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Boktor RR, Lee ST, Bom HSH. Is it Possible to Monitor CTEPH without Ventilation Study? Nucl Med Mol Imaging 2024; 58:389-391. [PMID: 39635634 PMCID: PMC11612038 DOI: 10.1007/s13139-024-00867-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 03/21/2024] [Accepted: 05/26/2024] [Indexed: 12/07/2024] Open
Affiliation(s)
- Raef R. Boktor
- Department of Molecular Imaging and Therapy, Austin Health, 145 Studley Rd, Heidelberg, VIC 3084 Australia
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC Australia
| | - Sze Ting Lee
- Department of Molecular Imaging and Therapy, Austin Health, 145 Studley Rd, Heidelberg, VIC 3084 Australia
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC Australia
| | - Hee-Seung Henry Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Jeonnam, South Korea
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2
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Le Roux PY, Le Pennec R, Salaun PY, Zuckier LS. Scintigraphic Diagnosis of Acute Pulmonary Embolism: From Basics to Best Practices. Semin Nucl Med 2023; 53:743-751. [PMID: 37142520 DOI: 10.1053/j.semnuclmed.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
In this article the technique, interpretation, and diagnostic performance of scintigraphy for the diagnosis of acute pulmonary embolism (PE) are reviewed. Lung scintigraphy has stood the test of time as a reliable and validated examination for the determination of PE. Ventilation/perfusion (V/Q) lung scintigraphy assesses the functional consequences of the clot on its downstream vascular bed in conjunction with the underlying ventilatory status of the affected lung region, in contrast to CT pulmonary angiography (CTPA), which visualizes presence of the clot within affected vessels. Most-commonly used ventilation radiopharmaceuticals are Technetium-99m labeled aerosols (such as 99mTechnetium-DTPA), or ultrafine particle suspensions (99mTc-Technegas) which reach the distal lung in proportion to regional distribution of ventilation. Perfusion images are obtained after intravenous administration 99mTc-labeled macro-aggregated albumin particles which lodge in the distal pulmonary capillaries. Both planar and tomographic methods of imaging, each favored in different geographical regions, will be described. Guidelines for interpretation of scintigraphy have been issues by both the Society of Nuclear Medicine and Molecular Imaging, and by the European Association of Nuclear Medicine. Breast tissue is particularly radiosensitive during pregnancy due to its highly proliferative state and many guidelines recommend use of lung scintigraphy rather than CTPA in this population. Several maneuvers are available in order to further reduce radiation exposure including reducing radiopharmaceutical dosages or omitting ventilation altogether, functionally converting the study to a low-dose screening examination; if perfusion defects are present, further testing is necessary. Several groups have also performed perfusion-only studies during the COVID epidemic in order to reduce risk of respiratory contagion. In patients where perfusion defects are present, further testing is again necessary to avoid false-positive results. Improved availability of personal protective equipment, and reduced risk of serious infection, have rendered this maneuver moot in most practices. First introduced 60 years ago, subsequent advances in radiopharmaceutical development and imaging methods have positioned lung scintigraphy to continue to play an important clinical and research role in the diagnosis of acute PE.
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Affiliation(s)
- Pierre-Yves Le Roux
- Service de Médecine Nucléaire, CHU Brest, INSERM UMR 1304 (GETBO), Université de Bretagne Occidentale, Brest, France
| | - Romain Le Pennec
- Service de Médecine Nucléaire, CHU Brest, INSERM UMR 1304 (GETBO), Université de Bretagne Occidentale, Brest, France
| | - Pierre-Yves Salaun
- Service de Médecine Nucléaire, CHU Brest, INSERM UMR 1304 (GETBO), Université de Bretagne Occidentale, Brest, France
| | - Lionel S Zuckier
- Division of Nuclear Medicine, Department of Radiology, 1695A Eastchester Road, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY.
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Vaz N, Franquet E, Heidari P, Chow DZ, Jacene HA, Ng TSC. COVID-19: Findings in nuclear medicine from head to toe. Clin Imaging 2023; 99:10-18. [PMID: 37043868 PMCID: PMC10081937 DOI: 10.1016/j.clinimag.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
COVID-19 is a multisystemic disease, and hence its potential manifestations on nuclear medicine imaging can extend beyond the lung. Therefore, it is important for the nuclear medicine physician to recognize these manifestations in the clinic. While FDG-PET/CT is not indicated routinely in COVID-19 evaluation, its unique capability to provide a functional and anatomical assessment of the entire body means that it can be a powerful tool to monitor acute, subacute, and long-term effects of COVID-19. Single-photon scintigraphy is routinely used to assess conditions such as pulmonary embolism, cardiac ischemia, and thyroiditis, and COVID-19 may present in these studies. The most common nuclear imaging finding of COVID-19 vaccination to date is hypermetabolic axillary lymphadenopathy. This may pose important diagnostic and management dilemmas in oncologic patients, particularly those with malignancies where the axilla constitutes a lymphatic drainage area. This article aims to summarize the relevant literature published since the beginning of the pandemic on the intersection between COVID-19 and nuclear medicine.
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Affiliation(s)
- Nuno Vaz
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United States.
| | - Elisa Franquet
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United States
| | - Pedram Heidari
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - David Z Chow
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - Heather A Jacene
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United States
| | - Thomas S C Ng
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
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4
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Tan TH, Ismail R. Utility of Lung Perfusion SPECT/CT in Detection of Pulmonary Thromboembolic Disease: Outcome Analysis. Nucl Med Mol Imaging 2023; 57:1-8. [PMID: 35013684 PMCID: PMC8731677 DOI: 10.1007/s13139-021-00726-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose To evaluate the clinical outcome of Q-SPECT/CT in pulmonary thromboembolic disease. Methods From Jan 2020 to Jan 2021, 30 consecutive patients (M:F = 8:22; median age = 52 year (21-89)) suspected of having acute pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension (CTEPH) were referred for non-contrasted Q-SPECT/CT. All patients were COVID-19 PCR negative. MSKCC Q-SPECT/CT and/or PISAPED criteria were used to determine the presence of thromboembolic disease in Q-SPECT/CT. Final diagnosis was made based on composite reference standards that included at least 2-month clinical cardiorespiratory assessment and follow-up imaging. Results Q-SPECT/CT was positive in 19 patients: indeterminate in 1 and 10 were negative. Three false positive cases were observed during follow-up. Of the remaining 16 true positives, all patients' cardiorespiratory symptom were improved or stabilised after treatment with anticoagulants. The overall sensitivity, specificity, PPV, NPV and accuracy of Q-SPECT/CT were 100% (95% CI, 79.41-100%), 78.57% (95% CI, 49.20-95.34%), 84.21% (95% CI, 66.41-93.57%), 100% and 90.00% (95% CI, 73.47-97.89%) respectively. Conclusions In the current COVID-19 pandemic, Q-SPECT/CT can be an alternative modality to detect pulmonary thromboembolic disease. Normal Q-SPECT/CT excludes pulmonary thromboembolic disease with high degree of certainty. However, false positive has been observed.
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Affiliation(s)
- Teik Hin Tan
- Nuclear Medicine, Sunway Medical Centre, 5, Jalan Lagoon Selatan, Bandar Sunway, 47500 Petaling Jaya, Selangor Malaysia
| | - Rosmadi Ismail
- Internal Medicine, Sunway Medical Centre, 5, Jalan Lagoon Selatan, Bandar Sunway, 47500 Petaling Jaya, Selangor Malaysia
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Le Roux PY, Schafer WM, Blanc-Beguin F, Tulchinsky M. Ventilation Scintigraphy With Radiolabeled Carbon Nanoparticulate Aerosol (Technegas): State-of-the-Art Review and Diagnostic Applications to Pulmonary Embolism During COVID-19 Pandemic. Clin Nucl Med 2023; 48:8-17. [PMID: 36288606 PMCID: PMC9762616 DOI: 10.1097/rlu.0000000000004426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/01/2022] [Indexed: 12/14/2022]
Abstract
ABSTRACT Invented and first approved for clinical use in Australia 36 years ago, Technegas is the technology that enabled ventilation scintigraphy with 99m Tc-labeled carbon nanoparticles ( 99m Tc-CNP). The US Food and Drug Administration (FDA) has considered this technology for more than 30 years but only now is getting close to approving it. Meanwhile, more than 4.4 million patients benefited from this technology in 64 countries worldwide. The primary application of 99m Tc-CNP ventilation imaging is the diagnostic evaluation for suspicion of pulmonary embolism using ventilation-perfusion quotient (V/Q) imaging. Because of 99m Tc-CNP's long pulmonary residence, tomographic imaging emerged as the preferred V/Q methodology. The FDA-approved ventilation imaging agents are primarily suitable for planar imaging, which is less sensitive. After the FDA approval of Technegas, the US practice will likely shift to tomographic V/Q. The 99m Tc-CNP use is of particular interest in the COVID-19 pandemic because it offers an option of a dry radioaerosol that takes approximately only 3 to 5 tidal breaths, allowing the shortest exposure to and contact with possibly infected patients. Indeed, countries where 99m Tc-CNP was approved for clinical use continued using it throughout the COVID-19 pandemic without known negative viral transmission consequences. Conversely, the ventilation imaging was halted in most US facilities from the beginning of the pandemic. This review is intended to familiarize the US clinical nuclear medicine community with the basic science of 99m Tc-CNP ventilation imaging and its clinical applications, including common artifacts and interpretation criteria for tomographic V/Q imaging for pulmonary embolism.
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Affiliation(s)
- Pierre-Yves Le Roux
- From the INSERM (National Institute of Health and Medical Research) and Department of Nuclear Medicine, University Hospital of Brest, CHRU Brest, UMR 1304, GETBO, Brest, France
| | - Wolfgang M. Schafer
- Nuclear Medicine Clinic, Maria Hilf Hospital Inc, Academic Teaching Hospital of RWTH Aachen University, Moenchengladbach, Germany
| | - Frédérique Blanc-Beguin
- From the INSERM (National Institute of Health and Medical Research) and Department of Nuclear Medicine, University Hospital of Brest, CHRU Brest, UMR 1304, GETBO, Brest, France
| | - Mark Tulchinsky
- Section of Nuclear Medicine, Department of Radiology, Penn State University Hospital, Hershey, PA
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6
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Tipre DN, Cidon M, Moats RA. Imaging Pulmonary Blood Vessels and Ventilation-Perfusion Mismatch in COVID-19. Mol Imaging Biol 2022; 24:526-536. [PMID: 35041149 PMCID: PMC8764889 DOI: 10.1007/s11307-021-01700-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 12/16/2022]
Abstract
COVID-19 hypoxemic patients although sharing a same etiology (SARS-CoV-2 infection) present themselves quite differently from one another. Patients also respond differently to prescribed medicine and to prone Vs supine bed positions. A severe pulmonary ventilation-perfusion mismatch usually triggers moderate to severe COVID-19 cases. Imaging can aid the physician in assessing severity of COVID-19. Although useful for their portability X-ray and ultrasound serving on the frontline to evaluate lung parenchymal abnormalities are unable to provide information about pulmonary vasculature and blood flow redistribution which is a consequence of hypoxemia in COVID-19. Advanced imaging modalities such as computed tomography, single-photon emission tomography, and electrical impedance tomography use a sharp algorithm visualizing pulmonary ventilation-perfusion mismatch in the abnormal and in the apparently normal parenchyma. Imaging helps to access the severity of infection, lung performance, ventilation-perfusion mismatch, and informs strategies for medical treatment. This review summarizes the capacity of these imaging modalities to assess ventilation-perfusion mismatch in COVID-19. Despite having limitations, these modalities provide vital information on blood volume distribution, pulmonary embolism, pulmonary vasculature and are useful to assess severity of lung disease and effectiveness of treatment in COVID-19 patients.
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Affiliation(s)
- Dnyanesh N Tipre
- Translational Biomedical Imaging Laboratory, Department of Radiology, Children's Hospital Los Angeles, The Saban Research Institute, 4650 Sunset Blvd Rm 305, Los Angeles, CA, USA.
| | - Michal Cidon
- Department of Rheumatology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Rex A Moats
- Translational Biomedical Imaging Laboratory, Department of Radiology, Children's Hospital Los Angeles, The Saban Research Institute, 4650 Sunset Blvd Rm 305, Los Angeles, CA, USA
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Ilicak E, Ozdemir S, Schad LR, Weis M, Schoenberg SO, Zöllner FG, Zapp J. Phase-cycled balanced SSFP imaging for non-contrast-enhanced functional lung imaging. Magn Reson Med 2022; 88:1764-1774. [PMID: 35608220 DOI: 10.1002/mrm.29302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To introduce phase-cycled balanced SSFP (bSSFP) acquisition as an alternative in Fourier decomposition MRI for improved robustness against field inhomogeneities. METHODS Series 2D dynamic lung images were acquired in 5 healthy volunteers at 1.5 T and 3 T using bSSFP sequence with multiple RF phase increments and compared with conventional single RF phase increment acquisitions. The approach was evaluated based on functional map homogeneity analysis, while ensuring image and functional map quality by means of SNR and contrast-to-noise ratio analyses. RESULTS At both field strengths, functional maps obtained with phase-cycled acquisitions displayed improved robustness against local signal losses compared with single-phase acquisitions. The coefficient of variation (mean ± SD, across volunteers) measured in the ventilation maps resulted in 29.7 ± 2.6 at 1.5 T and 37.5 ± 3.1 at 3 T for phase-cycled acquisitions, compared with 39.9 ± 5.2 at 1.5 T and 49.5 ± 3.7 at 3 T for single-phase acquisitions, indicating a significant improvement ( p < 0.05 $$ p<0.05 $$ ) in ventilation map homogeneity. CONCLUSIONS Phase-cycled bSSFP acquisitions improve robustness against field inhomogeneity artifacts and significantly improve ventilation map homogeneity at both field strengths. As such, phase-cycled bSSFP may serve as a robust alternative in lung function assessments.
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Affiliation(s)
- Efe Ilicak
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Safa Ozdemir
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Meike Weis
- Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jascha Zapp
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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8
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Suh M. In the COVID-19 Era, Is It OK to Perform a Perfusion-Only SPECT/CT for the Diagnosis of Pulmonary Embolism? Nucl Med Mol Imaging 2022; 56:67-70. [PMID: 35261689 PMCID: PMC8890985 DOI: 10.1007/s13139-022-00740-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Minseok Suh
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 03080 Republic of Korea
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Nguyen DM, Duong Trong L, McEwan AL. An efficient and fast multi-band focused bioimpedance solution with EIT-based reconstruction for pulmonary embolism assessment: a simulation study from massive to segmental blockage. Physiol Meas 2022; 43. [PMID: 34986471 DOI: 10.1088/1361-6579/ac4830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/05/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pulmonary embolism (PE) is an acute condition that blocks the perfusion to the lungs and is a common complication of Covid-19. However, PE is often not diagnosed in time, especially in the pandemic time due to complicated diagnosis protocol. In this study, a non-invasive, fast and efficient bioimpedance method with the EIT-based reconstruction approach is proposed to assess the lung perfusion reliably. APPROACH Some proposals are presented to improve the sensitivity and accuracy for the bioimpedance method: (1) a new electrode configuration and focused pattern to help study deep changes caused by PE within each lung field separately, (2) a measurement strategy to compensate the effect of different boundary shapes and varied respiratory conditions on the perfusion signals and (3) an estimator to predict the lung perfusion capacity, from which the severity of PE can be assessed. The proposals were tested on the first-time simulation of PE events at different locations and degrees from segmental blockages to massive blockages. Different object boundary shapes and varied respiratory conditions were included in the simulation to represent for different populations in real measurements. RESULTS The correlation between the estimator and the perfusion was very promising (R = 0.91, errors < 6%). The measurement strategy with the proposed configuration and pattern has helped stabilize the estimator to non-perfusion factors such as the boundary shapes and varied respiration conditions (3-5% errors). SIGNIFICANCE This promising preliminary result has demonstrated the proposed bioimpedance method's capability and feasibility, and might start a new direction for this application.
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Affiliation(s)
- Duc Minh Nguyen
- School of Biomedical Engineering, University of Sydney - Camperdown and Darlington Campus SciTech Library, Room 415, Level 4, Link Building Faculty of Engineering and IT, The University of Sydney, Darlington, Hanoi, New South Wales, 100000, AUSTRALIA
| | - Luong Duong Trong
- School of Electronics and Telecommunication, Hanoi University of Science and Technology, No. 1, Dai Co Viet Street, Hai Ba Trung District, Hanoi, 100000, VIET NAM
| | - Alistair L McEwan
- School of Biomedical Engineering, The University of Sydney, Room 415, Level 4, Link Building Faculty of Engineering and IT, The University of Sydney, Darlington NSW 2006, Australia, Sydney, New South Wales, 2006, AUSTRALIA
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10
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Abstract
One of the major effects of the COVID-19 pandemic within nuclear medicine was to halt performance of lung ventilation studies, due to concern regarding spread of contaminated secretions into the ambient air. A number of variant protocols for performing lung scintigraphy emerged in the medical literature which minimized or eliminated the ventilation component, due to the persistent need to provide this critical diagnostic service without compromising the safety of staff and patients. We have summarized and reviewed these protocols, many of which are based on concepts developed earlier in the history of lung scintigraphy. It is possible that some of these interim remedies may gain traction and earn a more permanent place in the ongoing practice of nuclear medicine.
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Affiliation(s)
- Lionel S Zuckier
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY.
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11
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Le Roux PY, Bonnefoy PB, Bahloul A, Denizot B, Barres B, Moreau-Triby C, Girma A, Pallardy A, Ceyrat Q, Sarda-Mantel L, Razzouk-Cadet M, Zsigmond R, Florent C, Karcher G, Salaun PY. Lung scintigraphy for pulmonary embolism diagnosis in COVID-19 patients: a multicenter study. J Nucl Med 2021; 63:1070-1074. [PMID: 34649944 PMCID: PMC9258571 DOI: 10.2967/jnumed.121.262955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
In patients with novel coronavirus disease 2019 (COVID-19) referred for lung scintigraphy for suspected pulmonary embolism (PE), there has been an ongoing debate within the nuclear medicine community as to whether and when the ventilation study should be performed. Indeed, while PE diagnosis typically relies on the recognition of ventilation/perfusion (V/P) mismatched defects, the ventilation procedure potentially increases the risk of contamination to the healthcare workers. The primary aim of this study was to assess the role of ventilation imaging when performing lung scintigraphy for suspected PE in COVID-19 patients. The secondary aim was to describe practices and imaging findings in this specific population. Methods: A national registry was created in collaboration with the French Society of Nuclear Medicine to collect lung scans performed in COVID-19 patients for suspected PE. Practices of departments were assessed regarding imaging protocols and aerosol precautions. A retrospective review of V/P SPECT/CT scans was then conducted. Two physicians blinded to clinical information reviewed each case by sequentially using P SPECT, P SPECT/CT and V/P SPECT/CT images. Scans were classified in one of the four following categories: patients for whom PE could reasonably be excluded based on 1) perfusion SPECT only, 2) P SPECT/CT, 3) V/P SPECT/CT; or 4) patients with mismatched defects suggestive of PE according to the EANM criteria. Results: Data from 12 French nuclear medicine departments were collected. Lung scans were performed between 03/2020 and 04/2021. Personal protective equipment and dedicated cleaning procedures were used in all departments. Out of the 145 V/Q SPECT/CT included in the central review, PE could be excluded using only P SPECT, P SPECT/CT and V/P SPECT/CT in 27 (19%), 55 (38%) and 45 (31%) patients, respectively. V/P SPECT/CT was positive for PE in 18 (12%) patients, including 12 (67%) with a low burden of PE (≤10%). Conclusion: In this population of COVID-19 patients assessed with lung scintigraphy, PE could be confidently excluded without ventilation in only 57% of patients. Ventilation imaging was required to confidently rule out PE in 31% of patients. Overall, the prevalence of PE was low (12%).
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Affiliation(s)
| | | | | | - Benoit Denizot
- Centre Hospitalier Alpes Léman, Service de Médecine Nucléaire
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12
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Trunz LM, Lee P, Lange SM, Pomeranz CL, Needleman L, Ford RW, Karambelkar A, Sundaram B. Imaging approach to COVID-19 associated pulmonary embolism. Int J Clin Pract 2021; 75:e14340. [PMID: 33966326 PMCID: PMC8237008 DOI: 10.1111/ijcp.14340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022] Open
Abstract
The novel coronavirus disease-2019 (COVID-19) illness and deaths, caused by the severe acute respiratory syndrome coronavirus-2, continue to increase. Multiple reports highlight the thromboembolic complications, such as pulmonary embolism (PE), in COVID-19. Imaging plays an essential role in the diagnosis and management of COVID-19 patients with PE. There continues to be a rapid evolution of knowledge related to COVID-19 associated PE. This review summarises the current understanding of prevalence, pathophysiology, role of diagnostic imaging modalities, and management, including catheter-directed therapy for COVID-19 associated PE. It also describes infection control considerations for the radiology department while providing care for patients with COVID-19 associated PE.
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Affiliation(s)
- Lukas M. Trunz
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Patrick Lee
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Steven M. Lange
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | | | | | - Robert W. Ford
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Ajit Karambelkar
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
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13
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Afshar-Oromieh A, Prosch H, Schaefer-Prokop C, Bohn KP, Alberts I, Mingels C, Thurnher M, Cumming P, Shi K, Peters A, Geleff S, Lan X, Wang F, Huber A, Gräni C, Heverhagen JT, Rominger A, Fontanellaz M, Schöder H, Christe A, Mougiakakou S, Ebner L. A comprehensive review of imaging findings in COVID-19 - status in early 2021. Eur J Nucl Med Mol Imaging 2021; 48:2500-2524. [PMID: 33932183 PMCID: PMC8087891 DOI: 10.1007/s00259-021-05375-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Abstract
Medical imaging methods are assuming a greater role in the workup of patients with COVID-19, mainly in relation to the primary manifestation of pulmonary disease and the tissue distribution of the angiotensin-converting-enzyme 2 (ACE 2) receptor. However, the field is so new that no consensus view has emerged guiding clinical decisions to employ imaging procedures such as radiography, computer tomography (CT), positron emission tomography (PET), and magnetic resonance imaging, and in what measure the risk of exposure of staff to possible infection could be justified by the knowledge gained. The insensitivity of current RT-PCR methods for positive diagnosis is part of the rationale for resorting to imaging procedures. While CT is more sensitive than genetic testing in hospitalized patients, positive findings of ground glass opacities depend on the disease stage. There is sparse reporting on PET/CT with [18F]-FDG in COVID-19, but available results are congruent with the earlier literature on viral pneumonias. There is a high incidence of cerebral findings in COVID-19, and likewise evidence of gastrointestinal involvement. Artificial intelligence, notably machine learning is emerging as an effective method for diagnostic image analysis, with performance in the discriminative diagnosis of diagnosis of COVID-19 pneumonia comparable to that of human practitioners.
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Affiliation(s)
- Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland.
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Cornelia Schaefer-Prokop
- Department of Radiology, Meander Medical Center, Amersfoort, Netherlands
- Department of Medical Imaging, Radboud University, Nijmegen, Netherlands
| | - Karl Peter Bohn
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Clemens Mingels
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Majda Thurnher
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Paul Cumming
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Alan Peters
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Silvana Geleff
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Adrian Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes T Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Matthias Fontanellaz
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stavroula Mougiakakou
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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14
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Zuckier LS. To everything there is a season: taxonomy of approaches to the performance of lung scintigraphy in the era of COVID-19. Eur J Nucl Med Mol Imaging 2021; 48:666-669. [PMID: 33159223 PMCID: PMC7647190 DOI: 10.1007/s00259-020-05100-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lionel S Zuckier
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center and the Albert Einstein College of Medicine, 1695A Eastchester Road, Bronx, NY, 10461, USA.
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