• Ramyar Mahdavi, Jonathan Caronia, Jazeela Fayyaz, Georgia Panagopoulos, Klaus D Lessnau, Stephen C Scharf, Bushra Mina, Charles Allred, and Larry DiFabrizio.
• Division of Pulmonary-Critical Care, Department of Medicine, Lenox Hill Hospital, 100 East 77th Street, New York, NY, 10021, USA, ramyarm@hotmail.com.
• Ann Nucl Med. 2013 Nov 1; 27 (9): 834-8.

ObjectiveTo track agreement between single positron emission computed tomography (SPECT) V/Q and CT angiography in patients with high clinical suspicion of pulmonary embolism (PE). If significant agreement occurs, a case could be made for more frequent use of chest radiography followed by SPECT V/Q scanning given its lower risk profile.IntroductionDiagnosis of PE can be difficult. CT pulmonary angiography (CTA) is the preferred initial test, but may be indeterminate, is a significant source of ionizing radiation, and is contraindicated in renal insufficiency. SPECT ventilation/perfusion imaging (V/Q) is therefore preferred in certain patients.MethodsTwo thousand nine hundred and twenty patients admitted to a tertiary care hospital in New York City were screened and 100 consecutive high-risk patients who required both CTA and V/Q for an initial indeterminate or negative imaging test despite a high pre-test probability were identified. The agreement between these tests was evaluated.ResultsThere was no significant agreement between CTA and V/Q when positive, negative and indeterminate results were included (K = 0.18, SE = 0.09, p = 0.051). However, in the presence of a positive finding on either test, there was substantial agreement between the two (K = 0.62, SE = 0.27, p = 0.02). In 30 cases in which CTA was indeterminate, V/Q was diagnostic 93 % of the time. In 12 cases in which V/Q was indeterminate, CTA was diagnostic 83 % of the time and negative in 100 % of those cases.ConclusionIn the presence of an indeterminate CTA in patients with high clinical suspicion of PE, SPECT V/Q often provides a diagnosis.

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