title: [A comparison of ventilation/perfusion single photon emission CT and CT pulmonary angiography for diagnosis of pulmonary embolism].
abstract: OBJECTIVE
  To assess the diagnostic accuracy of ventilation/perfusion (V/Q) single photon emission CT (SPECT) as compared to computed tomographic pulmonary angiography (CTPA) for pulmonary embolism (PE).
  
  
  METHODS
  In this prospective multicenter study, 111 patients in whom acute or sub-acute PE was clinically confirmed or suspected were enrolled. The patients underwent one-day method V/Q lung scan (including SPECT and planar imaging) within 3 days before and after completion of CTPA. The European Association of Nuclear Medicine (EANM) guidelines for ventilation/perfusion scintigraphy (2009) reference was used as the evaluation criteria of V/Q SPECT imaging. The refined modified prospective investigation of pulmonary embolism diagnosis (RM-PIOPED) criteria was used for evaluation of planar imaging. According to the direct and indirect signs of PE, the imaging of CTPA was evaluated. All patients were followed for at least 6 months. A diagnosis was finally made by consensus of respiratory physicians, radiologists and nuclear medicine physicians based on the clinical data, laboratory tests, imaging features and follow-up results. The difference among diagnostic methods was evaluated for significance using chi-square test. The receiver operator characteristic (ROC) curve was drawn according to the results of the 3 diagnostic tests. The area under ROC curve (AUC) was calculated and compared. P < 0.05 was considered statistically significant.
  
  
  RESULTS
  Among the 111 patients, PE was confirmed in 80, and excluded in 31. The diagnostic sensitivity/specificity/accuracy of V/Q SPECT, planar imaging, and CTPA were 85.9%/93.5%/88.1%, 75.7%/92.9%/81.4%, and 85.5%/90.0%/86.8%, respectively. By ROC curve analysis, the AUC values of V/Q SPECT, planar imaging and CTPA were 0.898, 0.838, and 0.877, respectively; with 95% confidence intervals [CI] 0.831 to 0.966, 0.759 to 0.917, and 0.801 to 0.954, respectively. The area of the fitted smooth ROC curve was statistically significant (P < 0.05) as compared with the area under the reference line.
  
  
  CONCLUSIONS
  The results indicate that SPECT V/Q imaging is superior to V/Q planar scan and CTPA in the diagnosis of PE.
authors.affiliation: Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors.forename: Jing-jing
authors.initials: JJ
authors.lastname: Meng
authors.forename: Li-jun
authors.initials: LJ
authors.lastname: Zhang
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Fang
authors.forename: Hao-jie
authors.initials: HJ
authors.lastname: Dai
authors.forename: Jue
authors.initials: J
authors.lastname: Yan
authors.forename: Tie
authors.initials: T
authors.lastname: Wang
authors.forename: Zhi-ming
authors.initials: ZM
authors.lastname: Yao
authors.forename: Jia
authors.initials: J
authors.lastname: He
authors.forename: Mei
authors.initials: M
authors.lastname: Li
authors.forename: Hong-zhi
authors.initials: HZ
authors.lastname: Mi
authors.forename: Jian
authors.initials: J
authors.lastname: Jiao
authors.forename: Yu-min
authors.initials: YM
authors.lastname: Zheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012123:Pulmonary Ventilation; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014692:Ventilation-Perfusion Ratio; D055815:Young Adult