Jui Liu1, George Larcos1,2. 1. Department of Nuclear Medicine and Ultrasound, Westmead Hospital, Sydney, New South Wales, Australia. 2. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Abstract
INTRODUCTION: Hybrid 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. METHODS: Two 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. RESULTS: S1 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 and k = 0.95 for S2; P < 0.001), but not with Q SPECT/CT (k = 0.4 for S1 and k = 0.62 for S2; P < 0.001). Inter-observer agreement was moderate for VQ SPECT (k = 0.65) and VQ SPECT/CT (k = 0.63). CONCLUSION: In our study, hybrid VQ SPECT/CT did not reduce the number of potentially false-positive VQ SPECT, nor did the CT obviate the need for a ventilation study. Thus, the routine use of hybrid SPECT/CT for suspected pulmonary embolism is not justified.
INTRODUCTION: Hybrid 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. METHODS: Two 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. RESULTS: S1 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 and k = 0.95 for S2; P < 0.001), but not with Q SPECT/CT (k = 0.4 for S1 and k = 0.62 for S2; P < 0.001). Inter-observer agreement was moderate for VQ SPECT (k = 0.65) and VQ SPECT/CT (k = 0.63). CONCLUSION: In our study, hybrid VQ SPECT/CT did not reduce the number of potentially false-positive VQ SPECT, nor did the CT obviate the need for a ventilation study. Thus, the routine use of hybrid SPECT/CT for suspected pulmonary embolism is not justified.
Authors: Romain Le Pennec; Cécile Tromeur; Charles Orione; Philippe Robin; Raphaël Le Mao; Claire De Moreuil; Mitja Jevnikar; Clément Hoffman; Laurent Savale; Francis Couturaud; Olivier Sitbon; David Montani; Xavier Jaïs; Grégoire Le Gal; Pierre Yves Salaün; Marc Humbert; Pierre Yves Le Roux Journal: Front Med (Lausanne) Date: 2022-03-07