The Utility of Hybrid SPECT/CT Lung Perfusion Scintigraphy in Pulmonary Embolism Diagnosis

BACKGROUND: Pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/Q) scintigraphy or pulmonary CT angiography. One of the imaging methods used in nuclear medicine is hybrid SPECT/CT scintigraphy. OBJECTIVES: The aim of this study was to evaluate the utility of SPECT/CT(Q) scintigraphy in the diagnosis of PE and to compare SPECT/CT(Q) with planar(Q) and SPECT(Q) methods. METHODS: The study group consisted of 109 consecutive patients suspected of having PE referred for performing lung scintigraphy. The inclusion criteria were: performance of perfusion planar, SPECT and SPECT/CT scans; availability of clinical data covering a 6-month follow-up period, and D-dimer level testing. The number of eligible patients was 84. PE was reported in patients with at least 1 segmental or 2 subsegmental perfusion defects without parenchymal abnormalities on CT scans. PE was excluded when there was a normal perfusion pattern or perfusion defects were caused by lung parenchymal abnormalities or were not arranged in accordance with the pulmonary vasculature. RESULTS: Twenty-six patients (31%) had a final diagnosis of PE. The sensitivity and specificity values of each method were as follows: planar(Q) 73 and 43%, SPECT(Q) 88 and 47% and SPECT/CT(Q) 100 and 83%. SPECT/CT(Q) yielded a significantly higher diagnostic accuracy than planar(Q) (p < 0.001) and SPECT(Q) (p < 0.001) scans. CONCLUSIONS: We conclude that hybrid SPECT/CT(Q) imaging has a high diagnostic efficacy in the diagnosis of PE. Lung perfusion scintigraphy performed with a hybrid SPECT/CT device has a significantly higher sensitivity and specificity than scanning performed with the planar or SPECT technique.