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Master thesis

La tomoscintigraphie pulmonaire de perfusion couplée à la tomodensitométrie en imagerie hybride dans le diagnostic de l'embolie pulmonaire: comparaison à la scintigraphie pulmonaire planaire de ventilation /perfusion

Abstract : By using a comparison with lung ventilation/perfusion (V/Q) scintigraphy, this study was aimed at assessing a new diagnostic tool for acute pulmonary embolism (PE): the perfusion pulmonary tomoscintigraphy associated with unenhanced computed tomogr'dphy on a hybrid SPECT -CT system. Methods : 76 patients with suspected PE were referred to V /Q scintigraphy followed by perfusion SPECT-CT. These 2 investigations were analyzed separately : (i) according to the modified PIOPED criteria for V/Q scintigraphy and (ii) by looking for a SPECT-CT mismatch (segmentaI perfusion SPECT defects unmatched to CT abnormalities). ResuJts: the number of segmentaI perfusion defects per patient was, on average, much higher with SPECT-CT than with scintigraphy (4.6[+ or -]3.7 vs. 2.7(+ or -]2.6 ; p<0,001l). A mismatch was found with SPECT-CT in 0% (0/12) of normal scintigraphy, and 3% (1/33) for low, 24% (4/17) for intermediate and 75% (9/12) for high probabilities of PE at scintigraphy. Among the 29 patients with intermediate to high probability at scintigraphy (i) the presence of a SPECT -CT mismatch was associated with a higher pretest likelihood of EP (p=0,04) and (ii) the absence of SPECT -CT mismach was related to the presence, in areas with SPECT defects, of the following CT abnormalities: hypodensity and/or emphysema (81%), condensation or atelectasia (19%), pleural disease (6%), extra-pulmonary structure (12%) and/or bronchial obstruction (12%) Conclusion : ln patients with suspected PE, results from pulmonary SPECT -CT are coherent with those from V /Q scintigraphy and with the pre-test likelihood of PE. Direct comparisons with angiographic techniques are now required to precise the diagnostic value ofthis new investigation.
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Master thesis
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Cédric Revel. La tomoscintigraphie pulmonaire de perfusion couplée à la tomodensitométrie en imagerie hybride dans le diagnostic de l'embolie pulmonaire: comparaison à la scintigraphie pulmonaire planaire de ventilation /perfusion. Sciences du Vivant [q-bio]. 2007. ⟨hal-01733259⟩

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