PT  - JOURNAL ARTICLE
AU  - Salomao Costa, Fernanda
AU  - Chambi, Alan
AU  - Azevedo, Jader
AU  - Veras, Mariana
AU  - palazzo, isabella
AU  - Maggiotto, Maria Marta
AU  - Sadeck, Gabriela
AU  - Melo, William
AU  - Mesquita, Claudio
TI  - Reduction of inconclusive results in the evaluation of pulmonary embolism with ventilation and perfusion lung scintigraphy using SPECT-CT. Experience of a tertiary cardiology hospital.
DP  - 2017 May 01
TA  - Journal of Nuclear Medicine
PG  - 1011--1011
VI  - 58
IP  - supplement 1
4099  - http://jnm.snmjournals.org/content/58/supplement_1/1011.short
4100  - http://jnm.snmjournals.org/content/58/supplement_1/1011.full
SO  - J Nucl Med2017 May 01; 58
AB  - 1011Objectives: There are two well-known methods for this purpose,being one the classic scintigraphy and the other the hybrid image - SPECT CT which is not so available.This study was designed to prove SPECT CT images,using PIOPED SPECT,is superior to planar images analyzed by Modified PIOPED and show how SPECT CT images can solve inconclusive results. We studied images from 31 patients that were separately analyzed by the same observer and used mathematic methods to test both test,using European classification as pattern.Our conclusion proved SPECT CT is superior than planar images to valuate pulmonary embolism. Background: Precocity diagnosis and a well indicated and fast begin of the anticoagulation therapy can reduce mortality and morbidity of pulmonary embolism (PE). V/Q scan is one of the best methods to study patients with preserved hemodynamic stability.It is considered method of choice to patients as: morbidly obese, pregnant, renal failure and allergic to iodine.V/Q scan has high sensibility,although low specificity,with best accuracy in patients with regular thorax XR and its use was reaffirmed with “Prospective Investigation of Pulmonary Embolism Diagnosis II” study (PIOPED II), which classified the image as normal,low,medium and high probability,literature confirms that normal results or high probability are enough to close the diagnosis,but when results are low or medium probability,scintigraphy is not enough and this is most part of the cases.To solve this cases,we are able to associate low dose SPECT CT,this association is even more accurate than angiography.It differs the normal perfusion images than normalized images because of perfused parenchyma overlap and so show more and smaller lesions.Moreover,we can diagnose differences causes of hipoperfusion,studying the CT.Methods: We made an observational,retrospective trial,including 50 patients(46%women),selected between January 2013 and January 2015,ages between 30-92 year old,with at least intermediate probability for PE by the Wells criteria,comparing SPECT to planar images.From this group,19 were excluded because it was missing images to analyze.Images were acquired in a hybrid Symbia equipment with 8 projections, done with 700Kcts for each position, SPECT with 64 projections were obtained with 10 seconds for projection. Low dose CT were performed free breathing. The images were analyzed by the same observer to evaluate the differences of the two complementary methods.Pattern was the emitted report that evolved the two methods and is always seen by tree observers.Modified PIOPED, PIOPED SPECT, PISAPED and European classification were used to analyze the images.This way we could make an statistical analysis employing the Qui Quadrate test and Fisher exact test to compare Modified PIOPED to PIOPED SPECT,using EUROPEAN classification as golden pattern.Results: 31 patient’s exams were reviewed to compare planar images to SPECT CT images, using European classification as pattern.Comparing Modified PIOPED to European using Fisher test we achieved p< 0,05,followed by the Qui Quadrate test when we find a sensibility = 78% and specificity = 82%.Comparing PIOPED SPECT to European using Fisher test the p=ns since there are no false negatives for this test,meanwhile Qui Quadrate test showed sensibility = 100% and specificity = 88%.Confronting both studied methods, using now PIOPED SPECT as the pattern, the sensibility of Modified PIOPED reduces to 68% which leads to an evolution of the nuclear medicine methods.Conclusion: We conclude hybrid SPECT/CT imaging has a high diagnostic efficacy in the diagnosis of PE.Lung perfusion scintigraphy performed with a hybrid SPECT/ CT device has clearly higher sensitivity and specificity than scanning performed with the planar or SPECT alone technique,reducing inconclusive results.