Lung Perfusion Case Study Solution

DISCUSSION

Lung Perfusion (Q) SPECT-CT which has a superior contrast resolution has been shown to be more sensitive, specific and accurate with a lower non-diagnostic rate than lung perfusion (Q) planar and SPECT imaging in the diagnosis and to detect pulmonary embolism (PE). This study found that lung perfusion (Q) Planar, SPECT and SPECT-CT have a similar performance in terms of specificity (100%), positive predictive value (100%) with the Computed Tomography Pulmonary Angiogram (CTPA) as the gold standard (p=0.00658) but different achievement in term of sensitivity (88.9%, 94.4% and 100% respectively), negative predictive value (33.3%, 50% and 100% respectively) and diagnostic accuracy (89.5%, 94.7% and 100% respectively) with the Computed Tomography Pulmonary Angiogram (CTPA) as the gold standard. The similar
Lung Perfusion (Q) SPECT-CT showed more and better delineated between mismatch versus match and segmental versus non-segmental defects quite in agreement with a previous study. In this study, the inferior reader confidence or lack of clarity in lung perfusion (Q) Planar and SPECT interpretation is in agreement with the fact that only 89.5% and 94.7% respectively of cases can be resolved by lung perfusion (Q) planar and SPECT scintigraphy. This study elucidated that despite the similar performance of these projections of lung perfusion (Q) Planar, SPECT and SPECT-CT, that lung perfusion (Q) SPECT-CT has a higher and better reader confidence amongst Nuclear Medicine Specialist in detect pulmonary embolism (PE). In this study, there was no difference in the diagnosis of pulmonary embolism (PE) based on the recently modified PIOPED criteria when all the reports were reviewed by a Nuclear Medicine Specialist. These three projections of lung perfusion (Q) Planar, SPECT and SPECT-CT had one true negative and zero false negative based on Computed Tomography Pulmonary Angiogram (CTPA) as gold standard for detection or diagnosis pulmonary