Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate

Nishant Kumar, Karen Xie, Winnie Mar, Thomas M. Anderson, Benjamin Carney, Nikhil Mehta, Roberto Machado, Michael J. Blend, Yang Lu

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: To investigate the diagnostic performance of perfusion single-photon emission computed tomography/computed tomography (Q-SPECT/CT) in patients suspected to have pulmonary embolism (PE) but with indeterminate computed tomographic pulmonary angiography (CTPA) or planar ventilation/perfusion (V/Q) scans. Methods: This retrospective study included two groups of patients. Group I consisted of 49 patients with nondiagnostic CTPA. These 49 patients underwent subsequent V/Q scans. Further Q-SPECTs were obtained in patients with indeterminate planar images and fused with existing CTPA. Group II consisted of 182 non-CTPA patients with indeterminate V/Q scans. These 182 patients underwent further Q-SPECT and separate noncontrast low-dose CT chest. Fusion Q-SPECT/CT scans were obtained through FDA-approved software and interpreted according to published criteria as positive, negative, or indeterminate for PE. Upon retrospective analyses, the final diagnosis was made using composite reference standards including all available clinical and imaging information for at least 6-month follow-up. Results: In group I patients, 1 was positive, 24 were negative, and another 24 (49 %, 24/49) were indeterminate. In the subsequent 24 Q-SPECT/CTPAs, 4 were positive, 19 were negative, and 1 was indeterminate (4.2 %, 1/24). In group II patients, 9 (4.9 %, 9/182) were indeterminate, 33 were positive, and 140 were negative. The combined nondiagnostic rate for Q-SPECT/CT was only 4.9 % (10/206). There was six false-negative and one false-positive Q-SPECT/CT examinations. The sensitivity, specificity, and positive and negative predictive value of Q-SPECT/CT were 85.7 % (36/42), 99.4 % (153/154), 97.3 % (36/37) and 96.2 % (153/159), respectively. Conclusions: Q-SPECT/CT improves the diagnostic rate with promising accuracy in diagnosing PE that yields a satisfactory clinical verdict, especially when the CTPA and planar V/Q scan are indeterminate.

Original languageEnglish (US)
Pages (from-to)303-311
Number of pages9
JournalNuclear Medicine and Molecular Imaging
Volume49
Issue number4
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Fingerprint

Pulmonary Embolism
Software
Perfusion
Angiography
Lung
Single-Photon Emission-Computed Tomography
Single Photon Emission Computed Tomography Computed Tomography
Ventilation
Thorax
Retrospective Studies
Sensitivity and Specificity

Keywords

  • CTPA
  • Pulmonary Embolism
  • Q-SPECT/CT
  • V/Q

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate. / Kumar, Nishant; Xie, Karen; Mar, Winnie; Anderson, Thomas M.; Carney, Benjamin; Mehta, Nikhil; Machado, Roberto; Blend, Michael J.; Lu, Yang.

In: Nuclear Medicine and Molecular Imaging, Vol. 49, No. 4, 01.12.2015, p. 303-311.

Research output: Contribution to journalArticle

Kumar, Nishant ; Xie, Karen ; Mar, Winnie ; Anderson, Thomas M. ; Carney, Benjamin ; Mehta, Nikhil ; Machado, Roberto ; Blend, Michael J. ; Lu, Yang. / Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate. In: Nuclear Medicine and Molecular Imaging. 2015 ; Vol. 49, No. 4. pp. 303-311.
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AU - Anderson, Thomas M.

AU - Carney, Benjamin

AU - Mehta, Nikhil

AU - Machado, Roberto

AU - Blend, Michael J.

AU - Lu, Yang

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N2 - Purpose: To investigate the diagnostic performance of perfusion single-photon emission computed tomography/computed tomography (Q-SPECT/CT) in patients suspected to have pulmonary embolism (PE) but with indeterminate computed tomographic pulmonary angiography (CTPA) or planar ventilation/perfusion (V/Q) scans. Methods: This retrospective study included two groups of patients. Group I consisted of 49 patients with nondiagnostic CTPA. These 49 patients underwent subsequent V/Q scans. Further Q-SPECTs were obtained in patients with indeterminate planar images and fused with existing CTPA. Group II consisted of 182 non-CTPA patients with indeterminate V/Q scans. These 182 patients underwent further Q-SPECT and separate noncontrast low-dose CT chest. Fusion Q-SPECT/CT scans were obtained through FDA-approved software and interpreted according to published criteria as positive, negative, or indeterminate for PE. Upon retrospective analyses, the final diagnosis was made using composite reference standards including all available clinical and imaging information for at least 6-month follow-up. Results: In group I patients, 1 was positive, 24 were negative, and another 24 (49 %, 24/49) were indeterminate. In the subsequent 24 Q-SPECT/CTPAs, 4 were positive, 19 were negative, and 1 was indeterminate (4.2 %, 1/24). In group II patients, 9 (4.9 %, 9/182) were indeterminate, 33 were positive, and 140 were negative. The combined nondiagnostic rate for Q-SPECT/CT was only 4.9 % (10/206). There was six false-negative and one false-positive Q-SPECT/CT examinations. The sensitivity, specificity, and positive and negative predictive value of Q-SPECT/CT were 85.7 % (36/42), 99.4 % (153/154), 97.3 % (36/37) and 96.2 % (153/159), respectively. Conclusions: Q-SPECT/CT improves the diagnostic rate with promising accuracy in diagnosing PE that yields a satisfactory clinical verdict, especially when the CTPA and planar V/Q scan are indeterminate.

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