Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

Open Access 01-07-2015 | Original Article

V/P SPECT as a diagnostic tool for pregnant women with suspected pulmonary embolism

Authors: Marika Bajc, Berit Olsson, Anders Gottsäter, Cecilia Hindorf, Jonas Jögi

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 8/2015

Abstract

Purpose

The purpose of the study was to assess the prevalence of pulmonary embolism (PE) and other lung diseases among pregnant women with suspected PE and to calculate the radiation exposure to patient and fetus in this population. As a secondary aim, we evaluated the negative predictive value of a normal ventilation/perfusion single photon emission computed tomography (V/P SPECT) examination in pregnancy.

Methods

We studied all 127 pregnant women who had suspected PE and had undergone V/P SPECT at our institution in the course of a 5-year period. Radiation exposure to patient and fetus and the negative predictive value of a normal V/P SPECT examination were also measured.

Results

V/P SPECT identified PE in 11 women (9 %). Moreover, in 15 women (12 %) the examination revealed pneumonia (in 2 cases in addition to PE) and in 1 woman signs of airway obstruction were revealed. Among the 116/127 women (91 %) where PE was ruled out by V/P SPECT, none was diagnosed subsequently with PE or deep venous thrombosis (DVT) during the same pregnancy or puerperal period. For P SPECT, the calculated fetal absorbed dose was < 0.6 mGy,and the calculated breast absorbed dose 0.6 mGy. For V SPECT, the calculated fetal absorbed dose was < 0.014 mGy and the breast absorbed dose 0.25 mGy.

Conclusion

The prevalence of PE was low (9 %) among pregnant women with suspected disease. Pneumonia was diagnosed in 12 % of patients. The negative predictive value of V/P SPECT was high, and the radiation exposure from V/P SPECT was low both for fetus and patient.

Henriksson P, Westerlund E, Wallén H, Brandt L, Hovatta O, Ekbom A. Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: cross sectional study. BMJ 2013;346:e8632.PubMedCentralPubMedCrossRef

Virkus RA, Løkkegaard EC, Lidegaard Ø, Langhoff-Roos J, Bjerregaard L, Skovlund CW, et al. Venous thromboembolism in pregnancy and the puerperal period: a study of 1210 events. Acta Obstet Gynecol Scand 2013;92(10):1135–42.PubMed

Gherman RB, Goodwin TM, Leung B, Byrne JD, Hethumumi R, Montoro M. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999;94(5 Pt 1):730–4.PubMedCrossRef

Cutts BA, Tran HA, Merriman E, Nandurkar D, Soo G, DasGupta D, et al. The utility of the Wells clinical prediction model and ventilation-perfusion scanning for pulmonary embolism diagnosis in pregnancy. Blood Coagul Fibrinolysis 2014;25(4):375–8.PubMedCrossRef

Sivandarajah S. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4: current evidence does not support the use of a negative D-dimer to rule out suspected pulmonary embolism in pregnancy. Emerg Med J 2011;28(3):245–6.PubMedCrossRef

Bajc M, Neilly JB, Miniati M, Schuemichen C, Meignan M, Jonson B. EANM guidelines for ventilation/perfusion scintigraphy: part 2. Algorithms and clinical considerations for diagnosis of pulmonary emboli with V/P(SPECT) and MDCT. Eur J Nucl Med Mol Imaging 2009;36(9):1528–38.PubMedCrossRef

Bajc M, Neilly JB, Miniati M, Schuemichen C, Meignan M, Jonson B et al. EANM guidelines for ventilation/perfusion scintigraphy: part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging 2009;36(8):1356–70.PubMedCrossRef

Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35(43):3033–69.PubMedCrossRef

Leung AN, Bull TM, Jaeschke R, Lockwood CJ, Boiselle PM, Hurwitz LM, et al. American Thoracic Society documents: an official American Thoracic Society/Society of Thoracic Radiology Clinical Practice Guideline–evaluation of suspected pulmonary embolism in pregnancy. Radiology 2012;262(2):635–46.PubMedCrossRef

10.

ICRP. Radiation dose to patients from radiopharmaceuticals, publication 53. Oxford: ICRP; 1988.

11.

ICRP. Radiation dose to patients from radiopharmaceuticals, publication 80 (addendum to ICRP 53). Ann ICRP 1998;28(3).

12.

Russell JR, Stablin MG, Sparks RB, Watson E. Radiation absorbed dose to the embryo/fetus from radiopharmaceuticals. Health Phys 1997;73:756–69.PubMedCrossRef

13.

Palmer J, Bitzén U, Jonson B, Bajc M. Comprehensive ventilation/perfusion SPECT. J Nucl Med 2001;42(8):1288–94.PubMed

14.

Bajc M, Olsson C-G, Palmer J, Jonson B. Quantitative ventilation/perfusion SPECT (QV/P_SPECT): a primary method for diagnosis of pulmonary embolism. In: Freeman ML, editor. Nuclear medicine annual. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 173.

15.

Bajc M, Markstad H, Jarenbäck L, Tufvesson E, Bjermer L, Jögi J. Grading obstructive lung disease using tomographic pulmonary scintigraphy in patients with chronic obstructive pulmonary disease (COPD) and long-term smokers. Ann Nucl Med 2015;29(1):91–9.PubMedCentralPubMedCrossRef

16.

Pahade JK, Litmanovich D, Pedrosa I, Romero J, Bankier AA, Boiselle PM. Quality initiatives: imaging pregnant patients with suspected pulmonary embolism: what the radiologist needs to know. Radiographics 2009;29(3):639–54.PubMedCrossRef

17.

Shahir K, Goodman LR, Tali A, Thorsen KM, Hellman RS. Pulmonary embolism in pregnancy: CT pulmonary angiography versus perfusion scanning. AJR Am J Roentgenol 2010;195(3):W214–20.PubMedCrossRef

18.

Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006;354(22):2317–27.PubMedCrossRef

19.

Ridge CA, McDermott S, Freyne BJ, Brennan DJ, Collins CD, Skehan SJ. Pulmonary embolism in pregnancy: comparison of pulmonary CT angiography and lung scintigraphy. AJR Am J Roentgenol 2009;193(5):1223–7.PubMedCrossRef

20.

Bajc M, Olsson CG, Olsson B, Palmer J, Jonson B. Diagnostic evaluation of planar and tomographic ventilation/perfusion lung images in patients with suspected pulmonary emboli. Clin Physiol Funct Imaging 2004;24(5):249–56.PubMedCrossRef

21.

Gutte H, Mortensen J, Jensen CV, von der Recke P, Petersen CL, Kristoffersen US, et al. Comparison of V/Q SPECT and planar V/Q lung scintigraphy in diagnosing acute pulmonary embolism. Nucl Med Commun 2010;31(1):82–6.PubMedCrossRef

22.

Quirce R, Ibáñez-Bravo S, Jiménez-Bonilla J, Martínez-Rodríguez I, Martínez-Amador N, Ortega-Nava F, et al. Contribution of V/Q SPECT to planar scintigraphy in the diagnosis of pulmonary embolism. Rev Esp Med Nucl Imagen Mol 2014;33(3):153–8.PubMed

23.

Reinartz P, Schirp U, Zimny M, Sabri O, Nowak B, Schäfer W, et al. Optimizing ventilation-perfusion lung scintigraphy: parting with planar imaging. Nuklearmedizin 2001;40(2):38–43.PubMed

24.

Bajc M, Olsson B, Palmer J, Jonson B. Ventilation/perfusion SPECT for diagnostics of pulmonary embolism in clinical practice. J Intern Med 2008;264(4):379–87.PubMedCrossRef

25.

Grüning T, Drake BE, Farrell SL, Nokes T. Three-year clinical experience with VQ SPECT for diagnosing pulmonary embolism: diagnostic performance. Clin Imaging 2014;38:831–5.

26.

Gutte H, Mortensen J, Jensen CV, Johnbeck CB, von der Recke P, Petersen CL, et al. Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT: head-to-head comparison with multidetector CT angiography. J Nucl Med 2009;50(12):1987–92.PubMedCrossRef

27.

Leblanc M, Leveillée F, Turcotte E. Prospective evaluation of the negative predictive value of V/Q SPECT using 99mTc-Technegas. Nucl Med Commun 2007;28(8):667–72.PubMedCrossRef

28.

Astani SA, Davis LC, Harkness BA, Supanich MP, Dalal I. Detection of pulmonary embolism during pregnancy: comparing radiation doses of CTPA and pulmonary scintigraphy. Nucl Med Commun 2014;35(7):704–11.PubMedCrossRef

29.

Hurwitz LM, Yoshizumi T, Reiman RE, Goodman PC, Paulson EK, Frush DP, et al. Radiation dose to the fetus from body MDCT during early gestation. AJR Am J Roentgenol 2006;186(3):871–6.PubMedCrossRef

30.

Hurwitz LM, Yoshizumi TT, Goodman PC, Nelson RC, Toncheva G, Nguyen GB, et al. Radiation dose savings for adult pulmonary embolus 64-MDCT using bismuth breast shields, lower peak kilovoltage, and automatic tube current modulation. AJR Am J Roentgenol 2009;192(1):244–53.PubMedCrossRef

31.

Hurwitz LM, Yoshizumi TT, Reiman RE, Paulson EK, Frush DP, Nguyen GT, et al. Radiation dose to the female breast from 16-MDCT body protocols. AJR Am J Roentgenol 2006;186(6):1718–22.PubMedCrossRef

32.

Nyman U, Bajc M, Eriksson H, Geijer H, Gunnarsson M, Hellgren M, et al. Diagnostik av Lungembolism under graviditet. Skintigrafi eller datortomografi? (Diagnosis of pulmonary embolism in pregnant women. Scintigraphy or computer tomography?). Lakartidningen 2010;107:989–94.

33.

Parker MS, Hui FK, Camacho MA, Chung JK, Broga DW, Sethi NN. Female breast radiation exposure during CT pulmonary angiography. AJR Am J Roentgenol 2005;185(5):1228–33.PubMedCrossRef

Title: V/P SPECT as a diagnostic tool for pregnant women with suspected pulmonary embolism
Authors: Marika Bajc
Berit Olsson
Anders Gottsäter
Cecilia Hindorf
Jonas Jögi
Publication date: 01-07-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 8/2015
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-015-3056-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

V/P SPECT as a diagnostic tool for pregnant women with suspected pulmonary embolism

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2015

Endotracheal metastasis from colorectal cancer

ImmunoPET of tissue factor expression in triple-negative breast cancer with a radiolabeled antibody Fab fragment

68Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate?

A multicentre comparison of quantitative 90Y PET/CT for dosimetric purposes after radioembolization with resin microspheres

Thoracic staging of non-small-cell lung cancer using integrated 18F-FDG PET/MR imaging: diagnostic value of different MR sequences

Peptide receptor radionuclide therapy with 90Y/177Lu-labelled peptides for inoperable head and neck paragangliomas (glomus tumours)