Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus
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SHORT COMMUNICATION
Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE Jeeban P. Das 1
&
Randy Yeh 1 & Heiko Schöder 1
Received: 23 July 2020 / Accepted: 14 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose We reviewed the clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARSCoV2). Methods Following the World Health Organization’s declaration of a global pandemic, our department policy recommended Qonly SPECT/CT for all patients undergoing nuclear medicine evaluation for suspected PE to reduce the risk of aerosolization of respiratory droplets. We performed a retrospective review of sequential patients admitted with COVID-19 imaged with QSPECT/CT between March 17, 2020, and June 30, 2020, at Memorial Sloan Kettering Cancer Center. We recorded patient demographics, clinical symptoms, Wells score (to stratify patients according to pre-test probability for PE prior to Q-SPECT/CT), and noted ancillary imaging findings on CT. Results Of the 33 patients imaged with Q-SPECT/CT, 6 patients (3 men, 3 women) had a laboratory confirmed diagnosis of COVID-19 (mean age, 55, ± 11.4 years, range 33–68). All patients had a current diagnosis of malignancy and had a moderate or high pre-test probability for PE (mean Wells score 2.8, range 2–4). Q-SPECT/CT was positive in 4/6 (67%) of patients. Distribution of pulmonary emboli was bilateral and segmental in 75% of patients. Ancillary acute findings on SPECT/CT included bilateral parenchymal ground glass opacities (n = 5), pleural effusions (n = 2), and pneumomediastinum (n = 1). Conclusion Q-SPECT/CT has clinical utility for diagnosing PE in patients with COVID-19 where there is a contraindication for iodinated contrast media and a moderate or high pre-test probability for PE. Keywords COVID-19 . Pulmonary embolism . V/Q SPECT/CT . Coagulopathy
Introduction The novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARSCOV2) originating in Wuhan, China, in December 2019, has now spread globally and was declared a pandemic by the World Health Organization in March 2020 [1]. This article is part of the Topical Collection on Infection and inflammation * Jeeban P. Das [email protected] 1
Department of Radiology/Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Hospitalized patients most commonly present with mild respiratory symptoms but can undergo rapid clinical deterioration as a result of severe pneumonia requiring intubation and ventilation [2]. Venous thromboembolic (VTE) disease diagnosed in patients with COVID-19 has been identified as a potential cause of accelerated clinical decline, potentiated by endothelial damage and excessive inflammation resulting in a
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