The diagnostic accuracy of perfusion-only scan in the diagnosis of pulmonary embolism in the era of COVID-19: A single-center study of 434 patients

• DOI: 10.4103/atm.atm_42_23
• Publication Date: 2023-10-18T15:12:28Z
• Authors: Turgut Bora Cengiz; Ahmed Abdelrahman; Scott A. Rohren; John Doucette; Munir Ghesani
• Keywords: Diseases of the respiratory system; pulmonary embolism; RC705-779; RC666-701; ventilation/perfusion; scintigraphy; Diseases of the circulatory (Cardiovascular) system; Original Article; 3. Good health

Abstract:

INTRODUCTION: There is a paucity of data in the literature regarding the diagnostic accuracy of perfusion (Q)-only studies in the absence of ventilation images. This study aims to assess the diagnostic accuracy of Q-only imaging in the pandemic era.

METHODS: Patients who underwent Q-only imaging for pulmonary embolism between March 2020 and February 2021 were analyzed. Patients who underwent lung quantification analysis were excluded. Q-only test results were reported as per modified PIOPED II criteria and single positron emission tomography/computed tomography (SPECT/CT) imaging was performed as needed. Patients were considered concordant or discordant by correlating the Q-only results with CT angiogram (CTA) or clinical diagnosis made through chart review. The diagnostic accuracy was calculated after excluding intermediate probability and nondiagnostic studies.

RESULTS: Four hundred and thirty-four patients were identified. One hundred and twenty-eight patients (29.4%) underwent ultrasound Doppler, 37 patients (8.5%) underwent CTA, and 16 patients (3.6%) underwent both. After excluding patients with intermediate probability or nondiagnostic studies and who did not have follow-up (a total of 87 patients [20%]), 347 patients were enrolled in the final analysis. The combined planar and SPECT/CT sensitivity and specificity were 85.4% (72.2%–93.9% confidence interval [CI]) and 98.7% (96.9%–98.6% CI), respectively. The positive predictive value (PPV) of the Q-only imaging was 89.1% (77.3%–95.1% CI) and the negative predictive value (NPV) was 98.2% (96.4%–99% CI). The sensitivity with SPECT/CT reached 100% (CI: 71.5%–100%) with a specificity of 92.3% (CI: 64%–99.8%). The PPV was 85.7% (CI: 62.1%–95.6%) and the NPV was 100%.

CONCLUSION: Q-only imaging provides clinically acceptable results. The sensitivity of the Q-only scan is increased when coupled with SPECT/CT.