RT Journal Article
SR Electronic
T1 Lung scintigraphy for pulmonary embolism diagnosis in COVID-19 patients: a multicenter study.
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP jnumed.121.262955
DO 10.2967/jnumed.121.262955
A1 Le Roux, Pierre-Yves
A1 Bonnefoy, Pierre-Benoit
A1 Bahloul, Achraf
A1 Denizot, Benoit
A1 Barres, Bertrand
A1 Moreau-Triby, Caroline
A1 Girma, Astrid
A1 Pallardy, Amandine
A1 Ceyrat, Quentin
A1 Sarda-Mantel, Laure
A1 Razzouk-Cadet, Micheline
A1 Zsigmond, Reka
A1 Florent, Cachin
A1 Karcher, Gilles
A1 Salaun, Pierre-Yves
YR 2021
UL http://jnm.snmjournals.org/content/early/2021/10/14/jnumed.121.262955.abstract
AB In patients with novel coronavirus disease 2019 (COVID-19) referred for lung scintigraphy for suspected pulmonary embolism (PE), there has been an ongoing debate within the nuclear medicine community as to whether and when the ventilation study should be performed. Indeed, while PE diagnosis typically relies on the recognition of ventilation/perfusion (V/P) mismatched defects, the ventilation procedure potentially increases the risk of contamination to the healthcare workers. The primary aim of this study was to assess the role of ventilation imaging when performing lung scintigraphy for suspected PE in COVID-19 patients. The secondary aim was to describe practices and imaging findings in this specific population. Methods: A national registry was created in collaboration with the French Society of Nuclear Medicine to collect lung scans performed in COVID-19 patients for suspected PE. Practices of departments were assessed regarding imaging protocols and aerosol precautions. A retrospective review of V/P SPECT/CT scans was then conducted. Two physicians blinded to clinical information reviewed each case by sequentially using P SPECT, P SPECT/CT and V/P SPECT/CT images. Scans were classified in one of the four following categories: patients for whom PE could reasonably be excluded based on 1) perfusion SPECT only, 2) P SPECT/CT, 3) V/P SPECT/CT; or 4) patients with mismatched defects suggestive of PE according to the EANM criteria. Results: Data from 12 French nuclear medicine departments were collected. Lung scans were performed between 03/2020 and 04/2021. Personal protective equipment and dedicated cleaning procedures were used in all departments. Out of the 145 V/Q SPECT/CT included in the central review, PE could be excluded using only P SPECT, P SPECT/CT and V/P SPECT/CT in 27 (19%), 55 (38%) and 45 (31%) patients, respectively. V/P SPECT/CT was positive for PE in 18 (12%) patients, including 12 (67%) with a low burden of PE (≤10%). Conclusion: In this population of COVID-19 patients assessed with lung scintigraphy, PE could be confidently excluded without ventilation in only 57% of patients. Ventilation imaging was required to confidently rule out PE in 31% of patients. Overall, the prevalence of PE was low (12%).