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European Journal of Nuclear Medicine and Molecular Imaging

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01-07-2019 | Angiography | Original Article

Independent and incremental value of ventilation/perfusion PET/CT and CT pulmonary angiography for pulmonary embolism diagnosis: results of the PECAN pilot study

Authors: Pierre-Yves Le Roux, Amir Iravani, Jason Callahan, Kate Burbury, Peter Eu, Daniel P. Steinfort, Eddie Lau, Beverly Woon, Pierre-Yves Salaun, Rodney J. Hicks, Michael S. Hofman

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 8/2019

Abstract

Purpose

This pilot study assessed the independent and incremental value of ⁶⁸Ga-V/Q PET/CT as compared with CT pulmonary angiography (CTPA) for the management of cancer patients with suspected acute pulmonary embolism (PE).

Methods

All 24 cancer patients with suspected acute PE prospectively recruited underwent both ⁶⁸Ga-V/Q PET/CT and CTPA within 24 h. PET/CT was acquired after inhalation of Galligas prepared using a Technegas generator and administration of ⁶⁸Ga-macroaggregated albumin. Initially, PET/CT and CTPA scans were read independently with the reader blinded to the results of the other imaging study. CTPA and PET/CT were then coregistered and reviewed by consensus between a radiologist and nuclear medicine physician. The therapeutic management was established by the managing physician based on all available data.

Results

The diagnostic conclusion was concordantly negative in 18 patients (75%). Of the six discordant diagnoses on independent reading, combined interpretation of V/Q PET/CTPA enabled a consensus conclusion in two patients, excluding PE in one and confirming PE in the other, similar to the initial diagnostic conclusion of the V/Q PET/CT. Of the remaining four patients, three had a single subsegmental thrombus on CTPA but a negative V/Q PET/CT scan, and two of these did not receive long-term anticoagulation and did not have a venous thromboembolic event during a 3-year follow-up period. The third patient, along with a patient with a positive V/Q PET/CT scan but a negative CTPA scan, presented with acute complications preventing any conclusions with regard to the appropriateness of the V/Q PET/CT results in the management of PE. Overall, V/Q PET had an impact on management in four patients (17%).

Conclusion

In this pilot study, we demonstrated the feasibility and potential utility of V/Q PET/CT for the management of patients with suspected PE. V/Q PET/CT may be of particular relevance in patients with equivocal findings or isolated subsegmental findings on CTPA, adding further discriminatory information to allow important decision-making regarding the use or withholding of anticoagulation. Given the other advantages of V/Q PET/CT (reduced acquisition time, low radiation dose), and with the increasing availability of ⁶⁸Ga generators, PET/CT is a potential replacement for V/Q SPECT/CT imaging.

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Title: Independent and incremental value of ventilation/perfusion PET/CT and CT pulmonary angiography for pulmonary embolism diagnosis: results of the PECAN pilot study
Authors: Pierre-Yves Le Roux
Amir Iravani
Jason Callahan
Kate Burbury
Peter Eu
Daniel P. Steinfort
Eddie Lau
Beverly Woon
Pierre-Yves Salaun
Rodney J. Hicks
Michael S. Hofman
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Keywords: Angiography
Positron Emission Tomography
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 8/2019
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-019-04338-z

At a glance: The STEP trials

Springer Medicine

Independent and incremental value of ventilation/perfusion PET/CT and CT pulmonary angiography for pulmonary embolism diagnosis: results of the PECAN pilot study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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