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Objective analysis of tomographic ventilation-perfusion scintigraphy in pulmonary embolism.

Abstract：

RATIONALE:Ventilation-perfusion scintigraphy is highly sensitive for pulmonary embolism (PE), but its clinical usefulness is limited by its nondiagnostic rate. Objective analysis of single photon emission computed tomography (SPECT) three-dimensional scintigraphy may improve its diagnostic performance compared with subjective interpretation. OBJECTIVES:To determine the diagnostic accuracy of objective SPECT analysis in PE. METHODS:We determined the ventilation/perfusion (V(.)/Q(.)) relationship using SPECT scintigraphy in a retrospective cohort of 73 patients. Measures of V(.)/Q(.) heterogeneity (logSD(Q(.)), logSD(V(.)), logSD(VQR)), including a novel parameter, the weighted median V(.)/Q(.) value, were calculated. Using receiver operating characteristic (ROC) analysis, each parameter's diagnostic accuracy was determined. The weighted median V(.)/Q(.) value was then assessed prospectively in a second cohort of 50 patients. MEASUREMENTS AND MAIN RESULTS:In cohort 1, all parameters of V(.)/Q(.) heterogeneity were higher in patients with PE (p < 0.002). The weighted median V(.)/Q(.) had the highest area under the ROC curve (0.93; 95% confidence interval, 0.87-0.98). When applied to the prospective cohort, the area under the ROC curve was 0.87 (95% confidence interval, 0.75-0.99), with diagnostic cutoff values having negative and positive predictive values of 96 and 83%, respectively. In the retrospective and prospective cohorts, 82 and 73% of initially reported intermediate or low probability scans had diagnostic weighted median V(.)/Q(.) values, with 90 and 100% accuracy, respectively. CONCLUSIONS:Objective analysis of SPECT scintigraphy has a high diagnostic accuracy in patients with suspected PE. Objective analysis has the potential to reduce the number of nondiagnostic scan results, and may be useful for quantifying V(.)/Q(.) mismatch in other pulmonary disorders.

journal_name

Am J Respir Crit Care Med

journal_title

American journal of respiratory and critical care medicine

authors

Harris B,Bailey D,Miles S,Bailey E,Rogers K,Roach P,Thomas P,Hensley M,King GG

doi

10.1164/rccm.200608-1110OC

subject

Has Abstract

pub_date

2007-06-01 00:00:00

pages

1173-80

issue

eissn

1073-449X

issn

1535-4970

pii

200608-1110OC

journal_volume

175

pub_type

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Objective analysis of tomographic ventilation-perfusion scintigraphy in pulmonary embolism.