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Annals of Nuclear Medicine
Published in: Annals of Nuclear Medicine 8/2020

01-08-2020 | Acute Pulmonary Embolism | Original Article

Applying Wells score to inconclusive perfusion only modified PIOPED II (Prospective Investigation of Pulmonary Embolism Diagnosis II) readings in order to optimize the lung scintigraphy diagnostic yield in acute pulmonary embolism detection

Authors: Seyed Kamaledin Hadei, Maryam Alvandi, Mehdi Ramezani, Oldooz Aloosh, Zahra Shaghaghi, Abbas Moradi

Published in: Annals of Nuclear Medicine | Issue 8/2020

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Abstract

Objective

When using perfusion only modified PIOPED II criteria for PE detection, generated non-diagnostic scans are found to be the main diagnostic restriction. The objective of current study is to identify the role of Wells criteria added to inconclusive readings with the intent of enhancing the lung scintigraphy diagnostic yield.

Methods

CTPA was performed in 34 suspected PE patients with inconclusive lung scintigraphy. They also were evaluated by Wells score and classified as low, intermediate and high probability. Overall prevalence and the rate of PE for each probability were calculated. Furthermore, NPV for scores < 2 and PPV for scores > 6 were computed.

Results

Having a mean age of 59.75 ± 17.38 years, 7 (20.6%), 23 (67.6%) and 4 (11.8%) of cases had total criteria point count < 2, 2–6 and > 6, respectively. Using CTPA, 5 patients (14.7%) were diagnosed with PE. None of the patients with scores < 2 had PE with an associated NVP of 100%. Patients with scores 2–6 had a PE rate of 4.3% and 100% of patients with scores > 6 were diagnosed with PE, implying that the PPV of scores > 6 was 100%.

Conclusion

Adding Wells score to non-diagnostic scans allowed identification of PE to be done reliably, and provided further insight into how lung scintigraphy in conjunction with clinical assessment is a practical strategy not only for the patients unfit for performing CTPA but also in all the patients referred for PE evaluation.
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Metadata
Title
Applying Wells score to inconclusive perfusion only modified PIOPED II (Prospective Investigation of Pulmonary Embolism Diagnosis II) readings in order to optimize the lung scintigraphy diagnostic yield in acute pulmonary embolism detection
Authors
Seyed Kamaledin Hadei
Maryam Alvandi
Mehdi Ramezani
Oldooz Aloosh
Zahra Shaghaghi
Abbas Moradi
Publication date
01-08-2020
Publisher
Springer Singapore
Published in
Annals of Nuclear Medicine / Issue 8/2020
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-020-01478-3

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