title: Follow-up of perfusion defects in pulmonary perfusion scanning after pulmonary embolism: are we too careless?
abstract: Persisting perfusion defects may still be found in pulmonary perfusion scintigraphy months or years after pulmonary embolism. The aim of this study was to investigate the rate of persisting perfusion defects and the pattern of scintigraphic follow-up of patients after pulmonary embolism. Only those patients were included into our study who received pulmonary perfusion scintigraphy between 1991 and 1999, and who had perfusion defects including at least one whole segment. These perfusion defects were considered as persisting perfusion defects if unchanged over at least 1 year. From 3640 patients examined, 451 (12.4%) had perfusion defects meeting the criteria of this study. Of those, 129 (28.6%) received a scintigraphic follow-up. In 62 patients (48.1%), a reperfusion of the defects was found. In 38 patients (29.5%), the defects persisted within a follow-up period of up to 12 weeks. However, no pulmonary perfusion scintigraphy was performed thereafter. Out of the 129 patients receiving a scintigraphic follow-up, only 29 (22.5%) had a follow-up over more than 1 year, 19 of those had persisting perfusion defects. It is concluded that our data show an inadequate scintigraphic follow-up of patients with pulmonary embolism which may lead to unnecessary anticoagulant treatment if persisting perfusion defects are misinterpreted as fresh pulmonary embolism. In many cases, there was no further follow-up even if reperfusion of the defects was lacking in early follow-up.
authors.affiliation: Department of Nuclear Medicine, Philipps-University of Marburg, Germany. gotthard@mailer.uni-marburg.de
authors.forename: M
authors.initials: M
authors.lastname: Gotthardt
authors.forename: M
authors.initials: M
authors.lastname: Schipper
authors.forename: C
authors.initials: C
authors.lastname: Franzius
authors.forename: M
authors.initials: M
authors.lastname: Béhé
authors.forename: A
authors.initials: A
authors.lastname: Barth
authors.forename: T
authors.initials: T
authors.lastname: Schurrat
authors.forename: H
authors.initials: H
authors.lastname: Höffken
authors.forename: S
authors.initials: S
authors.lastname: Gratz
authors.forename: K
authors.initials: K
authors.lastname: Joseph
authors.forename: T M
authors.initials: TM
authors.lastname: Behr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011652:Pulmonary Circulation / Q000502:physiology; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology*; D011786:Quality Control; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015424:Reperfusion / Q000379:methods; D015427:Reperfusion Injury / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012307:Risk Factors; D012308:Risk Management; D013668:Technetium Tc 99m Aggregated Albumin; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin