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Research ArticleContinuing Education

V/Q SPECT and SPECT/CT in Pulmonary Embolism

Geoffrey M. Currie and Dale L. Bailey
Journal of Nuclear Medicine Technology March 2023, 51 (1) 9-15; DOI: https://doi.org/10.2967/jnmt.122.264880
Geoffrey M. Currie
1Charles Sturt University, Wagga Wagga, New South Wales, Australia, and Baylor College of Medicine, Houston, Texas; and
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Dale L. Bailey
2Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia
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Figures

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  • FIGURE 1.
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    FIGURE 1.

    Planar V/Q scan with single mismatched perfusion defect (arrow) suggestive of intermediate probability of pulmonary embolism. LAO = left anterior oblique; LPO = left posterior oblique; RAP = right anterior oblique; RPO = right posterior oblique. (Reprinted from (5).)

  • FIGURE 2.
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    FIGURE 2.

    For same patient study as outlined in Figure 1, planar V/Q scan after SPECT with representative slices demonstrating multiple defects (arrows), indicating more widespread pulmonary emboli. (Reprinted from (5).)

  • FIGURE 3.
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    FIGURE 3.

    Slice-by-slice V/Q pairs for SPECT data with arrows highlighting mismatch defect typical of pulmonary embolism. (Reprinted from (26).)

  • FIGURE 4.
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    FIGURE 4.

    Representative slices for ventilation (top), perfusion (middle), and parametric V:Q ratio images (bottom), with positive segments for pulmonary embolism denoted by darker shading on parametric images. (Reprinted with permission of (27).)

  • FIGURE 5.
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    FIGURE 5.

    Representative SPECT/CT images of lung ventilation (top) and perfusion (bottom) demonstrating segmental perfusion defect (arrow in D and F) in left lower lobe with no CT opacity or matched ventilation defect consistent with pulmonary embolism. (Reprinted from (3).)

  • FIGURE 6.
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    FIGURE 6.

    Fusion of SPECT and low-dose CT showing opacity (arrows) on CT corresponding to perfusion defect producing matching defect consistent with lung metastases. (Reprinted from (5).)

  • FIGURE 7.
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    FIGURE 7.

    Fused perfusion SPECT and CTPA showing pulmonary emboli (arrows) bilaterally in arteries with associated perfusion defects on SPECT. (Reprinted with permission of (4).)

Tables

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    TABLE 1.

    Summary of Results of 24-Hour Social Media Poll Conducted August 22, 2022

    Imaging typeUnited States (%) (n = 222)Australia (%) (n = 154)
    Planar only66.73.2
    Planar and SPECT2.71.9
    SPECT only with planar generated from SPECT11.327.3
    Planar and SPECT/CT12.63.9
    SPECT/CT only with planar generated from SPECT5.461.1
    SPECT/CT only1.42.6
    • View popup
    TABLE 2.

    Characteristics Enhanced by SPECT over Planar Imaging for V/Q Scan

    ParameterPlanarV/Q SPECTV/Q SPECT/CTCTPAQ/CTSource
    Sensitivity85%100%———20
    76%97%———8
    —97%97%68%93%21
    —97%—86%—22
    ———83%—23
    87%91%100%—100%13
    HighVery highHighModerateVery high5,24
    Specificity100%95%———20
    78%96%———25
    85%91%———8
    —88%100%100%51%21
    —91%—98%—22
    ———96%—23
    40%56%98%—52%13
    ModerateHighVery highVery highLow5,24
    Other findingsUncommonUncommonOftenOftenOften5,24
    Radiation doseLowLowHighVery highHigh5,24
    Technical issuesRareRareUncommonOftenUncommon5,24
    AvailabilityDuring hours*During hours*During hours*During and after hours—5,24
    Adverse effectsNoNoNoYesNo5,24
    • ↵* Availability after hours is possible in some nuclear medicine departments.

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Journal of Nuclear Medicine Technology: 51 (1)
Journal of Nuclear Medicine Technology
Vol. 51, Issue 1
March 1, 2023
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V/Q SPECT and SPECT/CT in Pulmonary Embolism
Geoffrey M. Currie, Dale L. Bailey
Journal of Nuclear Medicine Technology Mar 2023, 51 (1) 9-15; DOI: 10.2967/jnmt.122.264880

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V/Q SPECT and SPECT/CT in Pulmonary Embolism
Geoffrey M. Currie, Dale L. Bailey
Journal of Nuclear Medicine Technology Mar 2023, 51 (1) 9-15; DOI: 10.2967/jnmt.122.264880
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  • Article
    • Abstract
    • THE V/Q TEST
    • SPECT V/Q
    • SPECT/CT V/Q
    • SPECT/CT V/Q AND CTPA
    • CONCLUSION
    • DISCLOSURE
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    • REFERENCES
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Keywords

  • lung imaging
  • V/Q
  • SPECT
  • SPECT/CT
  • CTPA
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