Acute pulmonary embolism detection with ventilation/perfusion SPECT combined with full dose CT: What is the best option?

Publication date: Available online 6 February 2017
Source:Revista Española de Medicina Nuclear e Imagen Molecular
Author(s): M. Milà, J. Bechini, A. Vázquez, V. Vallejos, M. Tenesa, A. Espinal, M. Fraile, M. Monreal
AimTo compare diagnostic accuracy of Ventilation/Perfusion (V/P) single-photon emission computed tomography (SPECT) combined with simultaneous full-dose CT with a hybrid SPECT/CT scanner versus planar ventilation/perfusion (V/P) SPECT and CT angiography (CTA) in patients suspected with acute pulmonary embolism (PE).MethodsBetween 2009 and 2011, consecutive patients suspected of acute PE were referred for V/P SPECT/CT (reviewed board approved study). A contrast agent was administered to patients who had no contraindications. Non-contrast V/P SPECT/CT was performed on the remaining patients. All patients were followed-up for at least 3 months.ResultsA total of 314 patients were available during the study period, with the diagnosis of PE confirmed in 70 (22.29%) of them. The overall population sensitivity and specificity was 90.91% and 92.44%, respectively for V/P SPECT, 80% and 99.15%, respectively, for CTA, and 95.52% and 97.08% for V/P SPECT/CT. SPECT/CT performed better than V/P SPECT (AUC differences=0.0419, P=0.0043, 95% CI; 0.0131–0.0706) and CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103–0.1259)). Comparing imaging modalities when contrast agent could be administered, sensitivity and specificity increased and V/P SPECT/CT was significantly better than CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103–0.1259) and V/P SPECT (AUC differences=0.0659, P=0.0052, 95% CI; 0.0197–0.1121). In case of non-contrast enhancement, there was non-significant increase of specificity. Secondary findings on CT impacted patient management in 14.65% of cases.ConclusionOur study shows that combined V/P SPECT/CT scanning has a higher diagnostic accuracy for detecting acute PE than V/P SPECT and CTA alone. When feasible, V/P SPECT/CT with contrast enhancement is the best option.



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