Head-to-head comparison of ventilation/perfusion single photon emission computed tomography/computed tomography and multidetector computed tomography angiography for the detection of acute pulmonary embolism in clinical practice

Introduction Computed tomography angiography (CTA) and ventilation/perfusion (V/Q) single photon emission computed tomography/CT (SPECT/CT) images have been widely used to detect PE, but few studies have performed a direct comparison between them. We aimed to evaluate the performance of these tests...

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Published in:	Perfusion Vol. 38; no. 3; pp. 637 - 644
Main Authors:	Martins, Gustavo H, Contardi, Ewandro B, Lopes, Djon M, de Souza, Thiago F, Grangeia, Tiago AG, Dertkigil, Sergio SJ, Amorim, Bárbara J, Ramos, Celso D
Format:	Journal Article
Language:	English
Published:	London, England SAGE Publications 01-04-2023 Sage Publications Ltd
Subjects:	Acute Disease Angiography Computed tomography Embolism Female Humans Male Medical imaging Middle Aged Multidetector Computed Tomography Nuclear medicine Patients Perfusion Photon emission Photons Physicians Pulmonary Embolism - diagnostic imaging Pulmonary embolisms Single photon emission computed tomography Tomography Tomography, Emission-Computed, Single-Photon - methods Ventilation Ventilation-Perfusion Ratio V/Q SPECT/CT computed tomography angiography multislice computed tomography acute pulmonary embolism ventilation/perfusion scintigraphy
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Summary:	Introduction Computed tomography angiography (CTA) and ventilation/perfusion (V/Q) single photon emission computed tomography/CT (SPECT/CT) images have been widely used to detect PE, but few studies have performed a direct comparison between them. We aimed to evaluate the performance of these tests in the same group of patients, selected from the routine practice of a general hospital. Methods Patients with suspected acute PE were prospectively submitted to CTA and V/Q SPECT/CT. General radiologists and nuclear physicians, respectively, interpreted the images. Data regarding age, sex, time between examinations, symptoms, and Wells score were also recorded. The final diagnosis was decided through a consensus among the clinicians, taking into account clinical, laboratory, follow-up, and all imaging procedures data. Results Twenty-eight patients (15 male, 13 female, and median age of 51.5 years) were studied. Median duration of the onset of symptoms was 4 (1–14) days, and the median Wells score was 3.5 (1.5–6). Sensitivity, specificity, positive and negative predictive values, and accuracy were 84.6%, 80.0%, 78.6%, 85.7%, and 82.1% for V/Q SPECT/CT, and 46.1%, 100%, 100%, 68.2%, and 75.0% for CTA. The overall agreement between the methods was 57.1%. Of the 22 patients with negative CTA, 10 (45.4%) had positives V/Q SPECT/CT and seven of them classified as true positives. Conclusions Our results suggest that V/Q SPECT/CT is more sensitive and accurate than CTA when interpreted by general radiologists and nuclear medicine physicians.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0267-6591 1477-111X 1477-111X
DOI:	10.1177/02676591221075934