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EANM guidelines for ventilation/perfusion scintigraphy

Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography
  • M. Bajc
  • J. B. Neilly
  • M. Miniati
  • C. Schuemichen
  • M. Meignan
  • B. Jonson
Guidelines

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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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • M. Bajc
    • 1
  • J. B. Neilly
    • 2
  • M. Miniati
    • 3
  • C. Schuemichen
    • 4
  • M. Meignan
    • 5
  • B. Jonson
    • 1
  1. 1.Department of Clinical PhysiologyLund University HospitalLundSweden
  2. 2.University Medical Unit and Department of Nuclear MedicineGlasgow Royal InfirmaryScotlandUK
  3. 3.Department of Medical and Surgical Critical CareUniversity of FlorenceFlorenceItaly
  4. 4.Clinic for Nuclear MedicineUniversity of RostockRostockGermany
  5. 5.Department of Nuclear MedicineCentre Hospitalo Universitaire Henri Mondor, Universite Paris 12CréteilFrance

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