Radionuclide lung scans for suspected acute pulmonary embolism: Single photon emission computed tomography (SPECT) or hybrid SPECT/CT?

AbstractIntroductionHybrid single photon emission computed tomography (SPECT) with CT (SPECT/CT) may improve diagnostic accuracy in suspected acute pulmonary embolism, but further research is needed. We evaluated whether the use of attenuation correction and/or the depiction of lung pathology with hybrid SPECT/CT could significantly reduce potentially false ‐positive ventilation–perfusion (VQ) SPECT studies or obviate the need for a ventilation study.MethodsTwo specialists (S1 and S2) reviewed prospectively acquired VQ SPECT/CT in 165 patients. Studies were reported using standard criteria and compared to VQ SPECT and Q SPECT/CT.ResultsS1 and S2 recorded positive VQ SPECT in 54 (32.7%) and 42 (25.6%) cases, respectively. Hybrid SPECT/CT showed non ‐embolic pathology in 41 (S1) and 46 (S2) patients, but compared to VQ SPECT, neither hybrid SPECT/CT nor attenuation correction SPECT/CT had significantly fewer positive studies. Intra‐observer agreement with VQ SPECT/CT was almost perfect (k = 0.91 for S1 andk = 0.95 for S2;P 
Source: Journal of Medical Imaging and Radiation Oncology - Category: Radiology Authors: Tags: Medical Imaging —Original Article Source Type: research

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AbstractPurpose of ReviewThe purpose of this article is to review the imaging findings and current imaging techniques of acute pulmonary embolism (PE) and chronic thromboembolic disease. Special considerations are also discussed, including pregnancy, congenital heart disease, lower extremity computed tomography (CT), and the isolated subsegmental PE.Recent FindingsCT pulmonary angiography and planar ventilation/perfusion (V/Q) lung scintigraphy are the primary means of evaluating pulmonary embolic disease. Magnetic resonance angiography avoids ionizing radiation and iodinated contrast in select patients. V/Q SPECT/CT provi...
Source: Current Respiratory Care Reports - Category: Respiratory Medicine Source Type: research
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 m...
Source: Nuclear Medicine Communications - Category: Nuclear Medicine Tags: ORIGINAL ARTICLES Source Type: research
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 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
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