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DIAGNOSTIC ACCURACY OF SPECT VENTILATION-PERFUSION SCAN VS CT PULMONARY ANGIOGRAPHY IN HIGH RISK PATIENTS FOR PULMONARY EMBOLISM FREE TO VIEW

Ramyar Mahdavi, MD*; Jazeela Fayyaz, DO; Larry DiFabrizio, MD; Steven Scharf, MD; Murray Rogers, MD; Neal Epstein, MD; Georgia Panagopoulos, PhD; Lalit Kanaparthi, MD; Rohit Goyal, MD
Author and Funding Information

Lenox Hill Hospital, New York, NY


Chest


Chest. 2009;136(4_MeetingAbstracts):15S. doi:10.1378/chest.136.4_MeetingAbstracts.15S-f
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Abstract

PURPOSE:  In many centers, multi-detector CTA has replaced V/Q scanning for the initial evaluation of pulmonary embolism. High risk patients for PE with a non-diagnostic CTA require additional testing. The PIOPED study showed that standard V/Q scans are indeterminate in up to two thirds of patients. Therefore, we compared the efficacy of spect V/Q scans to CTA in patients with a high clinical suspicion of PE.

METHODS:  From January 2007 to December 2008, we identified 100 patients at Lenox Hill Hospital with a moderate to high clinical probability for pulmonary embolism that underwent both SPECT V/Q scan and CTA within a 3 day period. The diagnostic utility of CTA was compared to spect V/Q scan.

RESULTS:  23 patients were clinically diagnosed with pulmonary embolism. 14 patients had CTA positive for PE, and 55 had negative CTA for PE. 31 out of 100 CTAs were non-diagnostic due to either technical issues (17) or non-diagnostic abnormalities (14). Of non-diagnostic CTAs, 5 patients (21.7%) were diagnosed with pulmonary embolism. The sensitivity and specificity of the two diagnostic modalities were similar, sensitivity for CTA and spect V/Q scan were 67% and 72%, respectively. Specificity of CTA and spect V/Q were 96% and 94%, respectively. Interestingly, only 9 patients had an indeterminate spect V/Q scans, of which only 1 was diagnosed with PE. CTA showed a lower false positive rate (2.6%) compared to V/Q scans (5.2 %). Among false positive V/Q spect scan 2 patients had “chronic/old” PE and 2 had malignancy.

CONCLUSION:  In patients with a moderate to high pre-test probability for PE, CTA remains a rapid and effective method in the evaluation of PE. However, in patients with technically limited or inconclusive CTA, V/Q scan reliably confirms or excludes the diagnosis of PE.

CLINICAL IMPLICATIONS:  Spect V/Q is comparable to CTA with less indeterminant scans than previously reported with standard V/Q imaging.

DISCLOSURE:  Ramyar Mahdavi, No Financial Disclosure Information; No Product/Research Disclosure Information

Monday, November 2, 2009

10:30 AM - 12:00 PM


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