The Diagnostic Accuracy of V/P Scintigraphy in Pulmonary Embolism and Superiority of V/P SPECT to V/P Planar Scintigraphy

Öz

Objective: The aim of this retrospective study is to investigate the diagnostic accuracy of planar V/P scintigraphy and V/P single-photon emission computed tomography (SPECT) in patients who referred to our clinic for V/P scintigraphy with prediagnosis of pulmonary embolism (PE), as well as to investigate the contribution of V/P SPECT technique to planar V/P technique. Material and Method: The records of 204 patients, who were preliminarily diagnosed with PE within 1 year, were retrospectively reviewed. In our investigation of the diagnostic accuracy of V/P scintigraphy in for PE, we excluded three patients who only underwent perfusion scintigraphy and 20 patients whose final diagnoses could not be confirmed. This left a total of 181 patients included in the statistical analysis. Furthermore, we evaluated the contribution of SPECT to planar imaging in 48 patients, for whom V/P Scintigraphy were reported as positive and whose final diagnoses confirmed PE. Results: The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy rate of V/P SPECT were calculated as 98%, 94.7%, 99.2%, 87.3%, and 95.6%, respectively. For planar scintigraphy, they were found to be 71.4%, 95.4%, 90%, 85.3%, and 88.9%, respectively. In SPECT, 13 (27.1%) patients who were not compatible with pulmonary embolism (PE) on planar imaging were found to have findings consistent with PE. In nine patients (18.8%), additional defects not observed on planar imaging were identified. Although the goodness of fit with the final diagnosis of both methods was statistically significant, SPECT (95.6%) performed better than planar (88.9%) imaging. Conclusion: Consistent with previous studies, it was found that while both imaging methods were successful, SPECT demonstrated higher diagnostic accuracy than planar scintigraphy in diagnosing PE. Therefore, it can be hypothesized that V/P scintigraphy can be safely deemed the first-choice in the diagnosis of PE.

Anahtar Kelimeler

• Pulmonary Embolism
• V-P Scintigraphy
• SPECT.

Pulmoner Embolizmde V/P Sintigrafisinin Tanısal Doğruluğu Ve V/P Spect'in V/P Planar Sintigrafiye Üstünlüğü

Öz

Amaç: Bu çalışmada pulmoner embolizm (PE) tanısında, ventilasyon/perfüzyon (V/P) planar sintigrafinin ve tek foton emisyonlu bilgisayarlı tomografi (SPECT)’nin tanısal doğruluğunu ve SPECT’in planar görüntülemeye katkısını araştırmak amaçlandı. Gereç ve Yöntem: 1 yıl boyunca Pulmoner Embolizm (PE) ön tanısı ile başvuran 204 hastanın kayıtları retrospektif olarak incelendi. Pulmoner embolizmde V/P sintigrafinin tanısal doğruluğu araştırılırken, sadece perüzyon sintigrafisi yapılan 3 hasta ve son tanısına ulaşılamayan 20 hasta dışlandı ve toplam 181 hasta istatistiksel analiz çalışmasına dahil edildi. SPECT’in planar görüntülemeye katkısı, V/P SPECT’ in PE ile uyumlu olarak raporlandığı ve son tanısı PE olan 48 hasta değerlendirilerek yapıldı. Bulgular: 181 hasta göz önüne alındığında; V/P SPECT’in sensitivitesi %98 (48/49), özgüllüğü %94,7 (125/132), negatif öngörü değeri %99,2, pozitif öngörü değeri %87,3 ve doğruluk oranı %95,6 olarak hesaplandı. Planar sintigrafi için sırasıyla 71.4%, 95.4%, 90% (126/140), 85.3 % (35/41) ve 88.9% olarak hesaplandı. SPECT görüntüleme, planar V/P sintigrafi ile PE tanısı konulamayan 13 hastada (%27,1) PE ile uyumlu sonuçların raporlanmasını sağladı. V/P SPECT ile 9 hastada takip sintigrafisinde önemli olabilecek ek lezyonlar (%18,8) tespit edildi. Her iki yöntemin kesin tanı ile uyumunun istatistiksel olarak anlamlı olduğu gözlemlendi, ancak SPECT bulgularının kesin tanı ile uyumunun (%95.6) planar bulguların kesin tanı ile uyumundan (%88.9) daha iyi olduğu görüldü. Sonuç: Önceki çalışmalarla benzer şekilde, V/P sintigrafide her iki görüntüleme yöntemi de başarılı olmasına rağmen, SPECT’in planar görüntülemeye önemli ölçüde katkıda bulunduğu ve SPECT’in PE tanısında yüksek hassasiyet, özgüllük ve doğruluk sağladığı bulundu.

Anahtar Kelimeler

• Pulmoner Emboli
• V/P Planar Sintigrafi
• SPECT.

Kaynakça

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