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Thromb Haemost 2023; 123(07): 700-713
DOI: 10.1055/a-1986-8878
Stroke, Systemic or Venous Thromboembolism

Diagnostic Accuracy of V/Q and Q SPECT/CT in Patients with Suspected Acute Pulmonary Embolism: A Systematic Review and Meta-analysis

Alessandro Squizzato 
1   Research Center on Thromboembolic Disorders and Antithrombotic Therapies, ASST Lariana, University of Insubria, Como, Italy
,
Alice Venturini
2   Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese and Como, Italy
,
Valentina Pelitti
2   Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese and Como, Italy
,
Beatrice Bellini
2   Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese and Como, Italy
,
Matteo Bernasconi
3   Internal Medicine Unit, ASST Sette Laghi, Cittiglio, Italy
,
Tommaso Depalo
4   Nuclear Medicine Unit, ‘Sant’Anna' Hospital, ASST Lariana, Como, Italy
,
Angelo Corso
4   Nuclear Medicine Unit, ‘Sant’Anna' Hospital, ASST Lariana, Como, Italy
,
Nicoletta Riva 
5   Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
› Author Affiliations Funding None.
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Abstract

Background Computed tomography (CT) pulmonary angiography has simplified the diagnostic approach to patients with clinically suspected acute pulmonary embolism (PE), but alternative imaging tests are still advocated. We aimed to systematically assess the diagnostic accuracy of ventilation/perfusion (V/Q) and Q single-photon emission CT combined with low-dose CT (SPECT/CT) for PE diagnosis.

Methods Studies evaluating the diagnostic accuracy of SPECT/CT for the diagnosis of acute PE were systematically searched in MEDLINE and EMBASE databases (up to August 2022). The QUADAS-2 tool was used for risk-of-bias assessment of the primary studies. A bivariate random-effects regression approach was used for summary estimates of both sensitivity and specificity. The PROSPERO registration number is CRD42021276538.

Results Eight studies, for a total of 1,086 patients, were included. The risk of bias of all included studies was high. The weighted mean prevalence of PE was 27.1% at the random-effects model. The SPECT/CT bivariate weighted mean sensitivity was 96% (95% confidence interval [CI]: 93–98%), with a bivariate weighted mean specificity of 95% (95% CI: 90–97%). At subgroup analysis, for V/Q SPECT/CT bivariate weighted mean sensitivity and specificity were 96% (95% CI: 89–98%) and 96% (95% CI: 91–99%), while for Q SPECT/CT they were 96% (95% CI: 92–98%) and 84% (95% CI: 66–93%), respectively.

Conclusion V/Q SPECT/CT has high sensitivity and specificity for the diagnosis of acute PE, meanwhile Q SPECT/CT has high sensitivity but limited specificity for the diagnosis of PE. Management studies will conclusively ascertain the actual role of SPECT/CT in the diagnostic workup of patients with suspected acute PE.

Keywords

SPECT - pulmonary embolism - diagnosis - sensitivity and specificity - systematic review - meta-analysis

Authors' Contribution

A.S., A.V., and N.R. were responsible for the conception and design of the study. A.V., V.P., and B.B. acquired the data. N.R. performed the statistical analysis. All authors interpretated the data, drafted the manuscript, made critical revisions of the manuscript for important intellectual content, and provided the final approval of the manuscript.




Publication History

Received: 29 March 2022

Accepted: 23 November 2022

Accepted Manuscript online:
24 November 2022

Article published online:
31 January 2023

© 2023. Thieme. All rights reserved.

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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