SPECT‐CT/VQ versus CTPA for diagnosing pulmonary embolus and other lung pathology: Pre‐existing lung disease should not be a contraindication. Issue 4 (11th May 2016)

• Record Type: Journal Article
• Authors: Bhatia, Kartik Dev; Ambati, Chaitanya; Dhaliwal, Rajiv; Paschkewitz, Royce; Hsu, Eugene; Ho, Bao; Young, Andy; Emmett, Louise
• Is Part Of: Journal of medical imaging and radiation oncology. Volume 60:Issue 4(2016:Aug.)
• Page Start: 492
• Page End: 497
• Publication Date: 2016-05-11
• Subjects: CTPA -- pulmonary embolus -- radiation dose -- SPECT -- VQ; Radiology, Medical -- Periodicals; Radiology, Medical -- Australasia -- Periodicals; 616.0757
• DOI: 10.1111/1754-9485.12471
• Languages: English
• ISSNs: 1754-9477

Abstract

Abstract: Introduction: Single Photon Emission Computed Tomography‐Ventilation‐Perfusion (SPECT‐VQ) with low‐dose CT (SPECT‐CT/VQ) has equivalent diagnostic accuracy to CTPA for diagnosing pulmonary embolus (PE) while using lower radiation doses, but is underutilized owing to perceived inaccuracy of scintigraphy in the setting of pre‐existing lung disease. This study assesses the accuracy of SPECT‐CT/VQ compared with CTPA for the diagnosis of PE, including in patients with pre‐existing lung disease. Methods: Retrospective non‐inferiority cohort study of all patients who underwent SPECT‐CT/VQ scanning at St Vincent's Hospital, NSW, from June 2012 to November 2013, who also had a CTPA within the same admission and <72 h apart ( n = 102). Results: SPECT‐CT/VQ had 100% sensitivity and 94.4% specificity when compared with CTPA. Of the 102 patients, 14 were lung transplant patients, and 27 had other pre‐existing lung disease (41/102, 40.2%), with SPECT‐CT/VQ having a sensitivity of 100% and specificity of 97.2% in this patient group. Non‐inferiority of SPECT‐CT/VQ was demonstrated at a significance level of 0.005. Conclusion: SPECT‐CT/VQ has high sensitivity and specificity for diagnosing PE compared with CTPA, even among patients with pre‐existing lung disease, with lower radiation doses.