Le Pennec Romain, Tromeur Cécile, Orione Charles, Robin Philippe, Le Mao Raphaël, De Moreuil Claire, Jevnikar Mitja, Hoffman Clément, Savale Laurent, Couturaud Francis, Sitbon Olivier, Montani David, Jaïs Xavier, Le Gal Grégoire, Salaün Pierre Yves, Humbert Marc, Le Roux Pierre Yves
Service de médecine nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Université de Bretagne Occidentale, Brest, France.
Département de Médecine Interne et Pneumologie, EA 3878 (GETBO), CHRU de Brest, Université de Bretagne Occidentale, Brest, France.
Front Med (Lausanne). 2022 Mar 7;9:851935. doi: 10.3389/fmed.2022.851935. eCollection 2022.
The diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) is a major challenge as it is a curable cause of pulmonary hypertension (PH). Ventilation/Perfusion (V/Q) lung scintigraphy is the imaging modality of choice for the screening of CTEPH. However, there is no consensus on the criteria to use for interpretation. The aim of this study was to assess the accuracy of various interpretation criteria of planar V/Q scintigraphy for the screening of CTEPH in patients with PH.
The eligible study population consisted of consecutive patients with newly diagnosed PH in the Brest University Hospital, France. Final diagnosis (CTEPH or non-CTEPH) was established in a referential center on the management of PH, based on the ESC/ERS guidelines and a minimum follow-up of 3 years. A retrospective central review of planar V/Q scintigraphy was performed by three nuclear physicians blinded to clinical findings and to final diagnosis. The number, extent (sub-segmental or segmental) and type (matched or mismatched) of perfusion defects were reported. Sensitivity and specificity were evaluated for various criteria based on the number of mismatched perfusion defects and the number of perfusion defects (regardless of ventilation). Receiver operating characteristic (ROC) curves were generated and areas under the curve (AUC) were calculated for both.
A total of 226 patients with newly diagnosed PH were analyzed. Fifty six (24.8%) were diagnosed with CTEPH while 170 patients (75.2%) were diagnosed with non-CTEPH. The optimal threshold was 2.5 segmental mismatched perfusion defects, providing a sensitivity of 100 % (95% CI 93.6-100%) and a specificity of 94.7% (95%CI 90.3-97.2%). Lower diagnostic cut-offs of mismatched perfusion defects provided similar sensitivity but lower specificity. Ninety five percent of patients with CTEPH had more than 4 segmental mismatched defects. An interpretation only based on perfusion provided similar sensitivity but a specificity of 81.8% (95%CI 75.3-86.9%).
Our study confirmed the high diagnostic performance of planar V/Q scintigraphy for the screening of CTEPH in patients with PH. The optimal diagnostic cut-off for interpretation was 2.5 segmental mismatched perfusion defects. An interpretation only based on perfusion defects provided similar sensitivity but lower specificity.
慢性血栓栓塞性肺动脉高压（CTEPH）的诊断是一项重大挑战，因为它是肺动脉高压（PH）的可治愈病因。通气/灌注（V/Q）肺闪烁扫描是筛查CTEPH的首选影像学检查方法。然而，对于用于解读的标准尚无共识。本研究的目的是评估平面V/Q闪烁扫描的各种解读标准在筛查PH患者CTEPH时的准确性。
符合条件的研究人群包括法国布雷斯特大学医院连续确诊的PH患者。最终诊断（CTEPH或非CTEPH）在一个PH管理参考中心依据ESC/ERS指南并经过至少3年的随访后确定。由三名对临床发现和最终诊断不知情的核医学医师对平面V/Q闪烁扫描进行回顾性集中审查。报告灌注缺损的数量、范围（亚段或段）和类型（匹配或不匹配）。基于不匹配灌注缺损的数量和灌注缺损的数量（无论通气情况），对各种标准评估敏感性和特异性。生成受试者工作特征（ROC）曲线并计算两者的曲线下面积（AUC）。
共分析了226例新确诊的PH患者。56例（24.8%）被诊断为CTEPH，170例患者（75.2%）被诊断为非CTEPH。最佳阈值为2.5个段的不匹配灌注缺损，敏感性为100%（95%CI 93.6 - 100%），特异性为94.7%（95%CI 90.3 - 97.2%）。较低的不匹配灌注缺损诊断阈值提供了相似的敏感性但特异性较低。95%的CTEPH患者有超过4个段的不匹配缺损。仅基于灌注的解读提供了相似的敏感性但特异性为81.8%（95%CI 75.3 - 86.9%）。
我们的研究证实了平面V/Q闪烁扫描在筛查PH患者CTEPH方面具有较高的诊断性能。解读的最佳诊断阈值为2.5个段的不匹配灌注缺损。仅基于灌注缺损的解读提供了相似的敏感性但特异性较低。
