Radionuclide lung scans for suspected acute pulmonary embolism: Single photon emission computed tomography (SPECT) or hybrid SPECT/CT?. Issue 6 (12th September 2019)

• Record Type: Journal Article
• Authors: Liu, Jui; Larcos, George
• Is Part Of: Journal of medical imaging and radiation oncology. Volume 63:Issue 6(2019:Dec.)
• Page Start: 731
• Page End: 736
• Publication Date: 2019-09-12
• Subjects: pulmonary embolism -- nuclear medicine -- single photon emission computed tomography; Radiology, Medical -- Periodicals; Radiology, Medical -- Australasia -- Periodicals; 616.0757
• DOI: 10.1111/1754-9485.12951
• Languages: English
• ISSNs: 1754-9477

Abstract

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.