The comparison of the diagnostic accuracy of lung perfusion scan between patients with and without chronic obstructive pulmonary disease

Document Type : Original Article

Authors

1 Department of Pulmonology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

2 Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Introduction: Diagnostic accuracy of lung perfusion scan (LPS) for detection of pulmonary thromboembolism (PTE) is not well defined in patients with chronic obstructive pulmonary disease (COPD). In the current study, we intended to compare the scan performance between patients with and without COPD.
Methods: Study comprised suspected PTE patients who had LPS in two group of patients with and without COPD. Scans were done employing SPECT imaging and interpreted using PISAPED positive/negative criteria considering chest CT comparison. The pulmonologist final decision on the presence or absence of PTE was collected at 3-month follow up visit. This clinical decision was made based on the response to anticoagulation or therapies directed to other diagnoses, and consideration of all imaging and examinations available including calf ultrasonography, echocardiography, CT angiography, and the 3-month delayed LPS. The accuracy of the LPSs between those with and without COPD was compared.
Results: Fifty-two patients without COPD and 49 patients with COPD were included. Out of all, 28 had PTE comprising 11 patients in COPD group (21.2%) and 17 in non-COPD (34.7%). In 3-month follow up, pulmonologist diagnosed 28 patients had PTE which exactly matched the initial report of LPS. The accuracy of the scan was 100% similarly in patients with and without COPD.
Conclusion: The results support the optimal diagnostic performance of LPS for PTE similarly in patients with and without COPD.

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  1. Sheh SH, Bellin E, Freeman KD, Haramati LB. Pulmonary embolism diagnosis and mortality with pulmonary CT angiography versus ventilation-perfusion scintigraphy: evidence of overdiagnosis with CT? AJR Am J Roentgenol. 2012 Jun;198(6):1340-5.
  2. Gharabaghi MA, Sarv F, Farzanehfar S, Abbasi M. The diagnostic accuracy of prospective investigative study of acute pulmonary embolism diagnosis criteria for the detection of acute pulmonary thromboembolism in acutely ill patients. World J Nucl Med. 2020 Jan 17;19(2):137-40.
  3. Reinartz P, Wildberger JE, Schaefer W, Nowak B, Mahnken AH, Buell U. Tomographic imaging in the diagnosis of pulmonary embolism: a comparison between V/Q lung scintigraphy in SPECT technique and multislice spiral CT. J Nucl Med. 2004 Sep;45(9):1501-8.
  4. Miniati M, Sostman HD, Gottschalk A, Monti S, Pistolesi M. Perfusion lung scintigraphy for the diagnosis of pulmonary embolism: a reappraisal and review of the prospective investigative study of acute pulmonary embolism diagnosis methods. Semin Nucl Med. 2008 Nov;38(6):450-61.
  5. Bajc M, Neilly JB, Miniati M, Schuemichen C, Meignan M, Jonson B; EANM Committee. EANM guidelines for ventilation/perfusion scintigraphy : Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging. 2009 Aug;36(8):1356-70.
  6. Castellucci P, Nanni C, Ambrosini V. Nuclear medicine imaging of prostate cancer in the elderly. Semin Nucl Med. 2018 Nov;48(6):541-7.
  7. Hartmann IJ, Hagen PJ, Melissant CF, Postmus PE, Prins MH. Diagnosing acute pulmonary embolism: effect of chronic obstructive pulmonary disease on the performance of D-dimer testing, ventilation/perfusion scintigraphy, spiral computed tomographic angiography, and conventional angiography. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localization of Pulmonary Embolism. Am J Respir Crit Care Med. 2000 Dec;162(6):2232-7.
  8. Hixson-Wallace JA, Dotson JB, Blakey SA. Effect of regimen complexity on patient satisfaction and compliance with warfarin therapy. Clin Appl Thromb Hemost. 2001 Jan;7(1):33-7.
  9. Mos IC, Klok FA, Kroft LJ, DE Roos A, Dekkers OM, Huisman MV. Safety of ruling out acute pulmonary embolism by normal computed tomography pulmonary angiography in patients with an indication for computed tomography: systematic review and meta-analysis. J Thromb Haemost. 2009 Sep;7(9):1491-8.
  10. Wang RC, Miglioretti DL, Marlow EC, Kwan ML, Theis MK, Bowles EJA, Greenlee RT, Rahm AK, Stout NK, Weinmann S, Smith-Bindman R. Trends in imaging for suspected pulmonary embolism across US health care systems, 2004 to 2016. JAMA Netw Open. 2020 Nov 2;3(11):e2026930.
  11. Bonnefoy PB, Prevot N, Mehdipoor G, Sanchez A, Lima J, Font L, Gil-Díaz A, Llamas P, Aibar J, Bikdeli B, Bertoletti L, Monreal M; And RIETE investigators. Ventilation/perfusion (V/Q) scanning in contemporary patients with pulmonary embolism: utilization rates and predictors of use in a multinational study. J Thromb Thrombolysis. 2022 May;53(4):829-840. doi: 10.1007/s11239-021-02579-0. Epub 2021 Oct 5.
  12. Børvik T, Evensen LH, Morelli VM, Melbye H, Brækkan SK, Hansen JB. Impact of respiratory symptoms and oxygen saturation on the risk of incident venous thromboembolism-the Tromsø study. Res Pract Thromb Haemost. 2020 Jan 9;4(2):255-2.
  13. O'Donnell DE, Laveneziana P. Physiology and consequences of lung hyperinflation in COPD. Eur Respir Rev. 2006;15(100):61-7.
  14. Miniati M, Pistolesi M, Marini C, Di Ricco G, Formichi B, Prediletto R, Allescia G, Tonelli L, Sostman HD, Giuntini C. Value of perfusion lung scan in the diagnosis of pulmonary embolism: results of the prospective investigative study of acute pulmonary embolism diagnosis (PISA-PED). Am J Respir Crit Care Med. 1996 Nov;154(5):1387-93.