Pulmonary perfusion by iodine subtraction maps CT angiography in acute pulmonary embolism: comparison with pulmonary perfusion SPECT (PASEP trial)
- 11 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Radiology
- Vol. 30 (9), 4857-4864
- https://doi.org/10.1007/s00330-020-06836-3
Abstract
Objective To assess the diagnostic accuracy of iodine map computed tomography pulmonary angiography (CTPA), for segment-based evaluation of lung perfusion in patients with acute pulmonary embolism (PE), using perfusion single-photon emission CT (SPECT) imaging as a reference standard. Methods Thirty participants who have been diagnosed with acute pulmonary embolism on CTPA underwent perfusion SPECT/CT within 24 h. Perfusion SPECT and iodine map were independently interpreted by 2 nuclear medicine physicians and 2 radiologists. For both modalities, each segment was classified as normoperfused or hypoperfused, as defined by a perfusion defect of more than 25% of a segment. The primary end point was the diagnostic accuracy (sensitivity and specificity) of iodine map for segment-based evaluation of lung perfusion, using perfusion SPECT imaging as a reference standard. Following blinded interpretation, a retrospective explanatory analysis was performed to determine potential causes of misinterpretation. Results The median time between CTPA with iodine maps and perfusion SPECT was 14 h (range 2–23 h). A total of 597 segments were analyzed. Sensitivity and specificity of iodine maps with CTPA for the detection of segmental perfusion defects were 231/284 = 81.3% (95% CI 76.4 to 85.4%) and 247/313 = 78.9% (95% CI 74.1 to 83.1%), respectively. In retrospect, false results were explained in 48.7%. Conclusion Iodine map CTPA showed promising results for the assessment of pulmonary perfusion in patients with acute PE, with sensitivity of 81.3% and specificity of 78.9%, respectively. Recognition of typical pitfalls such as atelectasis, fissures, or beam-hardening artifacts may further improve the accuracy of the test. Key Points • Sensitivity and specificity of iodine subtraction maps for the detection of segmental perfusion defects were 81.3% (95% CI 76.4 to 85.4%) and 78.9% (95% CI 74.1 to 83.1%), respectively. • Recognition of typical pitfalls such as atelectasis, fissures, or beam-hardening artifacts may further improve the diagnostic accuracy of the test.This publication has 23 references indexed in Scilit:
- Dual-energy CT lung ventilation/perfusion imaging for diagnosing pulmonary embolismEuropean Radiology, 2013
- Dual-Energy CT of the LungAmerican Journal of Roentgenology, 2012
- Dual Energy CT lung perfusion imaging—Correlation with SPECT/CTEuropean Journal of Radiology, 2012
- QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy StudiesAnnals of Internal Medicine, 2011
- Lung Perfused Blood Volume Images With Dual-Energy Computed Tomography for Chronic Thromboembolic Pulmonary HypertensionJournal of Computer Assisted Tomography, 2011
- Unprovoked Venous Thromboembolism: Short term or Indefinite Anticoagulation? Balancing Long-Term Risk and BenefitBlood Reviews, 2010
- Dual-Energy CT for Assessment of the Severity of Acute Pulmonary Embolism: Pulmonary Perfusion Defect Score Compared With CT Angiographic Obstruction Score and Right Ventricular/Left Ventricular Diameter RatioAmerican Journal of Roentgenology, 2010
- Lung Perfusion with Dual-energy Multidetector-row CT (MDCT): Feasibility for the Evaluation of Acute Pulmonary Embolism in 117 Consecutive PatientsAcademic Radiology, 2008
- Multidetector Computed Tomography for Acute Pulmonary EmbolismThe New England Journal of Medicine, 2006
- ANTICOAGULANT DRUGS IN THE TREATMENT OF PULMONARY EMBOLISM: A CONTROLLED TRIALThe Lancet, 1960