SPECT-TC DE VENTILACIÓN-PERFUSIÓN EN EL DIAGNÓSTICO DEL TROMBOEMBOLISMO PULMONAR AGUDO

Abstract

Aim of the study: To compare diagnostic accuracy of Ventilation/Perfusion (V/P) SPECT combined with simultaneous full-dose CT on a hybrid SPECT/CT scanner versus (V/Q) SPECT and CT angiography (CTA) in patients suspected for acute pulmonary embolism (PE)._x000D_ Methods: Between 2009 and 2011 consecutive patients suspected of acute PE were referred for V/P SPECT-CT (reviewed board approved study). In patients without contraindications, a contrast agent was administered. Non-contrast V/P SPECT-CT was performed in the remaining patients. All patients were followed-up for at least 3 months. _x000D_ Results: 314 patients were available during the study period. In 70 (22.29%) the diagnosis of PE was confirmed. Overall population sensitivity and specificity were: 90.91% and 92.44% respectively for V/P SPECT; 80% and 99.15% for CTA and 95.52% and 97.08% for V/P SPECT-CT. SPECT-CT performed better than V/Q SPECT (AUC differences=0.0419, p-value=0.0043, 95%CI (0.0131, 0.0706)) and CTA (AUC differences= 0.0681, p-value=0.0208, 95%CI (0.0103, 0.1259)). Comparing imaging modalities when contrast agent could be administered, sensitivity and specificity increased and V/P SPECT-CT was significantly better than CTA (AUC differences=0.0681, p-value=0.0208, 95%CI (0.0103, 0.1259)) and V/P SPECT (AUC differences=0.0659, p-value=0.0052, 95%CI (0.0197, 0.1121)). In case of non-contrast enhancement, there was non-significant increase of specificity. Secondary findings on CT impacted patient management in 14.65 % of cases._x000D_ Conclusion: Our study shows that combined V/P SPECT-CT scanning has a higher diagnostic accuracy for detecting acute PE than V/P SPECT and CTA alone. When feasible, V/P SPECT-CT with contrast enhancement makes the best option.

Date of Award	29 Jan 2016
Original language	Spanish
Supervisor	Manuel Monreal Bosch (Director) & Manuel Fraile López Amor (Director)