How Necessary It is to Perform a Ventilation Scan in Patients with a History of COVID-19 to Rule out Pulmonary Thromboembolism?

Overview

Journal Asia Ocean J Nucl Med Biol

Specialty Nuclear Medicine

Date 2025 Jan 2

PMID 39744051

Authors

Farivash Karamian

Roham Nikkhah

Mohammad Ghorbani

Elham Rahmanipour

Mohammad Mohammadi

Emran Askari

Ramin Sadeghi

Affiliations

Soon will be listed here.

Abstract

Objectives: 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.

References

Kumar A, Moadel R, Haramati L, Ye K, Freeman L, Zuckier L . Experience with a Perfusion-Only Screening Protocol for Evaluation of Pulmonary Embolism During the COVID-19 Pandemic Surge. J Nucl Med. 2021; 63(4):598-601. PMC: 8973288. DOI: 10.2967/jnumed.121.262580. View

Lu Y, Macapinlac H . Perfusion SPECT/CT to diagnose pulmonary embolism during COVID-19 pandemic. Eur J Nucl Med Mol Imaging. 2020; 47(9):2064-2065. PMC: 7205478. DOI: 10.1007/s00259-020-04851-6. View

Konstantinides S, Meyer G, Becattini C, Bueno H, Geersing G, Harjola V . 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2019; 41(4):543-603. DOI: 10.1093/eurheartj/ehz405. View

Zuckier L, Moadel R, Haramati L, Freeman L . Diagnostic Evaluation of Pulmonary Embolism During the COVID-19 Pandemic. J Nucl Med. 2020; 61(5):630-631. DOI: 10.2967/jnumed.120.245571. View

Zuckier L . Safe Pulmonary Scintigraphy in the Era of COVID-19. Semin Nucl Med. 2021; 52(1):48-55. PMC: 8216848. DOI: 10.1053/j.semnuclmed.2021.06.021. View

Lavely W, Patel V . Ventilation-Perfusion Scans After the COVID-19 Pandemic: Counterpoint-Ventilation Studies Are Here to Stay. AJR Am J Roentgenol. 2021; 218(1):31-32. DOI: 10.2214/AJR.21.26383. View

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. PMC: 4078029. DOI: 10.2478/raon-2013-0060. View

Le Roux P, Le Gal G, Salaun P . 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. PMC: 7375202. DOI: 10.1007/s00259-020-04964-y. View

Schaefer W, Knollmann D, Meyer P . 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):1022-1024. PMC: 8882886. DOI: 10.2967/jnumed.120.261263. View

10.

Voo 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):991-993. PMC: 7373360. DOI: 10.1097/MNM.0000000000001246. View

11.

Jayarangaiah A, Theetha Kariyanna P, Chen X, Jayarangaiah A, Kumar A . COVID-19-Associated Coagulopathy: An Exacerbated Immunothrombosis Response. Clin Appl Thromb Hemost. 2020; 26:1076029620943293. PMC: 7401047. DOI: 10.1177/1076029620943293. View

12.

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. PMC: 8890985. DOI: 10.1007/s13139-022-00740-y. View

13.

Rahmanipour E, Ghorbani M, Sadeghi R, Sadraei N, Borhani A, Mohammadi S . 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):178-186. DOI: 10.1097/MNM.0000000000001655. View

14.

Bajc M, Schumichen C, Gruning T, Lindqvist A, Le Roux P, Alatri A . 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):2429-2451. PMC: 6813289. DOI: 10.1007/s00259-019-04450-0. View

15.

Zuckier L . 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. 2020; 48(3):666-669. PMC: 7647190. DOI: 10.1007/s00259-020-05100-6. View

16.

Le Roux P, Bonnefoy P, Bahloul A, Denizot B, Barres B, Moreau-Triby C . Lung Scintigraphy for Pulmonary Embolism Diagnosis in COVID-19 Patients: A Multicenter Study. J Nucl Med. 2021; 63(7):1070-1074. PMC: 9258571. DOI: 10.2967/jnumed.121.262955. View

17.

Karamian F, Sadeghi R, Askari E . Lung Ventilation-Perfusion Scan in COVID-19: Various Patterns of Perfusion Defects. Clin Nucl Med. 2023; 48(5):e239-e243. PMC: 10081924. DOI: 10.1097/RLU.0000000000004545. View

18.

Lu Y, Lorenzoni A, Fox J, Rademaker J, Els N, Grewal R . 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):1079-1088. DOI: 10.1378/chest.13-2090. View