Lung Imaging with SPECT-CT. Michael M. Graham University of Iowa

Transcription

1 Lung Imaging with SPECT-CT Michael M. Graham University of Iowa

2 Timeline of Lung Scintigraphy Perfusion MAA Microspheres Ventilation Xe-133 Aerosol Technegas Imaging Planar SPECT SPECT/CT

3 Biersack HJ, et al. Single photon emission computed tomography of the lung: preliminary results. Eur J Nucl Med. 1982;7(4):

4 Touya JJ, et al. SPECT in the diagnosis of pulmonary thromboembolism. Semin Nucl Med. 1986; 16:

5 Collart JP, et al. Is a lung perfusion scan obtained by using single photon emission computed tomography able to improve the radionuclide diagnosis of pulmonary embolism? Nucl Med Commun. 2002; 23: Mont-Godinne Hospital, Université Catholique de Louvain, Yvoir, Belgium. The sensitivities for PE diagnosis were similar for planar and SPECT perfusion scans (80%), whereas SPECT had a higher specificity (96% vs 78%; P =0.01). SPECT correctly classified 8/9 intermediate and 31/32 low probability V/Q scans as negative.

6 Reinartz P, et al. Tomographic imaging in the diagnosis of pulmonary embolism: a comparison between V/Q lung scintigraphy in SPECT technique and multislice spiral CT. J Nucl Med. 2004; 45:

7 N=149 Clin Nucl Med 2015; 40: 553

8 Technegas Generator

9 Gutte H, et al. Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT: head-to-head comparison with multidetector CT angiography. J Nucl Med. 2009; 50:

10 Seminars in Nuclear Medicine V 40 November 2010 SPECT V/Q Imaging of the Lungs Edited by Bailey, DL and Roach, PJ Letter from the Editors: SPECT V/Q Imaging of the Lungs Leonard M. Freeman, M. Donald Blaufox Guest Editorial: Why SPECT for V/Q Lung Scanning? Dale L. Bailey, Paul J. Roach Transition from Planar to SPECT V/Q Scintigraphy: Rationale, Practicalities, and Challenges Paul J. Roach, Dale L. Bailey, Geoffrey P. Schembri, Paul A. Thomas V/Q Imaging in 2010: A Quick Start Guide Elizabeth A. Bailey, Dale L. Bailey, Paul J. Roach Methodology for Ventilation/Perfusion SPECT Marika Bajc, Brian Neilly, Massimo Miniati, Jan Mortensen, Björn Jonson V/Q SPECT and Computed Tomographic Pulmonary Angiography Michel Leblanc, Narinder Paul Radiation Dosimetry and Safety Issues in the Investigation of Pulmonary Embolism Geoffrey P. Schembri, Anne E. Miller, Richard Smart SPECT/CT in V/Q Scanning Paul J. Roach, Denis J. Gradinscak, Geoffrey P. Schembri, Elizabeth A. Bailey, Kathy P. Willowson, Dale L. Bailey V/Q SPECT: Utility for Investigation of Pulmonary Physiology Gregory G. King, Benjamin Harris, Sriram Mahadev SPECT Imaging of Pulmonary Emboli with Radiolabeled Thrombus-Specific Imaging Timothy A. Morris

11 SPECT V/Q Imaging at Iowa started in 2012 Ventilation with Tc-99m sulfur colloid (50 mci) SPECT imaging: 13 minutes; High Res; 60 stops Perfusion with Tc-99m MAA (6 mci) SPECT imaging: 11 minutes; High Res; 60 stops Reconstruct SPECT and generate planar images Display SPECT and planar images

12 Generation of Planar Images ANT RAO LAO RLAT LLAT RPO LPO POST

13 Normal VQ

14 Normal VQ SPECT

15 Lung Scan Interpretation Criteria Refined Modified PIOPED Grading Criteria PE is reported if there is a V/P mismatch of at least one segment or two sub-segments EANM Guidelines

16 Lung Scan Interpretation Criteria PE is reported if there is: V/P mismatch of at least one segment or two sub-segments that conforms to the pulmonary vascular anatomy No PE is reported if there is (are): Normal perfusion pattern Matched or reversed mismatch V/P defects Mismatch that does not have a lobar or segmental pattern Bajc M, Neilly JB, Miniati M, Schuemichen C, Meignan M, Jonson B; EANM Committee. EANM guidelines for ventilation/perfusion scintigraphy : Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging. 2009; 36:1356.

17 Le Roux PY, et al. Safety of V/Q SPECT for PE diagnosis. Eur J Nucl Med Mol Imaging. 2014; 41:1957. The final diagnostic conclusion was established by the physician responsible for patient care, based on clinical symptoms, laboratory test, V/Q SPECT and other imaging procedures performed. Patients in whom PE was deemed absent were not treated with anticoagulants and were followed up for 3 months. Positive is 1 segment or 2 sub-segments V/Q mismatch Specificity = 99.6% Sensitivity = 99.1%

18 Le Roux PY, et al. Safety of V/Q SPECT for PE diagnosis. Eur J Nucl Med Mol Imaging. 2014; 41:1957.

19 84 year old woman with dyspnea and mildly elevated right PA pressures concerning for pulmonary hypertension.

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21 Kan Y, Yuan L, Meeks JK, Li C, Liu W, Yang J. The accuracy of V/Q SPECT in the diagnosis of pulmonary embolism: a meta-analysis. Acta Radiol. 2015;56: Pooled Sensitivity = 0.96

22 Kan Y, Yuan L, Meeks JK, Li C, Liu W, Yang J. The accuracy of V/Q SPECT in the diagnosis of pulmonary embolism: a meta-analysis. Acta Radiol. 2015;56: Pooled Specificity= 0.97

23 USA Parker JA, et al. SNM practice guideline for lung scintigraphy 4.0. J Nucl Med Technol. 2012; 40: Issues requiring further clarification: There is considerable literature on SPECT lung scintigraphy, and there is emerging literature on SPECT/low-dose CT lung scintigraphy. However, there is currently no information about the comparison of these methods with planar imaging in a multiinstitutional setting. The criteria for interpretation of SPECT and SPECT/low-dose CT need to be established. Europe Current Status Bajc M, et al. EANM guidelines for ventilation/perfusion scintigraphy : Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging. 2009; 36: V/P(SPECT) is strongly preferred to V/P(PLANAR) as the former permits the accurate diagnosis of PE even in the presence of co-morbid diseases such as COPD and pneumonia. Technegas is preferred to DTPA in patients with COPD.

24 Is SPECT-CT better than SPECT alone?

25 Gutte H, et al. Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT: head-to-head comparison with multidetector CT angiography. J Nucl Med v50:

26 Gutte H, et al. Detection of pulmonary embolism with combined ventilationperfusion SPECT and low-dose CT: head-to-head comparison with multidetector CT angiography. J Nucl Med Dec;50(12): V/Q SPECT V/Q SPECT & CT Q SPECT & CT CT angio Sens=97% Spec=88% Sens=97% Spec=100% Sens=93% Spec=51% Sens=68% Spec=100%

27 Mortensen J, Gutte H. SPECT/CT and pulmonary embolism. Eur J Nucl Med Mol Imaging. 2014; 41 Suppl 1:S81-90.

28 Mortensen J, Gutte H. SPECT/CT and pulmonary embolism. Eur J Nucl Med Mol Imaging. 2014; 41 Suppl 1:S Gutte Ling Kan: Meta-analysis for V/Q SPECT Sens = 96% Spec = 97%

29 Roach PJ, Schembri GP, Bailey DL. V/Q scanning using SPECT and SPECT/CT. J Nucl Med. 2013; 54:

30 Le Roux PY, Pelletier-Galarneau M, De Laroche R, Hofman MS, Zuckier LS, Roach P, Vuillez JP, Hicks RJ, Le Gal G, Salaun PY. Pulmonary Scintigraphy for the Diagnosis of Acute Pulmonary Embolism: A Survey of Current Practices in Australia, Canada, and France. J Nucl Med Aug;56(8):

31 Graham, MM Estimation of the current approach to V/Q imaging in the United States SPECT-CT SPECT Planar with aerosol Planar with Xe- 133

32 Slowly Conclusions US sites are remarkably slow to adopt new methodology V/Q SPECT is more accurate than planar 94% vs 81% (planar w Xe-133 is almost certainly worse) V/Q SPECT-CT is slightly more accurate CT can pick up other abnormalities As SPECT-CT becomes available, sites will switch

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