIGINAL ARTICLES Source Type: research

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Conclusions: In this pilot study, we have demonstrated the feasibility and potential utility of V/Q PET/CT for the management of patients with suspected acute PE. V/Q PET/CT may be of particular relevance in cases of equivocal findings or isolated subsegmental findings on CTPA, adding further discriminatory information to allow important decision-making regarding application or withholding of treatment courses of therapeutic anticoagulation, which may confer an increased risk of bleeding. Given the other advantages of V/Q PET/CT (reduced acquisition time, low radiation dose), and with increasing availability of 68Ga-genera...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Outcomes/Infectious Disease/Pulmonary II Source Type: research
In conclusion, pulmonary embolism is an important complication of pregnancy. Understanding the recommendations from various specialty groups allows us to be better consultants and assist in the management of these patients. References 1. Righini M, Robert-Ebadi H, Elias A, et al. Diagnosis of pulmonary embolism during pregnancy. Ann Intern Med. 2018; 169:766-773 2. Kirsch J, Brown RKJ, Henry TS, et al. ACR Appropriateness Criteria ® Suspected Pulmonary Embolism. Available at https://acsearch.acr.org/docs/69404/Narrative/. American College of Radiology. Accessed January 2019. 3. Parker JA, Coleman RE, Grady E, et al. SN...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Educational Exhibit Posters Source Type: research
Conclusion: Hybrid SPECT/CT (Q) imaging has a high diagnostic accuracy for detecting PTE than planar (Q) scans interpreted with chest radiographs. In addition, low dose CT used in SPECT/CT was able to identify other non-embolic pathologies (eg: pneumonia, emphysematous bullae, tumor or lymphadenopathy) responsible for perfusion defects which could have been missed on chest radiography thereby increasing the specificity. Modified PIOPED II had a higher number of non-diagnostic results compared to PISAPED which increases the latter's clinical utility.
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Clinical Science Posters Source Type: research
AbstractPurpose of ReviewPulmonary embolism (PE) is a common condition with high morbidity and mortality particularly if misdiagnosed or untreated. It has non-specific clinical manifestations, often presenting similarly to other cardiovascular conditions. The aim of this review is to summarize the clinical presentation, diagnostic algorithms, and imaging studies utilized to efficiently make or exclude the diagnosis of pulmonary embolism.Recent FindingsRecent cohort studies have raised questions about the classic presentations of PE (particularly with regard to syncope) or lack thereof. Diagnosis of PE continues to evolve w...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
Conclusion Our study showed that the omission of a ventilation SPECT led to a high rate of false-positive diagnoses and that the ventilation scan cannot be replaced by a chest radiography.
Source: Nuclear Medicine Communications - Category: Nuclear Medicine Tags: Original Articles Source Type: research
AbstractPurpose of reviewCT angiography has become the gold standard for evaluation of suspected pulmonary embolism; however, continuous evolution in radiology has led to new imaging approaches that offer improved options for detection and characterization of pulmonary embolism while exposing patients to lower contrast and radiation dose. The purpose of this review is to summarize state of the art imaging approaches for the evaluation of pulmonary embolism, focusing on technical innovations in this field.Recent findingsThe introduction of dual-energy CT has resulted in the ability to add functional and prognostic informati...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
Conclusion In this case series, a large proportion of patients with isolated SSPE on V/Q imaging were not identified on corroborating CTPA performed within 48 h. In patients with isolated SSPE (identified by isolated subsegmental mismatch on V/Q single-photon emission computed tomography), we found no difference in risk of recurrent suspected VTE or all-cause mortality in those treated with anticoagulation and those not treated.
Source: Nuclear Medicine Communications - Category: Nuclear Medicine Tags: Original Articles Source Type: research
Conclusion: The SIMIND MC package enables the simulation of a realistic normal dual isotopes lung V/Q-SPECT. Compared to a normal cases database, most simulated voxels have Z-scores close to 0. This model may be used to create pulmonary embolism models and then to develop automated contouring methods for regional lung dysfunction measurements.
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Data Analysis & amp; Management Posters Source Type: research
1565Purpose: Acute pulmonary embolism (PE) is a serious and life threatening condition for which early diagnosis and initiation of therapy can significantly reduce morbidity and mortality. The European Society of Cardiology recommends computed tomography pulmonary angiogram (CTPA) to diagnose acute PE and the European Association of Nuclear Medicine recommends ventilation/perfusion single-photon emission computed tomography (V/Q SPECT). D-dimer is routinely used to rule out cases of PE with low clinical suspicion. This retrospective study analyzed the value of V/Q SPECT/CT, CTPA, and D-dimer independently and in combinatio...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Clinical Science Poster Session Source Type: research
1569Objectives: To evaluate the clinical value of ventilation/perfusion single photon emission computed tomography (V/Q SPECT) in patients with pulmonary embolism (PE) and anticoagulant therapy by using V/Q SPECT and indentify factors which may affect the effect of therapy. Material and method: A total of 195 patients who underwent V/Q SPECT in Anzhen Hospital from July 2014 till December 2016 were clinically diagnosed as PE. Sixty-three patients who performed more than twice V/Q SPECT examinations were recruited in our current study. According to extent of lung perfusion defect (PD) involved lung volume (%), the severity ...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Clinical Science Poster Session Source Type: research
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