Fiche publication
Date publication
juin 2008
Auteurs
Membres identifiés du Cancéropôle Est :
Pr KARCHER Gilles
,
Pr OLIVIER Pierre
Tous les auteurs :
Revel C, Poisson T, Revel A, Daragon N, Grandpierre S, Netter F, Scigliano S, Djaballah W, Olivier P, Karcher G, Marie PY
Résumé
The aim of this study is to assess a new tool for the diagnosis of acute pulmonary embolism (PE): single-photon emission computed tomography lung perfusion imaging associated with unenhanced computed tomography (SPECT/CT) compared to planar ventilation-perfusion (VQ) lung scintigraphy. Methods. - One hundred and three patients with suspected acute PE underwent VQ scintigraphy (two scans were uninterpretable) followed by perfusion SPECT/CT. The two types of images were analysed separately: (1) according to the modified PIOPED scintigraphic criteria for VQ lung scan and (2) with regard to SPECT/CT mismatches suggestive acute PE (segmental perfusion defects detected on SPECT images not matched with CT abnormalities). Results. - On average, the number of segmental perfusion defects per patient was higher with SPECT/CT than with planar scintigraphy (4.3 +/- 3.6 versus 2.8 +/- 2.6; p < 0.001). A mismatch was found with SPECT-CT in 0% (0/18) of normal scintigraphy, and 8% (3/39) for low, 32% (8/25) for intermediate and 74% (14/19) for high probabilities of PE at scintigraphy. The presence of a SPECT/CT mismatch was also associated with higher pretest probability of acute PE (p = 0.001), even for the 25 patients in the intermediate-probability subgroup (p = 0.02). Finally, a SPECT/CT match was found in 29 patients that was not suggestive of acute PE due to the presence, in areas with perfusion defects on SPECT images, of the following CT abnormalities: hypodensity and/or emphysema (71%), condensation or atelectasis (38%), pleural disease (7%), extrapulmonary structure (14%) and/or bronchial obstruction (7%). Conclusion. - In patients with suspected acute PE, the results obtained with pulmonary SPECT/CT images are consistent with those obtained with VQ scintigraphy and the pretest probability of PE. Further studies comparing SPECT/CT imaging with angiographic techniques are now required to evaluate more specifically the diagnostic value of this new tool. (C) 2008 Elsevier Masson SAS. All rights reserved.
Référence
Med Nucl-imag Fonct Metab. 2008 Jun;32(6):313-22
