title: Modified PISAPED Criteria in Combination with Ventilation Scintigraphic Finding for Predicting Acute Pulmonary Embolism.
abstract: This prospective clinical study aimed at assessing three pulmonary scintigraphic algorithms to detect acute pulmonary embolism (PE): Lung ventilation/perfusion (V/Q) scintigraphy along with modified prospective investigation of pulmonary embolism diagnosis (PIOPED) criteria; lung perfusion scintigraphy along with prospective investigative study of acute pulmonary embolism diagnosis (PISAPED) criteria; and lung perfusion scan in combination with ventilation scan, along with modified PISAPED criteria, which were newly developed. Patients with suspicion of PE were eligible for this study if they had no abnormal chest x-ray. Their diagnostic workup included a clinical assessment, a pulmonary V/Q scintigraphy, and CT pulmonary angiography (CTPA), as well as a clinical outcome assessment over a period of 24 weeks. Referred to the final clinical diagnosis of patients, the sensitivity and specificity of each algorithm were evaluated. The diagnostic performance of each algorithm by the area under the maximum likelihood fitted receiver operating characteristic (ROC) curve was determined. With respect to the PISAPED criteria, the sensitivity was 60.8% and specificity was 87.3%. No patient was classified into nondiagnostic category. The PIOPED criteria showed that the sensitivity was 95.0% and specificity was 88.2%, while 57.4% of the patients were in nondiagnostic category. The areas under the ROC curve constructed from the PISAPED criteria results and the modified PIOPED criteria results were 0.734 and 0.859 (P < 0.01), respectively. The modified PISAPED criteria demonstrated that the sensitivity was 83.8% and specificity was 89.1%. No patient was classified into nondiagnostic category. The area under the ROC curve constructed from modified PISAPED criteria was 0.864 (P < 0.01). Perfusion scans used with ventilation scans and modified PISAPED criteria may increase the diagnostic accuracy of pulmonary scintigraphy for acute PE, compared with the two major algorithms.
authors.affiliation: Department of Nuclear Sciences and Applications, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Watanabe
authors.affiliation: Department of Nuclear Medicine, University Medical Center, Ljubljana, Slovenia.
authors.forename: Jure
authors.initials: J
authors.lastname: Fettich
authors.affiliation: Department of Nuclear Medicine, Ankara University, Ankara, Turkey.
authors.forename: Nurie Özlem
authors.initials: NÖ
authors.lastname: Küçük
authors.affiliation: Department of Nuclear Medicine, University Hospital, University of Strava, Ostrava, Czech Republic.
authors.forename: Otakar
authors.initials: O
authors.lastname: Kraft
authors.affiliation: Nuclear Medicine Service, Spanish Association Hospital, Montevideo, Uruguay.
authors.forename: Fernando
authors.initials: F
authors.lastname: Mut
authors.affiliation: Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
authors.forename: Partha
authors.initials: P
authors.lastname: Choudhury
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Surendra K
authors.initials: SK
authors.lastname: Sharma
authors.affiliation: Kyoto Medical Science College, Kyoto, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Endo
authors.affiliation: Department of Nuclear Sciences and Applications, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Dondi
keywords: Acute pulmonary embolism; PISAPED criteria; modified prospective investigation of pulmonary embolism diagnosis criteria; modified prospective investigative study of acute pulmonary embolism diagnosis criteria; pulmonary scintigraphy