Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Nuclear Medicine, 06800, Bilkent, Ankara-Turkey.
Hell J Nucl Med. 2020 Sep-Dec;23(3):304-311. doi: 10.1967/s002449912209. Epub 2020 Dec 14.
Ventilation/perfusion single photon emission computed tomography (V/Q SPECT) is recommended as a reference radionuclide method in pulmonary thromboembolism (PTE) diagnosis. However, there is some logistic, economic, and infectious concern about the study's ventilation part. This study aimed to evaluate the effectiveness of hybrid perfusion SPECT with a low dose CT method in the diagnostic strategy of PTE.
Two physicians reviewed 305 patients' data for this retrospective study. All patients had Q SPECT/CT data as initial imaging, and Ventilation SPECT was added to the selected patients' algorithm. The diagnostic performance and inter-observer agreement were determined for both Q SPECT and Q SPECT/CT methods. The final diagnosis was made by clinical decision with all tests and follow-up for at least 6-month.
The majority (92%) of our study group were correctly diagnosed with the Q SPECT/CT method with excellent inter-observer agreements (κ=0.914). The sensitivity, specificity, and accuracy of methods were as follows; 92.2%, 76.3%, and 80.3% for Q SPECT; 96.1%, 94.5%, and 98.8% for Q SPECT/CT (P<0.001). The ventilation scan was applied to 29% (n=88) of the study group. It is prominent in 21/88 patients whose Q SPECT/CT result was non-diagnostic or discordant with clinical probability.
Q SPECT/CT recommended as the initial radionuclide imaging in PTE diagnosis, with high diagnostic accuracy and inter-observer agreement. Ventilation scans can be optimized according to Q SPECT/CT results avoiding unnecessary irradiation and other potential adverse effects, including infectious risk in the current pandemic context.
通气/灌注单光子发射计算机断层扫描（V/Q SPECT）被推荐为肺血栓栓塞症（PTE）诊断的参考放射性核素方法。然而，该研究的通气部分存在一些后勤、经济和感染方面的问题。本研究旨在评估低剂量 CT 方法与灌注 SPECT 相结合在 PTE 诊断策略中的有效性。
两名医生对 305 名患者的数据进行了回顾性研究。所有患者均有 Q SPECT/CT 数据作为初始影像学检查，并且通气 SPECT 被添加到选定患者的算法中。确定了 Q SPECT 和 Q SPECT/CT 两种方法的诊断性能和观察者间一致性。最终诊断是根据所有检查和至少 6 个月的随访由临床决策做出的。
我们的研究组中，92%的患者通过 Q SPECT/CT 方法得到了正确诊断，并且观察者间一致性很好（κ=0.914）。两种方法的灵敏度、特异性和准确性如下：Q SPECT 分别为 92.2%、76.3%和 80.3%；Q SPECT/CT 分别为 96.1%、94.5%和 98.8%（P<0.001）。通气扫描应用于研究组的 29%（n=88）。在 21/88 例 Q SPECT/CT 结果为非诊断性或与临床概率不一致的患者中，通气扫描结果明显。
Q SPECT/CT 被推荐作为 PTE 诊断的初始放射性核素成像方法，具有较高的诊断准确性和观察者间一致性。可以根据 Q SPECT/CT 结果优化通气扫描，避免不必要的辐射和其他潜在的不良影响，包括当前大流行背景下的感染风险。
