Utility of Lung Perfusion SPECT/CT in Detection of Pulmonary Thromboembolic Disease: Outcome Analysis

Purpose To evaluate the clinical outcome of Q-SPECT/CT in pulmonary thromboembolic disease. Methods From Jan 2020 to Jan 2021, 30 consecutive patients (M:F = 8:22; median age = 52 year (21–89)) suspected of having acute pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension (CTEPH) were referred for non-contrasted Q-SPECT/CT. All patients were COVID-19 PCR negative. MSKCC Q-SPECT/CT and/or PISAPED crite- ria were used to determine the presence of thromboembolic disease in Q-SPECT/CT. Final diagnosis was made based on composite reference standards that included at least 2-month clinical cardiorespiratory assessment and follow-up imaging. Results Q-SPECT/CT was positive in 19 patients: indeterminate in 1 and 10 were negative. Three false positive cases were observed during follow-up. Of the remaining 16 true positives, all patients’ cardiorespiratory symptom were improved or stabilised after treatment with anticoagulants. The overall sensitivity, specificity, PPV, NPV and accuracy of Q-SPECT/CT were 100% (95% CI, 79.41–100%), 78.57% (95% CI, 49.20–95.34%), 84.21% (95% CI, 66.41–93.57%), 100% and 90.00% (95% CI, 73.47–97.89%) respectively. Conclusions In the current COVID-19 pandemic, Q-SPECT/CT can be an alternative modality to detect pulmonary throm- boembolic disease. Normal Q-SPECT/CT excludes pulmonary thromboembolic disease with high degree of certainty. However, false positive has been observed. Keywords Perfusion · SPECT/CT · Thromboembolic · Pulmonary embolism · Chronic thromboembolic pulmonary hypertension Introduction Imaging plays a pivotal role in the diagnosis and man- agement of these patients. Computed tomography pulmo- Acute pulmonary embolism (PE) is a life-threatening but nary angiography (CTPA) is commonly used in the workup treatable illness caused by migration of thrombi to the pul- of suspected acute PE due to readily availability and...