Does lung perfusion scintigraphy continue to have a role in the clinical management of patients suspected of pulmonary e
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ORIGINAL ARTICLE
Does lung perfusion scintigraphy continue to have a role in the clinical management of patients suspected of pulmonary embolism in the CT pulmonary angiography era? Sophia I. Koukouraki1 · Adam A. Hatzidakis2 · Ioanna Mitrouska3 · Maria I. Stathaki1 · Kostas Perisinakis4 Received: 6 July 2018 / Accepted: 30 August 2018 © The Japanese Society of Nuclear Medicine 2018
Abstract Objective Acute pulmonary embolism (PE) is a life-threatening disorder with high mortality. A prompt diagnosis and treatment is essential for reducing the mortality rate. The purpose of the study is to evaluate if lung perfusion scintigraphy (LPS) continues to have a role in the clinical management of patients suspected of pulmonary embolism in the CT pulmonary angiography (CTPA) era. Methods For this study, 1183 patients who had been subjected to LPS were retrospectively evaluated and classified into the following groups: A (positive LPS), B (negative LPS) and C (indeterminate LPS). Patients were further classified into A1 (‘PE likely’ and LPS-negative), B1 (PE unlikely and LPS-positive) and C1 (PE likely and indeterminate LPS) by combining the LPS findings and the clinical pretest probability (cpp). Subgroups A1, B1 and C1 underwent additional CTPA. Results Groups A, B, and C included 1086/1183, 69/1183 and 28/1183 patients, respectively. The proportion of patients with inconsistent cpp LPS findings who underwent additional CTPA was 106/1183 patients: subgroup A1 (n = 73), B1 (n = 21), and C1 (n = 12). In subgroup A1, CTPA was negative in 61/73, non-diagnostic in 12/73 and positive in 0/73 patients. In subgroup B1, CTPA excluded PE in 2/21, non-diagnostic in 3/21 and positive in 16/21 patients. In group C1, CTPA was negative in 8/12, positive in 2/12 and non-diagnostic in 2/12 patients. Conclusion In the CTPA era, LPS continues to have a role in the clinical management of patients suspected of PE. Keywords Lung perfusion scintigraphy · CT pulmonary angiography · Pulmonary embolism
Introduction Acute pulmonary embolism (PE) is a life-threatening disorder with high mortality (10–30% in untreated cases) and morbidity rates. Prompt diagnosis and treatment are essential for reducing the mortality rate to 2–6% [1, 2]. Given the importance of selecting patients for further diagnostic * Sophia I. Koukouraki [email protected] 1
Department of Nuclear Medicine, Faculty of Medicine, University of Crete, Voutes Stavrakia, 71003 Crete, Greece
2
Department of Radiology, Faculty of Medicine, University of Crete, Crete, Greece
3
Department of Thoracic Medicine, Faculty of Medicine, University of Crete, Crete, Greece
4
Department of Medical Physics, Faculty of Medicine, University of Crete, Crete, Greece
tests, clinical evaluation is the first step in the diagnostic algorithm for patients suspected for PE. Clinical evaluation is challenging since clinical findings may be nonspecific. In patients with a low clinical suspicion of PE, low levels of plasma D dimers have an acceptable, negative predictive value that can rule o
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