Premium
Ventilation/perfusion SPECT for the diagnosis of pulmonary embolism: A systematic review
Author(s) -
Le Roux PierreYves,
Robin Philippe,
Tromeur Cécile,
Davis Alexandra,
RobertEbadi Helia,
Carrier Marc,
Le Gal Grégoire,
Salaun PierreYves
Publication year - 2020
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.15038
Subject(s) - medicine , pulmonary embolism , diagnostic accuracy , prospective cohort study , meta analysis , observational study , systematic review , medline , single photon emission computed tomography , radiology , nuclear medicine , political science , law
Background Ventilation/perfusion (V/Q) single‐photon emission computed tomography (SPECT) has largely replaced conventional planar V/Q scan in nuclear medicine departments for pulmonary embolism (PE) diagnosis. However, the diagnostic performance of the test and its role in the diagnostic management of acute PE are still a matter of debate. Objective The primary aim was to establish the diagnostic accuracy (sensitivity, specificity) of V/Q SPECT for PE diagnosis. The secondary aim was to review the clinical outcomes of patients investigated for PE suspicion with a standardized algorithm based on V/Q SPECT. Methods We conducted a systematic review of diagnostic accuracy and management outcome studies involving patients evaluated with V/Q SPECT for suspected acute PE. We searched from inception to June 23, 2020, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for diagnostic accuracy studies, randomized controlled trials, and observational cohort studies. The methodological quality and risk of bias of eligible studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) and the Risk of Bias in Nonrandomized Studies of Interventions tools. Results We identified 13 accuracy studies and one prospective outcome study. Eleven diagnostic accuracy studies were deemed at high risk of bias in at least two of the four domains of QUADAS‐2 evaluation and a further two studies raised concerns regarding the applicability of results, precluding the meta‐analysis for accuracy indices. The only prospective cohort study demonstrated critical risk of bias. Conclusions Although V/Q SPECT has been widely implemented in daily clinical practice, the exact diagnostic performance of V/Q SPECT for PE is still unknown. This systematic review clearly identifies knowledge gaps and sets the agenda for future research.