OC 31.4 - Diagnostic accuracy of V/Q and Q SPECT/CT in patients with suspected pulmonary embolism: a systematic review and meta-analysis

Monday, July 11, 2022

11:30 AM – 11:45 AM

Location: ExCel Center, S11A

Presentation Format: Virtual

Co-Author(s)

Alice Venturini

Doctor
Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese and Como, Italy
Como, Lombardia, Italy

Presenting Author(s)

Alessandro Squizzato

Professor of Internal Medicine, Head of the Internal Medicine ward ASST Lariana, San Fermo
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Como, Lombardia, Italy

Co-Author(s)

VP

Valentina Pelitti

Dr.
Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese and Como, Italy
Como, Lombardia, Italy
BB

Beatrice Bellini

Dr.
Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese and Como, Italy
Como, Lombardia, Italy
MB

Matteo Bernasconi

Dr.
Internal Medicine Unit, ASST Settelaghi, Cittiglio, Italy
Varese, Lombardia, Italy
AC

Angelo Corso

Dr.
Nuclear Medicine Unit, ‘Sant’Anna’ Hospital, ASST Lariana, Como, Italy
Como, Lombardia, Italy
NR

Nicoletta Riva, MD, PhD

MD
Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
Msida, Malta
TD

Tommaso Depalo

Dr.
Nuclear Medicine Unit, ‘Sant’Anna’ Hospital, ASST Lariana, Como, Italy
Como, Lombardia, Italy

Background: Computed tomography (CT) pulmonary angiography has simplified the diagnostic approach to patients with clinically suspected pulmonary embolism (PE), but alternative imaging tests are still advocated.

Aims: We aimed to systematically assess the diagnostic accuracy of ventilation/perfusion (V/Q) and Q single-photon emission CT combined with low-dose CT (SPECT/CT) for PE diagnosis.

Methods: Studies evaluating the diagnostic accuracy of SPECT/CT for the diagnosis of PE were systematically searched in MEDLINE and EMBASE databases (up to July 2021). QUADAS-2 tool was used for risk of bias assessment of the primary studies. A bivariate random-effects regression approach was used for summary estimates of both sensitivity and specificity. PROSPERO registration number is CRD42021276538

Results: Six studies, for a total of 974 patients, were included. Weighted mean prevalence of PE was 24.9% at random-effect model. Weighted mean inconclusive SPECT/CT results were 2.5% (95% CI, 0.2-6.9%) at random-effect model. After exclusion of technical inadequate results, SPECT/CT bivariate weighted mean sensitivity was 96% (95% confidence interval [CI], 93-98%), with a bivariate weighted mean specificity of 96% (95% CI, 94-97%).
At subgroup analysis, for V/Q SPECT/CT bivariate weighted mean sensitivity and specificity were 97% (95% CI, 92-99%) and 97% (95% CI, 95-98%), while for Q SPECT/CT they were 95% (95% CI, 90-98%) and 84% (95% CI, 61-95%), respectively.

Conclusion(s): V/Q SPECT/CT has high sensitivity and specificity for the diagnosis of PE, meanwhile Q SPECT/CT has high sensitivity but limited specificity for the diagnosis of PE. Management studies will conclusively ascertain the actual role of SPECT/CT in the diagnostic workup of patients with suspected PE.