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Review
. 2021 Mar;48(3):794-799.
doi: 10.1007/s00259-020-05043-y. Epub 2020 Sep 22.

Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE

Jeeban P Das  1 , Randy Yeh  2 , Heiko Schöder  2
Affiliations
Review

Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE

Jeeban P Das et al. Eur J Nucl Med Mol Imaging. 2021 Mar.

Abstract

Purpose: We reviewed the clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2).

Methods: Following the World Health Organization's declaration of a global pandemic, our department policy recommended Q-only SPECT/CT for all patients undergoing nuclear medicine evaluation for suspected PE to reduce the risk of aerosolization of respiratory droplets. We performed a retrospective review of sequential patients admitted with COVID-19 imaged with Q-SPECT/CT between March 17, 2020, and June 30, 2020, at Memorial Sloan Kettering Cancer Center. We recorded patient demographics, clinical symptoms, Wells score (to stratify patients according to pre-test probability for PE prior to Q-SPECT/CT), and noted ancillary imaging findings on CT.

Results: Of the 33 patients imaged with Q-SPECT/CT, 6 patients (3 men, 3 women) had a laboratory confirmed diagnosis of COVID-19 (mean age, 55, ± 11.4 years, range 33-68). All patients had a current diagnosis of malignancy and had a moderate or high pre-test probability for PE (mean Wells score 2.8, range 2-4). Q-SPECT/CT was positive in 4/6 (67%) of patients. Distribution of pulmonary emboli was bilateral and segmental in 75% of patients. Ancillary acute findings on SPECT/CT included bilateral parenchymal ground glass opacities (n = 5), pleural effusions (n = 2), and pneumomediastinum (n = 1).

Conclusion: Q-SPECT/CT has clinical utility for diagnosing PE in patients with COVID-19 where there is a contraindication for iodinated contrast media and a moderate or high pre-test probability for PE.

Keywords: COVID-19; Coagulopathy; Pulmonary embolism; V/Q SPECT/CT.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart showing the patients included in our final analysis
Fig. 2
Fig. 2
Axial fused perfusion SPECT and CT (a) and axial perfusion SPECT (b) demonstrating a left upper lobe wedge-shaped defect (arrows) suspicious for pulmonary embolism. Axial CT chest images showing ancillary findings of pneumomediastinum (arrow) (c) and bibasal subpleural airspace disease (arrows) (d) suspicious for COVID-19 pneumonia
Fig. 3
Fig. 3
Axial fused Q-SPECT/CT (a) and SPECT (b) showing a left upper lobe wedge-shaped defect (arrows) suspicious for pulmonary embolism. An additional right lower lobe wedge-shaped defect was also seen (not shown). Axial CT chest images (c, d) showing small bilateral pleural effusion and bibasilar GGOs suspicious for COVID-19 pneumonia
See this image and copyright information in PMC

Comment in

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