The impact of regional 99m Tc-HMPAO single-photon-emission computed tomography (SPECT) imaging on clinician diagnostic confidence in a mixed cognitive impairment sample.

Autor: Prosser AMJ; NIHR ARC Wessex, University of Southampton, UK; Faculty of Health Sciences, University of Southampton, UK. Electronic address: Angus.Prosser@soton.ac.uk., Tossici-Bolt L; Medical Physics and Bioengineering, University Hospital Southampton NHS Foundation Trust, UK., Kipps CM; NIHR ARC Wessex, University of Southampton, UK; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, UK.
Jazyk: angličtina
Zdroj: Clinical radiology [Clin Radiol] 2020 Sep; Vol. 75 (9), pp. 714.e7-714.e14. Date of Electronic Publication: 2020 Jun 04.
DOI: 10.1016/j.crad.2020.04.016
Abstrakt: Aim: To assess the clinical impact of regional cerebral blood flow (rCBF) single-photon-emission computed tomography (SPECT) imaging on diagnosis and clinician diagnostic confidence in a cohort of individuals with cognitive impairment.
Materials and Methods: Forty-one clinicians who referred 79 patients for a [ 99m Tc]-hexamethylpropyleneamine oxime (HMPAO) SPECT for cognitive complaints completed a two-part questionnaire to determine the diagnosis and diagnostic confidence (using a 0-100 visual analogue scale [VAS]) before and after imaging. SPECT images were analysed using statistical parametric mapping and interpreted semi-quantitatively. Clinicians were also asked directly for their opinion on whether the imaging contributed to their diagnostic process.
Results: Diagnosis changed after imaging in 44% of cases, and confidence was significantly improved (VAS score change= +26.3±22.2) after imaging in cases where the pre-imaging confidence was low (p<0.001). Clinician confidence was not significantly different (VAS score change=-6.6±25.5) after imaging when pre-imaging confidence was moderate to high. Interestingly, a proportion of clinicians with the highest confidence levels became less certain about their diagnosis following imaging results. When asked directly, 96% of clinicians stated that the imaging contributed to the diagnostic process.
Conclusions: In a mixed clinical cognitive impairment cohort, perfusion SPECT is valued by referring clinicians and contributes to diagnostic decision making. Imaging is of particular value when diagnostic confidence is low prior to imaging.
(Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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