Semin Thromb Hemost 2016; 42(08): 833-845
DOI: 10.1055/s-0036-1593376
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

State-of-the-Art Imaging in Pulmonary Embolism: Ventilation/Perfusion Single-Photon Emission Computed Tomography versus Computed Tomography Angiography — Controversies, Results, and Recommendations from a Systematic Review

Søren Hess
1   Department of Radiology and Nuclear Medicine, Hospital South West Jutland, Esbjerg, Denmark
2   Department of Nuclear Medicine, Odense University Hospital, Odense C, Denmark
3   Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
Evan C. Frary
1   Department of Radiology and Nuclear Medicine, Hospital South West Jutland, Esbjerg, Denmark
Oke Gerke
2   Department of Nuclear Medicine, Odense University Hospital, Odense C, Denmark
4   Centre of Health Economics Research, University of Southern Denmark, Odense M, Denmark
Poul Henning Madsen
5   Division of Respiratory Medicine, Department of Medicine, Lillebælt Hospital Vejle, Vejle, Denmark
› Author Affiliations
Further Information

Publication History

Publication Date:
20 October 2016 (online)


Pulmonary embolism (PE) is a common, ubiquitous, and potentially lethal disease. As symptoms and clinical findings are notoriously nonspecific, diagnostic imaging is essential to avoid undertreatment as well as overtreatment. Controversies remain regarding first-line imaging in suspected PE. The two main contemporary contenders are ventilation/perfusion scintigraphy with single-photon emission computed tomography (V/Q SPECT) with or without additional low-dose CT (SPECT/CT) and CT angiography (CTA). We present our results from a systematic review and meta-analysis of the diagnostic performances of these modalities: V/Q SPECT, V/Q SPECT/CT, and CTA are all viable options, but we consider V/Q SPECT/CT to be superior in most clinical settings with better overall diagnostic performance, that is, pooled sensitivities (97.6 vs. 82.0%), specificities (95.9 vs. 94.9%), positive predictive values (93.0 vs. 93.8%), negative predictive values (98.6 vs. 84.7%), and accuracies (96.5 vs. 88.6%). We further address some of the ongoing controversies regarding the various modalities, that is, radiation exposure, the issues of subsegmental PE, nondiagnostic studies, and various challenges in specific patient populations.

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