Stubbs Matthew, Chan Kenneth, McMeekin Helena, Navalkissoor Shaunak, Wagner Thomas
aDepartment of Nuclear Medicine, Royal Free NHS Foundation Trust, London bRadcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
Nucl Med Commun. 2017 Feb;38(2):135-140. doi: 10.1097/MNM.0000000000000632.
This study aims to compare the incidence of ventilation/perfusion (V/Q) scans interpreted as indeterminate for the diagnosis of pulmonary embolism (PE) using single-photon emission computed tomography (SPECT) versus planar scintigraphy and to consider the effect of variable interpretation of single subsegmental V/Q mismatch (SSM).
A total of 1300 consecutive V/Q scans were retrospectively reviewed. After exclusion and matching for age and sex, 542 SPECT and 589 planar scans were included in the analysis. European Association of Nuclear Medicine guidelines were used to interpret the V/Q scans, initially interpreting SSM as negative scans. Patients with SSM were followed up for 3 months and further imaging for PE was collected.
Indeterminate scans were significantly fewer in the SPECT than the planar group on the basis of the initial report (7.7 vs. 12.2%, P<0.05). This is irrespective of classification of SSM as a negative scan (4.6 vs. 12.1%, P<0.0001) or an indeterminate scan (8.3 vs. 12.2%, P<0.05). Of the 21 patients who had SSM, 19 underwent computer tomography pulmonary angiogram and embolism was found in one patient. None of these patients died at the 3-month follow-up.
V/Q SPECT has greater diagnostic certainty of PE, with a 41% reduction in an indeterminate scan compared with planar scintigraphy. This is irrespective of the clinician's interpretation of SSM as negative or intermediate probability. Patients with SSM would not require further computer tomography pulmonary angiogram imaging.
本研究旨在比较使用单光子发射计算机断层扫描（SPECT）与平面闪烁扫描对诊断肺栓塞（PE）而言判定为不确定的通气/灌注（V/Q）扫描的发生率，并探讨单个亚段V/Q不匹配（SSM）的不同解读的影响。
回顾性分析了连续的1300例V/Q扫描。在排除并按年龄和性别匹配后，分析纳入了542例SPECT扫描和589例平面扫描。采用欧洲核医学协会指南解读V/Q扫描，最初将SSM解读为阴性扫描。对有SSM的患者进行3个月的随访，并收集PE的进一步影像学检查结果。
根据初始报告，SPECT组的不确定扫描显著少于平面扫描组（7.7%对12.2%，P<0.05）。无论将SSM分类为阴性扫描（4.6%对12.1%，P<0.0001）还是不确定扫描（8.3%对12.2%，P<0.05）均如此。在21例有SSM的患者中，19例接受了计算机断层扫描肺动脉造影，其中1例发现有栓塞。这些患者在3个月随访时均未死亡。
V/Q SPECT对PE具有更高的诊断确定性，与平面闪烁扫描相比，不确定扫描减少了41%。无论临床医生将SSM解读为阴性还是中等概率均如此。有SSM的患者无需进一步进行计算机断层扫描肺动脉造影成像。
