Trial reportThe European respiratory journal2026
Comparison of three diagnostic strategies for suspicion of pulmonary embolism: planar ventilation/perfusion scan, CT pulmonary angiography and single-photon emission CT ventilation/perfusion scan - a multicentre, non-inferiority randomised controlled trial.
Trial report in The European respiratory journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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23 authors.
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Abstract
backgroundWhile single-photon emission computed tomography (SPECT) ventilation/perfusion (V/Q) has been widely adopted for pulmonary embolism (PE) diagnosis, it is not currently endorsed by clinical guidelines due to insufficient evidence.
methodsWe conducted a non-inferiority randomised trial comparing SPECT V/Q-, computed tomography pulmonary angiography (CTPA)- and planar V/Q-based diagnostic strategies using a 2:1:1 allocation. The primary end-point was the 3-month risk of venous thromboembolism (VTE) in untreated patients with a negative workup, comparing SPECT V/Q to the combined CTPA and planar V/Q arms. A non-inferiority margin of 1% absolute difference in 3-month VTE risk was defined. Secondary outcomes included PE diagnosis rates. The trial ended prematurely in October 2024 due to slow recruitment and funding limitations.
resultsFrom July 2017 to October 2024, 603 patients were randomised. PE was diagnosed in 61/303 (20.1%) in the SPECT V/Q arm, 31/150 (20.7%) in the CTPA arm and 24/150 (16.0%) in the planar V/Q arm. The 3-month VTE risk in patients left untreated after a negative workup was 0.5% (1/221) for SPECT V/Q, 0.0% (0/107) for CTPA and 0.8% (1/118) for planar V/Q. The difference in outcome between SPECT V/Q and the combined arms was 0.0% (95% CI -1.2-1.3%).
conclusionAfter being prematurely discontinued, this randomised trial did not demonstrate the non-inferiority of a SPECT V/Q-based strategy to reference standards for PE diagnosis. However, the results suggest a low 3-month VTE risk in patients managed using a SPECT V/Q-based diagnostic strategy. Among patients with clinically suspected acute PE requiring chest imaging, a SPECT V/Q-based algorithm might be a reliable alternative in clinical practice.
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