EANM guidelines for ventilation/perfusion scintigraphy
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Abstract
Pulmonary embolism (PE) can only be diagnosed with imaging techniques, which in practice is performed using ventilation/perfusion scintigraphy (V/PSCAN) or multidetector computed tomography of the pulmonary arteries (MDCT). The epidemiology, natural history, pathophysiology and clinical presentation of PE are briefly reviewed. The primary objective of Part 1 of the Task Group’s report was to develop a methodological approach to and interpretation criteria for PE. The basic principle for the diagnosis of PE based upon V/PSCAN is to recognize lung segments or subsegments without perfusion but preserved ventilation, i.e. mismatch. Ventilation studies are in general performed after inhalation of Krypton or technetium-labelled aerosol of diethylene triamine pentaacetic acid (DTPA) or Technegas. Perfusion studies are performed after intravenous injection of macroaggregated human albumin. Radiation exposure using documented isotope doses is 1.2–2 mSv. Planar and tomographic techniques (V/PPLANAR and V/PSPECT) are analysed. V/PSPECT has higher sensitivity and specificity than V/PPLANAR. The interpretation of either V/PPLANAR or V/PSPECT should follow holistic principles rather than obsolete probabilistic rules. PE should be reported when mismatch of more than one subsegment is found. For the diagnosis of chronic PE, V/PSCAN is of value. The additional diagnostic yield from V/PSCAN includes chronic obstructive lung disease (COPD), heart failure and pneumonia. Pitfalls in V/PSCAN interpretation are considered. V/PSPECT is strongly preferred to V/PPLANAR as the former permits the accurate diagnosis of PE even in the presence of comorbid diseases such as COPD and pneumonia. Technegas is preferred to DTPA in patients with COPD.
Keywords
Pulmonary embolism Radioncuclide imaging Ventilation perfusion scintigraphy Single photon emission tomography Multidetector CT scan’Abbreviations
- COPD
Chronic obstructive pulmonary disease
- DTPA
Diethylene triamine pentaacetic acid
- DVT
Deep venous thrombosis
- MAA
Macroaggregated human albumin
- MDCT
Multidetector computed tomography of the pulmonary arteries
- PA
Contrast-enhanced pulmonary angiography
- PE
Pulmonary embolism
- VTE
Venous thromboembolism
- V/PPLANAR
Ventilation/perfusion scintigraphy with planar imaging
- V/PSCAN
Ventilation/perfusion scintigraphy
- V/PSPECT
Ventilation/perfusion single photon emission computed tomography
Notes
Acknowledgments
We would like to thank the EANM Dosimetry Committee for their contribution, and Medan Rehani, chair of the Task Group on Radiation Protection, IAEA, for sharing his knowledge and for fruitful discussions.
Conflicts of interest
None.
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