EANM guidelines for ventilation/perfusion scintigraphy : Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography.
Pulmonary embolism (PE) can only be diagnosed with imaging techniques, which in practice is performed using ventilation/perfusion scintigraphy (V/P(SCAN)) 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/P(SCAN) 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/P(PLANAR) and V/P(SPECT)) are analysed. V/P(SPECT) has higher sensitivity and specificity than V/P(PLANAR). The interpretation of either V/P(PLANAR) or V/P(SPECT) 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/P(SCAN) is of value. The additional diagnostic yield from V/P(SCAN) includes chronic obstructive lung disease (COPD), heart failure and pneumonia. Pitfalls in V/P(SCAN) interpretation are considered. V/P(SPECT) is strongly preferred to V/P(PLANAR) 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.
Bajc
M
M
Department of Clinical Physiology, Lund University Hospital, S-221 85, Lund, Sweden. Marika.bajc@med.lu.se
Neilly
J B
JB
Miniati
M
M
Schuemichen
C
C
Meignan
M
M
Jonson
B
B
D002908:Chronic Disease; D005060:Europe; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007091:Image Processing, Computer-Assisted; D007267:Injections; D008168:Lung / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D009683:Nuclear Medicine / Q000379:methods*; D055420:Perfusion Imaging / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012123:Pulmonary Ventilation; D011786:Quality Control; D011829:Radiation Dosage; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012952:Societies; D015899:Tomography, Emission-Computed, Single-Photon / Q000009:adverse effects / Q000379:methods*
D019275:Radiopharmaceuticals