How necessary it is to perform a ventilation scan in patients with a history of COVID-19 to rule out pulmonary thromboembolism?

Document Type : Original Article

Authors

1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Isfahan Medical Students Research Committee (MSRC), Isfahan University of Medical Sciences, Isfahan, Iran

3 Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Immunology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 School of Medicine, Iran University of Medical Sciences, Tehran, Iran

Abstract

Objective(s): This study evaluated the necessity of a ventilation scan in patients suspected of PE with a history of COVID-19 infection.
Methods: This was a cross-sectional study of patients with PCR-confirmed COVID-19 and suspected PE at a tertiary care hospital in 2020. They underwent ventilation/perfusion (V/Q) scintigraphy using single-photon emission computed tomography/computed tomography (SPECT/CT) and CT scans with or without contrast. Two blinded nuclear medicine physicians interpreted the images for PE and COVID-19. Clinical and laboratory data were extracted and analyzed.
Results:  96 patients with suspected PE and COVID-19 infection. The study excluded eight patients who could not undergo ventilation scans and confirmed PE in five patients with multiple mismatched V/Q defects on SPECT/CT. The study ruled out PE in 83 patients who had either regular perfusion scans, perfusion defects with COVID-19 features, or matched V/Q defects. The study found that the prevalence of PE was 5.68%, and the necessity of ventilation scans was 28.40% in this population.
Conclusion: It was found that PE was present in 5.68% of the patients, and ventilation scans were needed for 28.40% of the patients to confirm or exclude it.

Keywords

Main Subjects

References

  1. Jayarangaiah A, Kariyanna PT, Chen X, Jayarangaiah A, Kumar A. COVID-19-Associated coagulopathy: an exacerbated immunothrombosis response. Clin Appl Thromb Hemost. 2020; 26: 1076029620943293.
  2. Zuckier LS. Safe pulmonary scintigraphy in the era of COVID-19. Semin Nucl Med. 2022; 52(1): 48-55.
  3. Bajc M, Schümichen C, Grüning T, Lindqvist A, Le Roux PY, Alatri A, et al. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging. 2019; 46(12): 2429-51.
  4. Skarlovnik A, Hrastnik D, Fettich J, Grmek M. Lung scintigraphy in the diagnosis of pulmonary embolism: current methods and interpretation criteria in clinical practice. Radiol Oncol. 2014; 48(2):113-9.
  5. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020; 41(4): 543-603.
  6. Rahmanipour E, Ghorbani M, Sadeghi R, Sadraei N, Borhani A, Mohammadi S, et al. Diagnostic importance of lung perfusion/ ventilation scans in the evaluation of pulmonary embolism in COVID-19 patients: systematic review of the literature. Nucl Med Commun. 2023; 44(3): 178-86.
  7. Zuckier LS, Moadel RM, Haramati LB, Freeman LM. Diagnostic evaluation of pulmonary embolism during the COVID-19 pandemic. J Nucl Med. 2020; 61(5):630-1.
  8. 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(3): 666-9.
  9. Lu Y, Lorenzoni A, Fox JJ, Rademaker J, Vander Els N, Grewal RK, et al. Noncontrast perfusion single-photon emission CT/CT scanning: a new test for the expedited, high-accuracy diagnosis of acute pulmonary embolism. Chest. 2014; 145(5): 1079-88.
  10. Lu Y, Macapinlac HA. Perfusion SPECT/CT to diagnose pulmonary embolism during COVID-19 pandemic. Eur J Nucl Med Mol Imaging. 2020; 47(9): 2064-5.
  11. Le Roux PY, Le Gal G, Salaun PY. Lung scintigraphy for pulmonary embolism diagnosis during the COVID-19 pandemic: does the benefit-risk ratio really justify omitting the ventilation study? Eur J Nucl Med Mol Imaging. 2020; 47(11): 2499-500.
  12. Schaefer WM, Knollmann D, Meyer PT. V/Q SPECT/CT in the time of COVID-19: changing the order to improve safety without sacrificing accuracy. J Nucl Med. 2021; 62(7): 1022-4.
  13. Lavely WC, Patel VK. Ventilation-perfusion scans after the COVID-19 pandemic: counterpoint-ventilation studies are here to stay. AJR Am J Roentgenol. 2022; 218(1): 31-2.
  14. Vöö S, Dizdarevic S. Single photon emission computed tomography lung perfusion imaging during the COVID-19 pandemic: does nuclear medicine need to reconsider its guidelines? Nucl Med Commun. 2020; 41(9): 991-3.
  15. Karamian F, Sadeghi R, Askari E. Lung ventilation-perfusion scan in COVID-19: various patterns of perfusion defects. Clinical Nuclear Medicine. 2023; 48(5): e239-e43.
  16. Ghorbani M, Esmaeilian S, Rahmanipour E, Sadeghi R, Zahergivar A, Nikkhah R, et al. Diagnostic importance of performing myocardial perfusion imaging in COVID-19 patients: A systematic review. Iran J Nucl Med. 2024; 32(2): 215-228.
  17. Le Roux P-Y, Le Gal G, Salaun P-Y. Lung scintigraphy for pulmonary embolism diagnosis during the COVID-19 pandemic: does the benefit-risk ratio really justify omitting the ventilation study? Eur J Nucl Med Mol Imaging. 2020; 47(11):2499-2500.
  18. Schaefer WM, Knollmann D, Meyer PT. Q/V-SPECT CT in times of COVID-19: Changing the order to improve safety without sacrificing accuracy. J Nucl Med. 2021; 62(7): 1022-1024.
  19. Zuckier LS. Safe Pulmonary Scintigraphy in the Era of COVID-19. Semin Nucl Med. 2022; 52(1): 48-55.
  20. Kumar A, Moadel RM, Haramati LB, Ye K, Freeman LM, Zuckier LS. Experience with a perfusion-only screening protocol for evaluation of pulmonary embolism during the COVID-19 pandemic surge. J Nucl Med. 2022; 63(4):598-601.
  21. 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(2): 67-70.
  22. Pierre-Yves Le R, Pierre-Benoit B, Achraf B, Benoit D, Bertrand B, Caroline M-T, et al. Lung scintigraphy for pulmonary embolism diagnosis in COVID-19 patients: A multicenter study. J Nucl Med. 2022; 63(7): 1070.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 13, Issue 1
January 2025
Pages 70-76

Files

Share

How to cite

Statistics