Alexandra Le Duc-Pennec1, Pierre-Yves Le Roux1, Jean-Christophe Cornily2, Morgan Jaffrelot3, Aurélien Delluc4, Luc de Saint-Martin4, Philippe Guillo1, Grégoire Le Gal5, Pierre-Yves Salaun1, Christophe Leroyer6. 1. Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; EA3878 (GETBO) IFR 148, CHU de la Cavale Blanche, Brest, France; Service de médecine nucléaire, CHU de la Cavale Blanche, Brest, France. 2. Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; EA4324 (ORPHY) IFR 148, Université de Brest, CHU de la Cavale Blanche, Brest, France; Département de cardiologie, CHU de la Cavale Blanche, Brest, France. 3. Service des urgences, CHU de la Cavale Blanche, Brest, France. 4. Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; EA3878 (GETBO) IFR 148, CHU de la Cavale Blanche, Brest, France; Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France. 5. Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France. 6. Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; EA3878 (GETBO) IFR 148, CHU de la Cavale Blanche, Brest, France; Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France. Electronic address: christophe.leroyer@chu-brest.fr.
Abstract
BACKGROUND: Planar ventilation/perfusion (V/Q) lung scintigraphy is a validated tool for the diagnosis of pulmonary embolism (PE). Nevertheless, given the high rate of nonconclusive V/Q, further investigation is often necessary. V/Q single-photon emission CT (SPECT) scan could improve V/Q performance, but sparse data are available on its accuracy. This study assessed the diagnostic performance of V/Q SPECT scan in a cohort of consecutive patients with suspected PE. METHODS: Three hundred twenty-one consecutive patients with a clinical suspicion of PE were prospectively included. Patients suspected of having PE were managed according to a reference diagnostic strategy validated by a 3-month follow-up. In addition to the reference strategy, patients had a V/Q SPECT scan, the results of which were compared with the initial work-up results. RESULTS: Prevalence of PE was 0 of 41 (0%; 95% CI, 0%-9%), six of 134 (4%; 95% CI, 2%-9%),15 of 36 (42%; 95% CI, 27%-58%), and 28 of 32 (88%; 95% CI, 72%-95%) in the normal, low,intermediate, and high V/Q SPECT scan probability groups, respectively. The combination of V/Q SPECT scan with clinical probability was diagnostic in 88% of patients. CONCLUSIONS: V/Q SPECT scan results show satisfactory accuracy for PE diagnosis. Validation of dedicated interpretation criteria is required, followed by outcome studies that use V/Q SPECT scan as part of a diagnostic strategy to rule out PE. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01183026; URL: www.clinicaltrials.gov
BACKGROUND: Planar ventilation/perfusion (V/Q) lung scintigraphy is a validated tool for the diagnosis of pulmonary embolism (PE). Nevertheless, given the high rate of nonconclusive V/Q, further investigation is often necessary. V/Q single-photon emission CT (SPECT) scan could improve V/Q performance, but sparse data are available on its accuracy. This study assessed the diagnostic performance of V/Q SPECT scan in a cohort of consecutive patients with suspected PE. METHODS: Three hundred twenty-one consecutive patients with a clinical suspicion of PE were prospectively included. Patients suspected of having PE were managed according to a reference diagnostic strategy validated by a 3-month follow-up. In addition to the reference strategy, patients had a V/Q SPECT scan, the results of which were compared with the initial work-up results. RESULTS: Prevalence of PE was 0 of 41 (0%; 95% CI, 0%-9%), six of 134 (4%; 95% CI, 2%-9%),15 of 36 (42%; 95% CI, 27%-58%), and 28 of 32 (88%; 95% CI, 72%-95%) in the normal, low,intermediate, and high V/Q SPECT scan probability groups, respectively. The combination of V/Q SPECT scan with clinical probability was diagnostic in 88% of patients. CONCLUSIONS: V/Q SPECT scan results show satisfactory accuracy for PE diagnosis. Validation of dedicated interpretation criteria is required, followed by outcome studies that use V/Q SPECT scan as part of a diagnostic strategy to rule out PE. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01183026; URL: www.clinicaltrials.gov
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