Annals of Nuclear Medicine

, Volume 23, Issue 1, pp 1–16 | Cite as

Ventilation/perfusion lung scintigraphy: what is still needed? A review considering technetium-99m-labeled macro-aggregates of albumin

  • Klaus Zöphel
  • Claudia Bacher-Stier
  • Jörg Pinkert
  • Joachim Kropp
Review Article


Lung perfusion scintigraphy (LPS) with technetium-99m-labeled macro-aggregates of albumin (Tc-99m-MAA) is well established in the diagnostic of pulmonary embolism (PE). In the last decade, it was shown that single-photon emission computer tomography (SPECT) acquisition of LPS overcame static scintigraphy. Furthermore, there are rare indications for LPS, such as preoperative quantification of regional lung function prior to lung resection or transplantation, optimization of lung cancer radiation therapy, quantification of right-left shunt, planning of intra-arterial chemotherapy, and several rare indications in pediatrics. Moreover, LPS with Tc-99m-MAA is a safe method with low radiation exposure. PE can also be diagnosed by spiral computer tomography (CT), ultrasound, magnetic resonance angiography, or pulmonary angiography (PA, former gold standard). The present review considers all these methods, especially spiral CT, and compares them with LPS with respect to sensitivity and specificity and gives an overview of established and newer publications. It shows that LPS with Tc-99m-MAA represents a diagnostic method of continuing value for PE. In comparison with spiral CT and/or PA, LPS is not to be defeated as mentioned also by the most actual Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II reports. This applies in particular to chronic or recurring embolisms, whereas currently spiral CT may be of greater value for major or life-threatening embolisms. At present, LPS cannot be replaced by other methods in some applications, such as pediatrics or in the quantification of regional pulmonary function in a preoperative context or prior to radiation therapy. LPS still has a place in the diagnostics of PE and is irreplaceable in several rare indications as described earlier.


Lung perfusion scintigraphy Tc-99m-MAA SPECT Pulmonary embolism Lung resection 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kumar AM, Parker JA. Ventilation/perfusion scintigraphy. Emerg Med Clin North Am 2001;19:957–973.PubMedCrossRefGoogle Scholar
  2. 2.
    Taplin GV, MacDonald NS. Radiochemistry of macroaggregated albumin and newer lung scanning agents. Semin Nucl Med 1971;1:132–152.PubMedGoogle Scholar
  3. 3.
    Wagner HN. Regional ventilation and perfusion. Princ Nucl Med 1995;2:887–895.Google Scholar
  4. 4.
    Weiss K. Pulmonary thromboembolism: epidemiology and techniques of nuclear medicine. Semin Thromb Hemost 1996;22:27–32.PubMedCrossRefGoogle Scholar
  5. 5.
    Tow DE, Wagner HN Jr, Lopez-Majano V, Smith EM, Migita T. Validity of measuring regional pulmonary arterial blood flow with macroaggregates of human serum albumin. Am J Roentgenol Radium Ther Nucl Med 1966;96:664–676.Google Scholar
  6. 6.
    Darte L, Persson BR, Soderbom L. Quality control and testing of 99mTc-macroaggregated albumin. Nuklearmedizin 1976;15:80–85.PubMedGoogle Scholar
  7. 7.
    Malone LA, Malone JF, Ennis JT. Kinetics of technetium 99m labelled macroaggregated albumin in humans. Br J Radiol 1983;56:109–112.PubMedGoogle Scholar
  8. 8.
    Chandra R, Shamoun J, Braunstein P, DuHov OL. Clinical evaluation of an instant kit for preparation of 99mTc-MAA for lung scanning. J Nucl Med 1973;14:702–705.PubMedGoogle Scholar
  9. 9.
    Monroe LA, Thompson WL, Anderton NS, Burdine JA. Evaluation of an improved 99mTc-stannous aggregated albumin preparation for lung imaging. J Nucl Med 1974;15:192–194.PubMedGoogle Scholar
  10. 10.
    Neumann RD, Sostman HD, Gottschalk A. Current status of ventilation-perfusion imaging. Semin Nucl Med 1980;10:198–217.PubMedCrossRefGoogle Scholar
  11. 11.
    Robbins PJ, Feller PA, Nishiyama H. Evaluation and dosimetry of a 99mTc-Sn-MAA lung imaging agent in humans. Health Phys 1976;30:173–178.PubMedGoogle Scholar
  12. 12.
    Weibel ER. Morphometry of the human lung. Heidelberg: Springer; 1963.Google Scholar
  13. 13.
    Schümichen C. Nuclear medicine diagnosis of the lung. Radiology 2000;40:878–887.CrossRefGoogle Scholar
  14. 14.
    Stein PD, Gottschalk A. Critical review of ventilation/perfusion lung scans in acute pulmonary embolism. Prog Cardiovasc Dis 1994;37:13–24.PubMedCrossRefGoogle Scholar
  15. 15.
    Heck LL, Duley JW Jr. Statistical considerations in lung imaging with 99mTc albumin particles. Radiology 1974;113:675–679.PubMedGoogle Scholar
  16. 16.
    Parker JA, Coleman RE, Siegel BA, Sostman HD, McKusick KA, Royal HD. Procedure guideline for lung scintigraphy: 1.0. Society of Nuclear Medicine. J Nucl Med 1996;37:1906–1910.PubMedGoogle Scholar
  17. 17.
    Schümichen C. Guidelines for lung scintigraphy. Nuklearmedizin 1999;38:233–236.PubMedGoogle Scholar
  18. 18.
    European Society of Cardiology. Guidelines on diagnosis and management of acute pulmonary embolism. Task force on pulmonary embolism. Eur Heart J 2000;21:1301–1336.CrossRefGoogle Scholar
  19. 19.
    Patriquin L, Khorasani R, Polak JF. Correlation of diagnostic imaging and subsequent autopsy findings in patients with pulmonary embolism. AJR Am J Roentgenol 1998;171:347–349.PubMedGoogle Scholar
  20. 20.
    Stein PD, Henry JW. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest 1995;108:978–981.PubMedCrossRefGoogle Scholar
  21. 21.
    Goldhaber SZ. Pulmonary embolism. Lancet 2004;363:1295–1305.PubMedCrossRefGoogle Scholar
  22. 22.
    Wilson MA. Pulmonary system. Chapter 4. Textbook of nuclear medicine. New York: Lippincott-Raven; 1997. p.89–116.Google Scholar
  23. 23.
    Barritt DW, Jordan SC. Anticoagulant drugs in the treatment of pulmonary embolism: a controlled trial. Lancet 1960;1:1309–1312.PubMedCrossRefGoogle Scholar
  24. 24.
    Douketis JD, Foster GA, Crowther MA, Prins MH, Ginsberg JS. Clinical risk factors and timing of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy. Arch Intern Med 2000;160:3431–3436.PubMedCrossRefGoogle Scholar
  25. 25.
    de Monyé W, Van Strijen MJ, Huisman MV, Kieft GJ, Pattynama PM. Suspected pulmonary embolism: prevalence and anatomic distribution in 487 consecutive patients. Advances in New Technologies Evaluating the Localisation of Pulmonary Embolism (ANTELOPE) Group. Radiology 2000;215:184–188.PubMedGoogle Scholar
  26. 26.
    Landefeld CS, Beyth RJ. Anticoagulant-related bleeding: clinical epidemiology, prediction, and prevention. Am J Med 1993;95:315–328.PubMedCrossRefGoogle Scholar
  27. 27.
    Fedullo PF, Tapson VF. Clinical practice: the evaluation of suspected pulmonary embolism. N Engl J Med 2003;349:1247–1256.PubMedCrossRefGoogle Scholar
  28. 28.
    Deutsche Gesellschaft Für Angiologie. AWMF Leitlinie: Diagnostik und Therapie der Bein-und Beckenvenenthrombose und Lungenembolie; 2005.
  29. 29.
    Neumann SM, Freyschmidt J, Holland BR, Henschel M, Gahnem NR. Comparison of ventilation-/perfusion scintigraphy with spiral CT in acute lung embolism. Med Klin (Munich) 1997;92:635–641.Google Scholar
  30. 30.
    Goldhaber SZ, Elliott CG. Acute pulmonary embolism. Part I: epidemiology, pathophysiology, and diagnosis. Circulation 2003;108:2726–2729.PubMedCrossRefGoogle Scholar
  31. 31.
    Powell T, Muller NL. Imaging of acute pulmonary thromboembolism: should spiral computed tomography replace the ventilation-perfusion scan? Clin Chest Med 2003;24:29–38.PubMedCrossRefGoogle Scholar
  32. 32.
    Meyer G, Roy PM, Sors H, Sanchez O. Laboratory tests in the diagnosis of pulmonary embolism. Respiration 2003;70:125–132.PubMedCrossRefGoogle Scholar
  33. 33.
    Perrier A. Noninvasive diagnosis of pulmonary embolism. Haematologica 1997;82:328–331.PubMedGoogle Scholar
  34. 34.
    Dunn KL, Wolf JP, Dorfman DM, Fitzpatrick P, Baker JL, Goldhaber SZ. Normal D-dimer levels in emergency department patients suspected of acute pulmonary embolism. J Am Coll Cardiol 2002;40:1475–1478.PubMedCrossRefGoogle Scholar
  35. 35.
    Kipper MS, Moser KM, Kortman KE, Ashburn WL. Longterm follow-up of patients with suspected pulmonary embolism and a normal lung scan: perfusion scans in embolic suspects. Chest 1982;82:411–415.PubMedCrossRefGoogle Scholar
  36. 36.
    Quinn DA, Fogel RB, Smith CD, Laposata M, Taylor TB, Johnson SM, et al. D-dimers in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 1999;159:1445–1449.PubMedGoogle Scholar
  37. 37.
    Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med 2004;140:589–602.PubMedGoogle Scholar
  38. 38.
    Schümichen C, Krause T, Reinartz P. Leitlinie für die Lungenszintigraphie (version 2). Nuklearmedizin. Accessed 2007
  39. 39.
    Robinson PJ. Ventilation-perfusion lung scanning and spiral computed tomography of the lungs: competing or complementary modalities? Eur J Nucl Med 1996;23:1547–1553.PubMedCrossRefGoogle Scholar
  40. 40.
    Mathis G, Blank W, Reißig A, Lechleitner P, Reuß J, Schuler A, et al. Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients. Chest 2005;128:1531–1538.PubMedCrossRefGoogle Scholar
  41. 41.
    Perrier A, Roy PM, Sanchez O, Le Gal G, Meyer G, Gourdier AL, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med 2005;352:1760–1768.PubMedCrossRefGoogle Scholar
  42. 42.
    Anderson DR, Kovacs MJ, Dennie C, Kovacs G, Stiell I, Dreyer J, et al. Use of spiral computed tomography contrast angiography and ultrasonography to exclude the diagnosis of pulmonary embolism in the emergency department. J Emer Med 2005;29:399–404.CrossRefGoogle Scholar
  43. 43.
    Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006;354:2317–2327.PubMedCrossRefGoogle Scholar
  44. 44.
    Bettmann MA, Boxt LM, Gomes AS, Grollman J, Henkin RE, Higgins CB, et al. Acute chest pain: suspected pulmonary embolism. American College of Radiology. ACR appropriateness criteria. Radiology 2000;215:15–21.PubMedGoogle Scholar
  45. 45.
    Tapson VF, Carroll BA, Davidson BL, Elliott CG, Fedullo PF, Hales CA, et al. The diagnostic approach to acute venous thromboembolism: clinical practice guideline. American Thoracic Society. Am J Respir Crit Care Med 1999;160:1043–1066.PubMedGoogle Scholar
  46. 46.
    Ten Wolde M, Hagen PJ, Macgillavry MR, Pollen IJ, Mairuhu AT, Koopman MM, et al. Non-invasive diagnostic work-up of patients with clinically suspected pulmonary embolism; results of a management study. J Thromb Haemost 2004;2:1110–1117.PubMedCrossRefGoogle Scholar
  47. 47.
    Riedel M. Diagnosing pulmonary embolism. Postgrad Med J 2004;80:309–319.PubMedCrossRefGoogle Scholar
  48. 48.
    Fleischmann D, Kontrus M, Bankier AA, Wiesmayr MN, Janata-Schwatczek K, Herold CJ. Spiral CT in acute pulmonary embolism. Radiologe 1996;36:489–495.PubMedCrossRefGoogle Scholar
  49. 49.
    Grenier PA, Beigelman C. Spiral computed tomographic scanning and magnetic resonance angiography for the diagnosis of pulmonary embolism. Thorax 1998;53:S25–S31.PubMedGoogle Scholar
  50. 50.
    Khan A, Cann AD, Shah RD. Imaging of acute pulmonary emboli. Thorac Surg Clin 2004;14:113–124.PubMedCrossRefGoogle Scholar
  51. 51.
    British Thoracic Society. Suspected acute pulmonary embolism: a practical approach. Thorax 1997;52:S1–S24.CrossRefGoogle Scholar
  52. 52.
    Berman AR, Arnsten JH. Diagnosis and treatment of pulmonary embolism in the elderly. Clin Geriatr Med 2003;19:157–175.PubMedCrossRefGoogle Scholar
  53. 53.
    Kauczor HU, Heussel CP, Thelen M. Update on diagnostic strategies of pulmonary embolism. Eur Radiol 1999;9:262–275.PubMedCrossRefGoogle Scholar
  54. 54.
    Wilson HT, Meagher TM, Williams SJ. Combined helical computed tomographic pulmonary angiography and lung perfusion scintigraphy for investigating acute pulmonary embolism. Clin Radiol 2002;57:33–36.PubMedCrossRefGoogle Scholar
  55. 55.
    Giordano A, Angiolillo DJ. Current role of lung scintigraphy in pulmonary embolism. Q J Nucl Med 2001;45:294–301.PubMedGoogle Scholar
  56. 56.
    Kruip MJ, Leclercq MG, van der HC, Prins MH, Buller HR. Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies: a systematic review. Ann Intern Med 2003;138:941–951.PubMedGoogle Scholar
  57. 57.
    Ramzi DW, Leeper KV. DVT and pulmonary embolism: Part I. Diagnosis. Am Fam Physician 2004;69:2829–2836.PubMedGoogle Scholar
  58. 58.
    Bounameaux H, Perrier A. Diagnostic approaches to suspected deep vein thrombosis and pulmonary embolism. Hematol J 2003;4:97–103.PubMedCrossRefGoogle Scholar
  59. 59.
    British Thoracic Society. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003;58:470–483.CrossRefGoogle Scholar
  60. 60.
    Scatarige JC, Weiss CR, Diette GB, Haponik EF, Merriman B, Fishman EK. Scanning systems and protocols used during imaging for acute pulmonary embolism: how much do our clinical colleagues know? Acad Radiol 2006;13:678–685.PubMedCrossRefGoogle Scholar
  61. 61.
    Madsen PH, Hess S, Jorgensen HB, Hoilund-Carlsen PF. Diagnostic imaging in acute pulmonary embolism in Denmark: a survey. Ugeskr Laeger 2005;167:3875–3877.PubMedGoogle Scholar
  62. 62.
    PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990;263:2753–2759.CrossRefGoogle Scholar
  63. 63.
    Gottschalk A, Juni JE, Sostman HD, Coleman RE, Thrall J, McKusick KA, et al. Ventilation-perfusion scintigraphy in the PIOPED study. Part I. Data collection and tabulation. J Nucl Med 1993;34:1109–1118.PubMedGoogle Scholar
  64. 64.
    Gottschalk A, Sostman HD, Coleman RE, Juni JE, Thrall J, McKusick KA, et al. Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations. J Nucl Med 1993;34:1119–1126.PubMedGoogle Scholar
  65. 65.
    Sostman HD, Coleman RE, DeLong DM, Newman GE, Paine S. Evaluation of revised criteria for ventilationperfusion scintigraphy in patients with suspected pulmonary embolism. Radiology 1994;193:103–107.PubMedGoogle Scholar
  66. 66.
    British Nuclear Medicine Society. BNMS Quality Guidelines for ventilation/perfusion imaging for pulmonary embolism. British Nuclear Medicine Society, editor. BNMS Quality Guidelines; 2003.Google Scholar
  67. 67.
    Macdonald WB, Patrikeos AP, Thompson RI, Adler BD, van der Schaaf AA. Diagnosis of pulmonary embolism: ventilation perfusion scintigraphy versus helical computed tomography pulmonary angiography. Australas Radiol 2005;49:32–38.PubMedCrossRefGoogle Scholar
  68. 68.
    Tunariu N, Gibbs SJ, Win Z, Gin-Sing W, Graham A, Gishen P, et al. Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med 2007;48:680–684.PubMedCrossRefGoogle Scholar
  69. 69.
    van Beek EJ, Brouwers EM, Song B, Bongaerts AH, Oudkerk M. Lung scintigraphy and helical computed tomography for the diagnosis of pulmonary embolism: a meta-analysis. Clin Appl Thromb Hemost 2001;7:87–92.PubMedCrossRefGoogle Scholar
  70. 70.
    Schoepf UJ, Costello P. CT angiography for diagnosis of pulmonary embolism: state of the art. Radiology 2004;230:329–337.PubMedCrossRefGoogle Scholar
  71. 71.
    Schümichen C. Pulmonary embolism: is multislice CT the method of choice? Against. Eur J Nucl Med Mol Imaging 2005;32:103–107.CrossRefGoogle Scholar
  72. 72.
    Michiels JJ, Gadisseur A, van der Planken M, Schroyens W, de Maeseneer M, Hermesen JT, et al. A critical of noninvasive diagnosis and exclusion of deep vein thrombosis and pulmonary embolism in outpatients with suspected deep vein thrombosis or pulmonary embolism: how many tests do we need? Int Angiol 2005;24:29–39.Google Scholar
  73. 73.
    Garg K, Sieler H, Welsh CH, Johnston RJ, Russ PD. Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment. AJR Am J Roentgenol 1999;172:1627–1631.PubMedGoogle Scholar
  74. 74.
    Miniati M, Pistolesi M, Marini C, Di Ricco G, Formichi B, Prediletto R, et al. Value of perfusion lung scan in the diagnosis of pulmonary embolism: results of the prospective investigative study of acute pulmonary embolism diagnosis (PISA-PED). Am J Respir Crit Care Med 1996;154:1387–1393.PubMedGoogle Scholar
  75. 75.
    Nilsson T, Mare K, Carlsson A. Value of structured clinical and scintigraphic protocols in acute pulmonary embolism. J Intern Med 2001;250:213–218.PubMedCrossRefGoogle Scholar
  76. 76.
    Bonnin F, Hadjikostova H, Jebrak G, Denninger MH, Vera P, Rufat P, et al. Complementarity of lung scintigraphy and D-dimer test in pulmonary embolism. Eur J Nucl Med 1997;24:444–447.PubMedGoogle Scholar
  77. 77.
    Freitas JE, Sarosi MG, Nagle CC, Yeomans ME, Freitas AE, Juni JE. Modified PIOPED criteria used in clinical practice. J Nucl Med 1995;36:1573–1578.PubMedGoogle Scholar
  78. 78.
    Howarth DM, Lan L, Thomas PA, Allen LW. 99mTc Technegas ventilation and perfusion lung scintigraphy for the diagnosis of pulmonary embolus. J Nucl Med 1999;40:579–584.PubMedGoogle Scholar
  79. 79.
    Lowe VJ, Bullard AG, Coleman RE. Ventilation/perfusion lung scan probability category distributions in university and community hospitals. Clin Nucl Med 1995;20:1079–1083.PubMedCrossRefGoogle Scholar
  80. 80.
    Worsley DF, Alavi A. Radionuclide imaging of acute pulmonary embolism. Semin Nucl Med 2003;33:259–2578.PubMedCrossRefGoogle Scholar
  81. 81.
    Goodman LR, Lipchik RJ, Kuzo RS, Liu Y, McAuliffe TL, O’Brien DJ. Subsequent pulmonary embolism: risk after a negative helical CT pulmonary angiogram: prospective comparison with scintigraphy. Radiology 2000;215:535–542.PubMedGoogle Scholar
  82. 82.
    van Rossum AB, Pattynama PM, Mallens WM, Hermans J, Heijerman HG. Can helical CT replace scintigraphy in the diagnostic process in suspected pulmonary embolism? A retrolective-prolective cohort study focusing on total diagnostic yield. Eur Radiol 1998;8:90–96.PubMedCrossRefGoogle Scholar
  83. 83.
    Barghouth G, Yersin B, Boubaker A, Doenz F, Schnyder P, Delaloye AB. Combination of clinical and V/Q scan assessment for the diagnosis of pulmonary embolism: a 2-year outcome prospective study. Eur J Nucl Med 2000;27:1280–1285.PubMedCrossRefGoogle Scholar
  84. 84.
    Mayo JR, Remy-Jardin M, Muller NL, Remy J, Worsley DF, Hossein-Foucher C, et al. Pulmonary embolism: prospective comparison of spiral CT with ventilation-perfusion scintigraphy. Radiology 1997;205:447–452.PubMedGoogle Scholar
  85. 85.
    Kearon C, Ginsberg JS, Douketis J, Turpie AG, Bates SM, Lee AY, et al. An evaluation of D-dimer in the diagnosis of pulmonary embolism. Ann Intern Med 2006;144:812–821.PubMedGoogle Scholar
  86. 86.
    Stein PD, Athanasoulis C, Alavi A, Greenspan RH, Hales CA, Saltzman HA, et al. Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation 1992;85:462–468.PubMedGoogle Scholar
  87. 87.
    Zuckerman DA, Sterling KM, Oser RF. Safety of pulmonary angiography in the 1990s. J Vasc Interv Radiol 1996;7:199–205.PubMedCrossRefGoogle Scholar
  88. 88.
    Radan L, Mor M, Gips S, Schlag-Eisenberg D, Lurie Y, Dickstein K, et al. The added value of spiral computed tomographic angiography after lung scintigraphy for the diagnosis of pulmonary embolism. Clin Nucl Med 2004;29:255–261.PubMedCrossRefGoogle Scholar
  89. 89.
    Gottsäter A, Berg A, Centergard J, Frennby B, Nirhov N, Nyman U. Clinically suspected pulmonary embolism: is it safe to withhold anticoagulation after a negative spiral CT? Eur Radiol 2001;11:65–72.PubMedCrossRefGoogle Scholar
  90. 90.
    Bateman NT, Coakley AJ, Croft DN, Lyall JR. Ventilationperfusion lung scans for pulmonary emboli: accuracy of reporting. Eur J Nucl Med 1977;2:201–203.PubMedCrossRefGoogle Scholar
  91. 91.
    Sullivan DC, Coleman RE, Mills SR, Ravin CE, Hedlund LW. Lung scan interpretation: effect of different observers and different criteria. Radiology 1983;149:803–807.PubMedGoogle Scholar
  92. 92.
    van Beek EJ, Tiel-van Buul MM, Hoefnagel CA, Jagt HH, van Royen EA. Reporting of perfusion/ventilation lung scintigraphy using an anatomical lung segment chart: a prospective study. Nucl Med Commun 1994;15:746–751.PubMedCrossRefGoogle Scholar
  93. 93.
    Coche E, Verschuren F, Keyeux A, Goffette P, Goncette L, Hainaut P, et al. Diagnosis of acute pulmonary embolism in outpatients: comparison of thin-collimation multi-detector row spiral CT and planar ventilation-perfusion scintigraphy. Radiology 2003;229:757–765.PubMedCrossRefGoogle Scholar
  94. 94.
    Reinartz P, Schirp U, Zimny M, Sabri O, Nowak B, Schafer W, et al. Optimizing ventilation-perfusion lung scintigraphy: parting with planar imaging. Nuklearmedizin 2001;40:38–43.PubMedGoogle Scholar
  95. 95.
    Reinartz P, Wildberger JE, Schaefer W, Nowak B, Mahnken AH, Buell U. Tomographic imaging in the diagnosis of pulmonary embolism: a comparison between V/Q lung scintigraphy in SPECT technique and multislice spiral CT. J Nucl Med 2004;45:1501–1508.PubMedGoogle Scholar
  96. 96.
    Bajc M, Olsson CG, Olsson B, Palmer J, Jonson B. Diagnostic evaluation of planar and tomographic ventilation/perfusion lung images in patients with suspected pulmonary emboli. Clin Physiol Funct Imaging 2004;24:249–256.PubMedCrossRefGoogle Scholar
  97. 97.
    Palmer J, Bitzen U, Jonson B, Bajc M. Comprehensive ventilation/perfusion SPECT. J Nucl Med 2001;42:1288–1294.PubMedGoogle Scholar
  98. 98.
    Collart JP, Roelants V, Vanpee D, Lacrosse M, Trigaux JP, Delaunois L, et al. Is a lung perfusion scan obtained by using single photon emission computed tomography able to improve the radionuclide diagnosis of pulmonary embolism? Nucl Med Commun 2002;23:1107–1113.PubMedCrossRefGoogle Scholar
  99. 99.
    Corbus HF, Seitz JP, Larson RK, Stobbe DE, Wooten W, Sayre JW, et al. Diagnostic usefulness of lung SPET in pulmonary thromboembolism: an outcome study. Nucl Med Commun 1997;18:897–906.PubMedCrossRefGoogle Scholar
  100. 100.
    Reinartz P, Kaiser H-J, Wildberger JE, Gordji C, Nowak B, Buell U. SPECT imaging in the diagnosis of pulmonary embolism: automated detection of match and mismatch defects by means of image-processing techniques. J Nucl Med 2006;47:968–973.PubMedGoogle Scholar
  101. 101.
    Blachere H, Latrabe V, Montaudon M, Valli N, Couffinhal T, Raherisson C, et al. Pulmonary embolism revealed on helical CT angiography: comparison with ventilationperfusion radionuclide lung scanning. AJR Am J Roentgenol 2000;174:1041–1047.PubMedGoogle Scholar
  102. 102.
    Remy-Jardin M, Remy J, Deschildre F, Artaud D, Beregi JP, Hossein-Foucher C, et al. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Radiology 1996;200:699–706.PubMedGoogle Scholar
  103. 103.
    Herold CJ. Spiral computed tomography of pulmonary embolism. Eur Respir J Suppl 2002;35:13s–21s.PubMedCrossRefGoogle Scholar
  104. 104.
    Blum AG, Delfau F, Grignon B, Beurrier D, Chabot F, Claudon M, et al. Spiral-computed tomography versus pulmonary angiography in the diagnosis of acute massive pulmonary embolism. Am J Cardiol 1994;74:96–98.PubMedCrossRefGoogle Scholar
  105. 105.
    Remy-Jardin M, Remy J, Wattinne L, Giraud F. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique: comparison with pulmonary angiography. Radiology 1992;185:381–387.PubMedGoogle Scholar
  106. 106.
    Raptopoulos V, Boiselle PM. Multi-detector row spiral CT pulmonary angiography: comparison with single-detector row spiral CT. Radiology 2001;221:606–613.PubMedCrossRefGoogle Scholar
  107. 107.
    Ghaye B, Remy J, Remy-Jardin M. Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years. Eur Radiol 2002;12:1886–1905.PubMedGoogle Scholar
  108. 108.
    Dresel S, Stabler A, Scheidler J, Holzknecht N, Tatsch K, Hahn K. Diagnostic approach in acute pulmonary embolism: perfusion scintigraphy versus spiral computed tomography. Nucl Med Commun 1995;16:1009–1015.PubMedCrossRefGoogle Scholar
  109. 109.
    Perrier A, Howarth N, Didier D, Loubeyre P, Unger PF, De Moerloose P, et al. Performance of helical computed tomography in unselected outpatients with suspected pulmonary embolism. Ann Intern Med 2001;135:88–97.PubMedGoogle Scholar
  110. 110.
    van Rossum AB, Pattynama PM, Ton ER, Treurniet FE, Arndt JW, van Eck B, et al. Pulmonary embolism: validation of spiral CT angiography in 149 patients. Radiology 1996;201:467–470.PubMedGoogle Scholar
  111. 111.
    Van Strijen MJ, De Monye W, Kieft GJ, Pattynama PM, Prins MH, Huisman MV. Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: a prospective multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy. J Thromb Haemost 2005;3:17–25.PubMedCrossRefGoogle Scholar
  112. 112.
    Lomis NN, Yoon HC, Moran AG, Miller FJ. Clinical outcomes of patients after a negative spiral CT pulmonary arteriogram in the evaluation of acute pulmonary embolism. J Vasc Interv Radiol 1999;10:707–712.PubMedCrossRefGoogle Scholar
  113. 113.
    Jimenez D, Gomez M, Herrero R, Lapresa E, Diaz G, Lanzara L, et al. Thrombembolic events in patients after a negative computed tomography pulmonary angiogram: a retrospective study of 165 patients. Arch Bronconeumol 2006;42:344–348.PubMedGoogle Scholar
  114. 114.
    Cross JJ, Kemp PM, Walsh CG, Flower CD, Dixon AK. A randomized trial of spiral CT and ventilation perfusion scintigraphy for the diagnosis of pulmonary embolism. Clin Radiol 1998;53:177–182.PubMedCrossRefGoogle Scholar
  115. 115.
    Gottschalk A, Stein PD, Goodman LR, Sostman HD. Overview of prospective investigation of pulmonary embolism diagnosis II. Semin Nucl Med 2002;32:173–182.PubMedCrossRefGoogle Scholar
  116. 116.
    Gottschalk A, Stein PD, Sostmann HD, Matta F, Beemath A. Very low probability interpretation of V/Q lung scans in combination with low probability objective clinical assessment reliably excludes pulmonary embolism: data from PIOPED II. J Nucl Med 2007;48:1411–1415.PubMedCrossRefGoogle Scholar
  117. 117.
    Roberts HC, Kauczor HU, Pitton MB, Schweden F, Thelen M. The algorithm of imaging diagnostics of pulmonary embolism: is it time for a new definition? Röfo 1997;166:463–474.PubMedGoogle Scholar
  118. 118.
    Strashun AM. A reduced role of V/Q scintigraphy in the diagnosis of acute pulmonary embolism. J Nucl Med 2007;48:1405–1407.PubMedCrossRefGoogle Scholar
  119. 119.
    Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. Am J Med 2006;119:1048–1055.PubMedCrossRefGoogle Scholar
  120. 120.
    Glassroth J. Imaging of pulmonary embolism: too much of a good thing? JAMA 2007;298:2788–2789.PubMedCrossRefGoogle Scholar
  121. 121.
    Anderson DR, Kahn SR, Rodger MA, Kovacs MJ, Morris T, Hirsch A, et al. Computed tomographic pulmonary angiography vs. ventilation-perfusion lung scanning in patients with suspected pulmonary embolism. A randomized controlled trial. JAMA 2007;298:2743–2753.PubMedCrossRefGoogle Scholar
  122. 122.
    van Beek EJ, Wild JM, Fink C, Moody AR, Kauczor HU, Oudkerk M. MRI for the diagnosis of pulmonary embolism. J Magn Reson Imaging 2003;18:627–640.PubMedCrossRefGoogle Scholar
  123. 123.
    Kline JA. New diagnostic tests for pulmonary embolism. Ann Emerg Med 2000;36:280–281.PubMedCrossRefGoogle Scholar
  124. 124.
    Oudkerk M, van Beek EJ, Wielopolski P, van Ooijen PM, Brouwers-Kuyper EM, Bongaerts AH, et al. Comparison of contrast-enhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: a prospective study. Lancet 2002;359:1643–1647.PubMedCrossRefGoogle Scholar
  125. 125.
    Meaney JF, Weg JG, Chenevert TL, Stafford-Johnson D, Hamilton BH, Prince MR. Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med 1997;336:1422–1427.PubMedCrossRefGoogle Scholar
  126. 126.
    Kluge A, Gerriets T, Stolz E, Dill T, Mueller KD, Mueller C, et al. Pulmonary perfusion in acute pulmonary embolism: agreement of MRI and SPECT for lobar, segmental and subsegmental perfusion defects. Acta Radiol 2006;47:933–940.PubMedCrossRefGoogle Scholar
  127. 127.
    Cheely R, McCartney WH, Perry JR, Delany DJ, Bustad L, Wynia VH, et al. The role of noninvasive tests versus pulmonary angiography in the diagnosis of pulmonary embolism. Am J Med 1981;70:17–22.PubMedCrossRefGoogle Scholar
  128. 128.
    Henry JW, Relyea B, Stein PD. Continuing risk of thromboemboli among patients with normal pulmonary angiograms. Chest 1995;107:1375–1378.PubMedCrossRefGoogle Scholar
  129. 129.
    Hull RD, Hirsh J, Carter CJ, Jay RM, Dodd PE, Ockelford PA, et al. Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med 1983;98:891–899.PubMedGoogle Scholar
  130. 130.
    Novelline RA, Baltarowich OH, Athanasoulis CA, Waltman AC, Greenfield AJ, McKusick KA. The clinical course of patients with suspected pulmonary embolism and a negative pulmonary arteriogram. Radiology 1978;126:561–567.PubMedGoogle Scholar
  131. 131.
    van Beek EJ, Reekers JA, Batchelor DA, Brandjes DP, Buller HR. Feasibility, safety and clinical utility of angiography in patients with suspected pulmonary embolism. Eur Radiol 1996;6:415–419.PubMedCrossRefGoogle Scholar
  132. 132.
    Lette J, Cerino M, Barrette G, Dufresne MP, De Maria S, Eybalin MC, et al. Scintigraphic probability and angiographic diagnostic certainty in acute pulmonary embolism. Clin Nucl Med 2003;28:897–904.PubMedCrossRefGoogle Scholar
  133. 133.
    Nosske D, Minkov V, Brix G. Establishment and application of diagnostic reference levels for nuclear medicine procedures in Germany. Nuklearmedizin 2004;43:79–84.PubMedGoogle Scholar
  134. 134.
    ICRP Publication 80. Addendum 2 to ICRP Publication 72. Recalculated dose data for 19 frequently used radiopharmaceuticals from ICRP Publication 53. New York: Pergamon Press; 1999. p. 47–69.Google Scholar
  135. 135.
    Piepsz A, Hahn K, Roca I, Ciofetta G, Toth G, Gordon I, et al. A radiopharmaceuticals schedule for imaging in paediatrics. Paediatric Task Group European Association Nuclear Medicine. Eur J Nucl Med 1990;17:127–129.PubMedCrossRefGoogle Scholar
  136. 136.
    Stabin MG, Breitz HB. Breast milk excretion of radiopharmaceuticals: mechanisms, findings, and radiation dosimetry. J Nucl Med 2000;41:863–873.PubMedGoogle Scholar
  137. 137.
    Al Janabi MA, Yousif ZM, Kadim AH, Al Salem AM. A new technique for the preparation of ready-to-use macroaggregated albumin (MAA) kits to be labelled with 99mTc for lung scanning. Int J Appl Radiat Isot 1983;34:1473–1478.CrossRefGoogle Scholar
  138. 138.
    Clayton BD, Ice RD, Beierwaltes WH. Preparation, quality control and clinical acceptance of labeled Macrotec. Radiology 1975;116:223–225.PubMedGoogle Scholar
  139. 139.
    Bundesgesundheitsamt. Aufbereitungsmonographie Macrosalb-[99mTc] Technetium Bundesanzeiger 1991; Nr 182, 6902.Google Scholar
  140. 140.
    Child JS, Wolfe JD, Tashkin D, Nakano F. Fatal lung scan in a case of pulmonary hypertension due to obliterative pulmonary vascular disease. Chest 1975;67:308–310.PubMedCrossRefGoogle Scholar
  141. 141.
    Dworkin HJ, Smith JR, Bull FE. A reaction following administration of macroaggregated albumin (MAA) for a lung scan. Am J Roentgenol Radium Ther Nucl Med 1966;98:427–433.PubMedGoogle Scholar
  142. 142.
    Dworkin HJ, Smith JR, Bull FE. Reaction after administration of macroaggregated albumin for a lung scan. N Engl J Med 1966;275:376.PubMedCrossRefGoogle Scholar
  143. 143.
    Williams JO. Death following injection of lung scanning agent in a case of pulmonary hypertension. Br J Radiol 1974;47:61–63.PubMedCrossRefGoogle Scholar
  144. 144.
    Wu MT, Pan HB, Chiang AA, Hsu HK, Chang HC, Peng NJ, et al. Prediction of postoperative lung function in patients with lung cancer: comparison of quantitative CT with perfusion scintigraphy. AJR Am J Roentgenol 2002;178:667–672.PubMedGoogle Scholar
  145. 145.
    Chenuel B, Haouzi P, Olivier P, Marie PY, Chalon B, Borrelly J. Effect of exercise on lung-perfusion scanning in patients with bronchogenic carcinoma. Eur Respir J 2002;20:710–716.PubMedCrossRefGoogle Scholar
  146. 146.
    Fleming JS, Whalley DR, Skrypniuk JV, Jarritt PH, Houston AS, Cosgriff PS, et al. UK audit of relative lung function measurement from planar radionuclide imaging. Nucl Med Commun 2004;25:923–934.PubMedCrossRefGoogle Scholar
  147. 147.
    Curran WJ Jr, Moldofsky PJ, Solin LJ. Observations on the predictive value of perfusion lung scans on post-irradiation pulmonary function among 210 patients with bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 1992;24:31–36.PubMedGoogle Scholar
  148. 148.
    Lehnhardt S, Thorsten WJ, Strecker R, Hogerle S, Herget G, Geens V, et al. Assessment of pulmonary perfusion with ultrafast projection magnetic resonance angiography in comparison with lung perfusion scintigraphy in patients with malignant stenosis. Invest Radiol 2002;37:594–599.PubMedCrossRefGoogle Scholar
  149. 149.
    Eichinger M, Tetzlaff R, Puderbach M, Woodhouse N, Kauczor HU. Proton magnetic resonance imaging for assessment of lung function and respiratory dynamics. Eur J Radiol 2007;64:329–334.PubMedCrossRefGoogle Scholar
  150. 150.
    Stanchina ML, Tantisira KG, Aquino SL, Wain JC, Ginns LC. Association of lung perfusion disparity and mortality in patients with cystic fibrosis awaiting lung transplantation. J Heart Lung Transplant 2002;21:217–225.PubMedCrossRefGoogle Scholar
  151. 151.
    Hardoff R, Steinmetz AP, Krausz Y, Bar-Sever Z, Liani M, Kramer MR. The prognostic value of perfusion lung scintigraphy in patients who underwent single-lung transplantation for emphysema and pulmonary fibrosis. J Nucl Med 2000;41:1771–1776.PubMedGoogle Scholar
  152. 152.
    Goethals I, Dierckx R, De Meerleer G, De Sutter J, De Winter O, De Neve W, et al. The role of nuclear medicine in the prediction and detection of radiation-associated normal pulmonary and cardiac damage. J Nucl Med 2003;44:1531–1539.PubMedGoogle Scholar
  153. 153.
    Seppenwoolde Y, Engelsman M, De Jaeger K, Muller SH, Baas P, McShan DL, et al. Optimizing radiation treatment plans for lung cancer using lung perfusion information. Radiother Oncol 2002;63:165–177.PubMedCrossRefGoogle Scholar
  154. 154.
    De Jaeger K, Seppenwoolde Y, Boersma LJ, Muller SH, Baas P, Belderbos JS, et al. Pulmonary function following high-dose radiotherapy of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2003;55:1331–1340.PubMedGoogle Scholar
  155. 155.
    Graves MW, Kiratli PO, Mozley D, Palevsky H, Zukerberg B, Alavi A. Scintigraphic diagnosis of a right to left shunt in end-stage lung disease. Respir Med 2003;97:549–554.PubMedCrossRefGoogle Scholar
  156. 156.
    Sostman HD, Stein PD, Gottschalk A, Matta F, Hull R, Goodman L. Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Radiology 2008;246:941–946.PubMedCrossRefGoogle Scholar
  157. 157.
    Hull RD, Raskob GE, Ginsberg JS, Panju AA, Brill-Edwards P, Coates G, et al. A noninvasive strategy for the treatment of patients with suspected pulmonary embolism. Arch Intern Med 1994;154:289–297.PubMedCrossRefGoogle Scholar
  158. 158.
    van Beek EJ, Kuyer PM, Schenk BE, Brandjes DP, ten Cate JW, Buller HR. A normal perfusion lung scan in patients with clinically suspected pulmonary embolism: frequency and clinical validity. Chest 1995;108:170–173.PubMedCrossRefGoogle Scholar
  159. 159.
    Hull RD, Hirsh J, Carter CJ, Raskob GE, Gill GJ, Jay RM, et al. Diagnostic value of ventilation-perfusion lung scanning in patients with suspected pulmonary embolism. Chest 1985;88:819–828.PubMedCrossRefGoogle Scholar
  160. 160.
    Spies WG, Burstein SP, Dillehay GL, Vogelzang RL, Spies SM. Ventilation-perfusion scintigraphy in suspected pulmonary embolism: correlation with pulmonary angiography and refinement of criteria for interpretation. Radiology 1986;159:383–390.PubMedGoogle Scholar
  161. 161.
    Trujillo NP, Pratt JP, Talusani S, Quaife RA, Kumpe D, Lear JL. DTPA aerosol in ventilation/perfusion scintigraphy for diagnosing pulmonary embolism. J Nucl Med 1997;38:1781–1783.PubMedGoogle Scholar
  162. 162.
    Kahn D, Bushnell DL, Dean R, Perlman SB. Clinical outcome of patients with a “low probability” of pulmonary embolism on ventilation-perfusion lung scan. Arch Intern Med 1989;149:377–379.PubMedCrossRefGoogle Scholar
  163. 163.
    Lee ME, Biello DR, Kumar B, Siegel BA. “Low-probability” ventilation-perfusion scintigrams: clinical outcomes in 99 patients. Radiology 1985;156:497–500.PubMedGoogle Scholar
  164. 164.
    Goodman LR, Curtin JJ, Mewissen MW, Foley WD, Lipchik RJ, Crain MR, et al. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography. AJR Am J Roentgenol 1995;164:1369–1374.PubMedGoogle Scholar
  165. 165.
    Senac JP, Vernhet H, Bousquet C, Giron J, Pieuchot P, Durand G, et al. Pulmonary embolism: contribution of spiral X-ray computed tomography. J Radiol 1995;76:339–345.PubMedGoogle Scholar
  166. 166.
    Garg K, Welsh CH, Feyerabend AJ, Subber SW, Russ PD, Johnston RJ, et al. Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning: correlation with pulmonary angiographic results or clinical outcome. Radiology 1998;208:201–208.PubMedGoogle Scholar
  167. 167.
    Qanadli SD, Hajjam ME, Mesurolle B, Barre O, Bruckert F, Joseph T, et al. Pulmonary embolism detection: prospective evaluation of dual-section helical CT versus selective pulmonary arteriography in 157 patients. Radiology 2000;217:447–455.PubMedGoogle Scholar
  168. 168.
    Christiansen F. Diagnostic imaging of acute pulmonary embolism. Acta Radiol Suppl 1997;410:1–33.PubMedGoogle Scholar
  169. 169.
    Bajc M, Albrechtsson U, Olsson CG, Olsson B, Jonson B. Comparison of ventilation/perfusion scintigraphy and helical CT for diagnosis of pulmonary embolism: strategy using clinical data and ancillary findings. Clin Physiol Funct Imaging 2002;22:392–397.PubMedCrossRefGoogle Scholar
  170. 170.
    Ferretti GR, Bosson JL, Buffaz PD, Ayanian D, Pison C, Blanc F, et al. Acute pulmonary embolism: role of helical CT in 164 patients with intermediate probability at ventilationperfusion scintigraphy and normal results at duplex US of the legs. Radiology 1997;205:453–458.PubMedGoogle Scholar
  171. 171.
    Swensen SJ, Sheedy PF, Ryu JH, Pickett DD, Schleck CD, Ilstrup DM, et al. Outcomes after withholding anticoagulation from patients with suspected acute pulmonary embolism and negative computed tomographic findings: a cohort study. Mayo Clin Proc 2002;77:130–138.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2009

Authors and Affiliations

  • Klaus Zöphel
    • 1
  • Claudia Bacher-Stier
    • 2
  • Jörg Pinkert
    • 3
  • Joachim Kropp
    • 4
  1. 1.Department of Nuclear Medicine, Carl Gustav Carus Medical SchoolUniversity of Technology DresdenDresdenGermany
  2. 2.Bayer Schering Pharma AGBerlinGermany
  3. 3.Bayer Vital GmbHLeverkusenGermany
  4. 4.Department of Nuclear MedicineCarl-Thiem-Klinikum Cottbus gGmbHCottbusGermany

Personalised recommendations