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Meeting ReportClinical Science

Lung ventilation/perfusion scintigraphy for the screening of chronic thromboembolic pulmonary hypertension (CTEPH): which criteria to use?

Romain Le Pennec, Cécile Tromeur, Charles Orione, Philippe Robin, Raphaël Le Mao, Claire De Moreuil, Mitja Jevnikar, Clément Hoffman, Laurent Savale, Francis Couturaud, Olivier Sitbon, David Montani, Xavier Jaïs, Gregoire Le Gal, Pierre-Yves Salaün, Marc Humbert and Pierre-Yves Le Roux
Journal of Nuclear Medicine June 2022, 63 (supplement 2) 3352;
Romain Le Pennec
1CHU Brest - France
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Cécile Tromeur
1CHU Brest - France
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Charles Orione
1CHU Brest - France
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Philippe Robin
1CHU Brest - France
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Raphaël Le Mao
1CHU Brest - France
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Claire De Moreuil
1CHU Brest - France
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Mitja Jevnikar
2APHP - Bicêtre - Paris - France
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Clément Hoffman
1CHU Brest - France
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Laurent Savale
2APHP - Bicêtre - Paris - France
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Francis Couturaud
1CHU Brest - France
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Olivier Sitbon
2APHP - Bicêtre - Paris - France
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David Montani
2APHP - Bicêtre - Paris - France
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Xavier Jaïs
3Hôpital Bicêtre
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Gregoire Le Gal
4The Ottawa Hospital
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Pierre-Yves Salaün
1CHU Brest - France
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Marc Humbert
2APHP - Bicêtre - Paris - France
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Pierre-Yves Le Roux
1CHU Brest - France
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Abstract

3352

Introduction: The diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) is a major challenge as it is a curable cause of pulmonary hypertension (PH). Ventilation/Perfusion (V/Q) lung scintigraphy is the imaging modality of choice for the screening of CTEPH. However, there is no consensus on the criteria to use for interpretation. The aim of this study was to assess the accuracy of various interpretation criteria of planar V/Q scintigraphy for the screening of CTEPH in patients with PH.

Methods: The eligible study population consisted of consecutive patients with newly diagnosed PH in the Brest University Hospital, France. Final diagnosis (CTEPH or non-CTEPH) was established in a referential center on the management of PH, based on the ESC/ERS guidelines and a minimum follow-up of 3 years. A retrospective central review of planar V/Q scintigraphy was performed by three nuclear physicians blinded to clinical findings and to final diagnosis. The number, extent (sub segmental or segmental) and type (matched or mismatched) of perfusion defects were reported. Sensitivity and specificity were evaluated for various criteria based on the number of mismatched perfusion defects and the number of perfusion defects (regardless of ventilation). Receiver operating characteristic (ROC) curves were generated and areas under the curve (AUC) were calculated for both.

Results: A total of 226 patients with newly diagnosed PH were analyzed. 56 (24.8%) were diagnosed with CTEPH while 170 patients (75.2%) were diagnosed with non-CTEPH. The optimal threshold was 2.5 segmental mismatched perfusion defects, providing a sensitivity of 100 % (95% CI 93.6-100%) and a specificity of 94.7% (95%CI 90.3-97.2%). Lower diagnostic cut-offs of mismatched perfusion defects provided similar sensitivity but lower specificity. Ninety five percent of patients with CTEPH had more than 4 segmental mismatched defects. An interpretation only based on perfusion provided similar sensitivity but a specificity of 81.8% (95%CI 75.3-86.9%).

Conclusions: Our study confirmed the high diagnostic performance of planar V/Q scintigraphy for the screening of CTEPH in patients with PH. The optimal diagnostic cut-off for interpretation was 2.5 segmental mismatched perfusion defects. An interpretation only based on perfusion defects provided similar sensitivity but lower specificity.

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Journal of Nuclear Medicine
Vol. 63, Issue supplement 2
June 1, 2022
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Lung ventilation/perfusion scintigraphy for the screening of chronic thromboembolic pulmonary hypertension (CTEPH): which criteria to use?
Romain Le Pennec, Cécile Tromeur, Charles Orione, Philippe Robin, Raphaël Le Mao, Claire De Moreuil, Mitja Jevnikar, Clément Hoffman, Laurent Savale, Francis Couturaud, Olivier Sitbon, David Montani, Xavier Jaïs, Gregoire Le Gal, Pierre-Yves Salaün, Marc Humbert, Pierre-Yves Le Roux
Journal of Nuclear Medicine Jun 2022, 63 (supplement 2) 3352;

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Lung ventilation/perfusion scintigraphy for the screening of chronic thromboembolic pulmonary hypertension (CTEPH): which criteria to use?
Romain Le Pennec, Cécile Tromeur, Charles Orione, Philippe Robin, Raphaël Le Mao, Claire De Moreuil, Mitja Jevnikar, Clément Hoffman, Laurent Savale, Francis Couturaud, Olivier Sitbon, David Montani, Xavier Jaïs, Gregoire Le Gal, Pierre-Yves Salaün, Marc Humbert, Pierre-Yves Le Roux
Journal of Nuclear Medicine Jun 2022, 63 (supplement 2) 3352;
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