Diagnosis of pulmonary embolus using ventilation/perfusion lung scintigraphy: more than 0.5 segment of ventilation/perfusion mismatch is sufficient

Howarth, Douglas M.; Booker, John A.; Voutnis, Demetrius

doi:10.1111/j.1445-5994.2006.01070.x

Cited by 16 publications

(13 citation statements)

References 31 publications

(56 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore it is not surprising that the prevalence of PE in the group of 98 patients who underwent planar scintigraphy was low (9%) and was comparable to that in the population studied by Howarth (13%) 12. In the group of 49 patients who underwent V/Q SPECT the prevalence of PE was similar to that in the PIOPED II study (19%) 17…”

Section: Discussionsupporting

confidence: 54%

Lung scintigraphy in the diagnosis of pulmonary embolism: current methods and interpretation criteria in clinical practice

Skarlovnik

Hrastnik

Fettich

et al. 2014

Radiology and Oncology

View full text Add to dashboard Cite

BackgroundIn current clinical practice lung scintigraphy is mainly used to exclude pulmonary embolism (PE). Modified diagnostic criteria for planar lung scintigraphy are considered, as newer scitigraphic methods, especially single photon emission computed tomography (SPECT) are becoming more popular.Patients and methods.Data of 98 outpatients who underwent planar ventilation/perfusion (V/Q) scintigraphy and 49 outpatients who underwent V/Q SPECT from the emergency department (ED) were retrospectively collected. Planar V/Q images were interpreted according to 0.5 segment mismatch criteria and revised PIOPED II criteria and perfusion scans according to PISA-PED criteria. V/Q SPECT images were interpreted according to the criteria suggested in EANM guidelines. Final diagnosis of PE was based on the clinical decision of an attending physician and evaluation of a 12 months follow-up period.ResultsUsing 0.5 segment mismatch criteria and revised PIOPED II, planar V/Q scans were diagnostic in 93% and 84% of cases, respectively. Among the diagnostic planar scans readings specificity for 0.5 segment mismatch criteria was 98%, and 99% for revised PIOPED II criteria. V/Q SPECT showed a sensitivity of 100% and a specificity of 98%, without any non-diagnostic cases. In patients with low pretest probability for PE, planar V/Q scans assessed by 0.5 segment mismatch criteria were diagnostic in 92%, and in 85% using revised PIOPED II criteria, while perfusion scintigraphy without ventilation scans was diagnostic in 80%.ConclusionsLung scintigraphy yielded diagnostically definitive results and is reliable in ruling out PE in patients from ED. V/Q SPECT has excellent specificity and sensitivity without any non-diagnostic results. Percentage of non-diagnostic results in planar lung scintigraphy is considerably smaller when 0.5 segment mismatch criteria instead of revised PIOPED II criteria are used. Diagnostic value of perfusion scintigraphy according to PISA-PED criteria is inferior to combined V/Q scintigraphy; the difference is evident especially in patients with low pretest probability for PE.

show abstract

Section: Discussionsupporting

confidence: 54%

Lung scintigraphy in the diagnosis of pulmonary embolism: current methods and interpretation criteria in clinical practice

Skarlovnik

Hrastnik

Fettich

et al. 2014

Radiology and Oncology

View full text Add to dashboard Cite

show abstract

“…It has been shown that more than 0.5 segment of V/Q mismatch is sufficient for the diagnosis of PE. 65 The holistic interpretation of V/Q SPECT should be based upon:…”

Section: V/q Patternsmentioning

confidence: 99%

Methodology for Ventilation/Perfusion SPECT

Bajc

Neilly

Miniati

et al. 2010

Seminars in Nuclear Medicine

View full text Add to dashboard Cite

Ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) is the scintigraphic technique of choice for the diagnosis of pulmonary embolism and many other disorders that affect lung function. Data from recent ventilation studies show that the theoretic advantages of Technegas over radiolabeled liquid aerosols are not restricted to the presence of obstructive lung disease. Radiolabeled macroaggregated human albumin is the imaging agent of choice for perfusion scintigraphy. An optimal combination of nuclide activities and acquisition times for ventilation and perfusion, collimators, and imaging matrix yields an adequate V/Q SPECT study in approximately 20 minutes of imaging time. The recommended protocol based on the patient remaining in an unchanged position during the initial ventilation study and the perfusion study allows presentation of matching ventilation and perfusion slices in all projections as well as in rotating volume images based upon maximum intensity projections. Probabilistic interpretation of V/Q SPECT should be replaced by a holistic interpretation strategy on the basis of all relevant information about the patient and all ventilation/perfusion patterns. PE is diagnosed when there is more than one subsegment showing a V/Q mismatch representing an anatomic lung unit. Apart from pulmonary embolism, other pathologies should be identified and reported, for example, obstructive disease, heart failure, and pneumonia. Pitfalls exist both with respect to imaging technique and scan interpretation. Semin Nucl Med 40: [415][416][417][418][419][420][421][422][423][424][425]

show abstract

“…The fundamental point is that lobar, segmental or sub-segmental V/P mismatch serves as the basis for confirming a diagnosis of PE among patients with suspected PE. Howarth et al state that: "at least 0.5 of a segment of ventilation/perfusion mismatch is considered diagnostic of PE" (Howarth et al, 2006). This simplified criterion gave the highest combined sensitivity and specificity, observer reproducibility and fewest indeterminate results.…”

Section: Criteria For Acute Pe According the European Guidelinesmentioning

confidence: 99%

Quantitative Ventilation/Perfusion Tomography: the Foremost Technique for Pulmonary Embolism Diagnosis

Bajc¹,

Jögi²

2012

Pulmonary Embolism

View full text Add to dashboard Cite

Diagnosis of pulmonary embolus using ventilation/perfusion lung scintigraphy: more than 0.5 segment of ventilation/perfusion mismatch is sufficient

Cited by 16 publications

References 31 publications

Lung scintigraphy in the diagnosis of pulmonary embolism: current methods and interpretation criteria in clinical practice

Lung scintigraphy in the diagnosis of pulmonary embolism: current methods and interpretation criteria in clinical practice

Methodology for Ventilation/Perfusion SPECT

Quantitative Ventilation/Perfusion Tomography: the Foremost Technique for Pulmonary Embolism Diagnosis

Contact Info

Product

Resources

About