Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Division of Hematology, Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; and.
J Nucl Med. 2018 Aug;59(8):1255-1259. doi: 10.2967/jnumed.117.205641. Epub 2018 Feb 1.
Sickle cell disease, a complex disorder with known pulmonary complications, has the potential to confound the diagnosis of pulmonary embolism. We hypothesized that when the choice of imaging is guided by chest radiographic results, CT pulmonary angiography (CTPA) and ventilation-perfusion (V/Q) scintigraphy have comparable diagnostic performance in sickle cell disease. A retrospective cohort of adults with sickle cell disease who were imaged for suspected pulmonary embolism with either CTPA or V/Q, from 2000 to 2016 at our institution, was established. To reduce radiation exposure, our practice recommends V/Q for stable patients with normal chest radiographs. Results of index pulmonary embolism imaging, 90-d follow-up, and results of chest radiography were recorded. Two hundred forty-five adults with sickle cell disease comprised the cohort. The mean age (±SD) was 33 ± 10.5 y, and 58% (141) were men. Index imaging was V/Q in 62.9% ( = 154) and CTPA in 37.1% ( = 91). Chest radiographs, performed in 96.3% ( = 236), were normal in 72.9% ( = 172). Imaging results for pulmonary embolism were negative in 88.2% ( = 216), positive in 4.1% ( = 10), and indeterminate in 7.8% ( = 19) with no difference between V/Q and CTPA ( = 0.63). Reimaging within 90 d occurred in 9.8% ( = 24), 14.7% (20/136) after initial V/Q, and 5% (4/109) after initial CTPA ( = 0.08). Reimaging revealed a pulmonary embolism diagnosis after negative/indeterminate results in 0.7% (1/149) of V/Qs and 1.2% of (1/86) CTPAs ( = 0.69). Over the 17-y study period, 47% (114/245) underwent repeated imaging, and 11% (27/245) were diagnosed with pulmonary embolism at least once. In sickle cell disease patients with suspected pulmonary embolism, positive imaging rates were low for any given clinical presentation, but 11% of the cohort was diagnosed with pulmonary embolism over the 17-y study period. CTPA and V/Q performed comparably for pulmonary embolism diagnosis when the choice of imaging was guided by results of chest radiography. Hence, V/Q is a reasonable first choice for sickle cell disease patients with normal chest radiographs.
镰状细胞病是一种伴有已知肺部并发症的复杂疾病，可能使肺栓塞的诊断复杂化。我们假设，当影像学选择由胸部 X 线检查结果指导时，CT 肺动脉造影（CTPA）和通气-灌注（V/Q）闪烁扫描在镰状细胞病中的诊断性能相当。 我们建立了一个回顾性队列，该队列包括 2000 年至 2016 年在我院因疑似肺栓塞而接受 CTPA 或 V/Q 成像检查的镰状细胞病成年患者。为了减少辐射暴露，我们的实践建议对胸部 X 线检查正常的稳定患者进行 V/Q。记录了指数性肺栓塞成像、90 天随访和胸部 X 线检查结果。 该队列包括 245 例镰状细胞病患者。平均年龄（±SD）为 33 ± 10.5 岁，58%（141 人）为男性。指数成像为 V/Q 的占 62.9%（= 154），CTPA 的占 37.1%（= 91）。96.3%（= 236）的患者进行了胸部 X 线检查，其中 72.9%（= 172）的胸部 X 线检查正常。肺栓塞的影像学结果为阴性占 88.2%（= 216），阳性占 4.1%（= 10），不确定占 7.8%（= 19），V/Q 和 CTPA 之间无差异（= 0.63）。90 天内再次成像的发生率为 9.8%（= 24），首次 V/Q 后为 14.7%（20/136），首次 CTPA 后为 5%（4/109）（= 0.08）。在 V/Q 后的 0.7%（1/149）和 CTPA 的 1.2%（1/86）的阴性/不确定结果后，有 0.7%（1/149）的患者重新成像后诊断为肺栓塞（= 0.69）。在 17 年的研究期间，47%（245 例中有 114 例）进行了重复成像，11%（245 例中有 27 例）在 17 年的研究期间被诊断为肺栓塞。 在疑似肺栓塞的镰状细胞病患者中，无论临床表现如何，阳性成像率均较低，但在 17 年的研究期间，该队列中有 11%的患者被诊断为肺栓塞。当影像学选择由胸部 X 线检查结果指导时，CTPA 和 V/Q 对肺栓塞的诊断性能相当。因此，对于胸部 X 线检查正常的镰状细胞病患者，V/Q 是合理的首选。
