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Original Research: Pulmonary Vascular Disease |

Noncontrast Perfusion Single-Photon Emission CT/CT ScanningA New Test for the Diagnosis of Pulmonary Embolism: A New Test for the Expedited, High-Accuracy Diagnosis of Acute Pulmonary Embolism

Yang Lu, MD, PhD; Alice Lorenzoni, MD; Josef J. Fox, MD; Jürgen Rademaker, MD; Nicholas Vander Els, MD; Ravinder K. Grewal, MD; H. William Strauss, MD; Heiko Schöder, MD
Author and Funding Information

From the Molecular Imaging and Therapy Service (Drs Lu, Lorenzoni, Fox, Grewal, Strauss, and Schöder) and Body Imaging Section (Dr Rademaker), Department of Radiology and Pulmonary Disease Service (Dr Vander Els), Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.

Correspondence to: Heiko Schöder, MD, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; e-mail: schoderh@mskcc.org


Dr Lu is currently at the University of Illinois Hospital and Health Sciences System (Chicago, IL).

Dr Lorenzoni is currently at the University of Pisa (Pisa, Italy).

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):1079-1088. doi:10.1378/chest.13-2090
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Background:  Standard ventilation and perfusion (V˙/Q˙ ) scintigraphy uses planar images for the diagnosis of pulmonary embolism (PE). To evaluate whether tomographic imaging improves the diagnostic accuracy of the procedure, we compared noncontrast perfusion single-photon emission CT (Q˙ -SPECT)/CT scans with planar V˙/Q˙ scans in patients at high risk for PE.

Methods:  Between 2006 and 2010, most patients referred for diagnosis of PE underwent both Q˙ -SPECT/CT scan and planar V˙/Q˙ scintigraphy. All scans were reviewed retrospectively by four observers; planar scans were read with modified Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II and Prospective Investigative Study of Pulmonary Embolism Diagnosis (PISA-PED) criteria. On Q˙ -SPECT/CT scan, any wedge-shaped peripheral perfusion defect occupying > 50% of a segment without corresponding pulmonary parenchymal or pleural disease was considered to show PE. The final diagnosis was established with a composite reference standard that included ECG, ultrasound of lower-extremity veins, D-dimer levels, CT pulmonary angiography (when available), and clinical follow-up for at least 3 months.

Results:  One hundred six patients with cancer and mean Wells score of 4.4 had sufficient follow-up; 22 patients were given a final diagnosis of PE, and 84 patients were given a final diagnosis of no PE. According to PIOPED II, 13 studies were graded as intermediate probability. Sensitivity and specificity for PE were 50% and 98%, respectively, based on PIOPED II criteria; 86% and 93%, respectively, based on PISA-PED criteria; and 91% and 94%, respectively, based on Q˙ -SPECT/CT scan. Seventy-six patients had additional relevant findings on the CT image of the Q˙ -SPECT/CT scan.

Conclusions:  Noncontrast Q˙ -SPECT/CT imaging has a higher accuracy than planar V˙/Q˙ imaging based on PIOPED II criteria in patients with cancer and a high risk for PE.

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