Technegas versus (81m)Kr ventilation-perfusion scintigraphy: a comparative study in patients with suspected acute pulmonary embolism.
81mKr is widely used as a ventilation agent to diagnose pulmonary embolism (PE). However, (81m)Kr is expensive, which limits its continuous availability. Technegas can be an alternative ventilation agent with the advantage of being less expensive and available daily. The aim of this study was to compare the value of technegas with that of (81m)Kr in the detection of PE.


METHODS
Ninety-two consecutive patients (29 men; mean +/- SD, 53 +/- 17 y old) with at least one segmental perfusion defect (Hull criteria) were studied prospectively. Perfusion and ventilation (V/Q) lung scintigraphy with both technegas and (81m)Kr were performed within 24 h on all patients. V/Q lung scan results were classified as high probability for PE (normal ventilation study) or nondiagnostic (abnormal ventilation study). All V/Q lung scans were read by two experienced nuclear physicians in consensus. For the intra- and interobserver variabilities, two experienced observers independently read the V/Q lung scans.


RESULTS
(81m)Kr and technegas showed a good agreement (kappa, 0.68; 95% confidence interval [CI], 0.53-0.82). However, technegas significantly increased the number of nondiagnostic V/Q lung scans (P: = 0.035). In 15 patients, a discrepancy was found between (81m)Kr and technegas. False-positive V/Q lung scan results occurred in 4 of 12 patients (33%) with (81m)Kr and in 2 of 3 patients (66%) with technegas. The intra- and interobserver variabilities were 0.71-0.88 (95% CI, 0.56-1.0) for perfusion/(81m)Kr and 0.74-0.96 (95% CI, 0.58-1.0) for perfusion/technegas.


CONCLUSIONS
In comparison with (81m)Kr, technegas does not result in more false-positive V/Q lung scan results. The use of technegas, however, increases the number of nondiagnostic V/Q lung scan results, which would increase the demand for further additional testing to confirm or refute PE.
Hartmann
I J
IJ
Department of Radiology, University Medical Center, Utrecht, The Netherlands.
Hagen
P J
PJ
Stokkel
M P
MP
Hoekstra
O S
OS
Prins
M H
MH
D000208:Acute Disease; D000792:Angiography; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007727:Krypton Radioisotopes; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013670:Sodium Pertechnetate Tc 99m; D014057:Tomography, X-Ray Computed; D014692:Ventilation-Perfusion Ratio
D007727:Krypton Radioisotopes; D019275:Radiopharmaceuticals; C056708:Technegas; D013670:Sodium Pertechnetate Tc 99m