EANM guidelines for ventilation/perfusion scintigraphy

Abstract

As emphasized in Part 1 of these guidelines, the diagnosis of pulmonary embolism (PE) is confirmed or refuted using ventilation/perfusion scintigraphy (V/P(SCAN)) or multidetector computed tomography of the pulmonary arteries (MDCT). To reduce the costs, the risks associated with false-negative and false-positive diagnoses, and unnecessary radiation exposure, preimaging assessment of clinical probability is recommended. Diagnostic accuracy is approximately equal for MDCT and planar V/P(SCAN) and better for tomography (V/P(SPECT)). V/P(SPECT) is feasible in about 99% of patients, while MDCT is often contraindicated. As MDCT is more readily available, access to both techniques is vital for the diagnosis of PE. V/P(SPECT) gives an effective radiation dose of 1.2-2 mSv. For V/P(SPECT), the effective dose is about 35-40% and the absorbed dose to the female breast 4% of the dose from MDCT performed with a dose-saving protocol. V/P(SPECT) is recommended as a first-line procedure in patients with suspected PE. It is particularly favoured in young patients, especially females, during pregnancy, and for follow-up and research.

The Utility of Hybrid SPECT/CT Lung Perfusion Scintigraphy in Pulmonary Embolism Diagnosis

“…SPECT(Q) and planar(Q) scans are characterized by a relatively high sensitivity for detecting PE (SPECT > planar), but also by a low specificity. For this reason, it is recommended that perfusion scans should be performed in combination with ventilation scans instead of performing only perfusion scans [3]. The aim of ventilation scans is to increase the specificity of the perfusion scans, that is, to exclude nonembolic perfusion defects.…”

“…Although both modalities provide data on radioisotope distribution, they do not give any anatomical detail. Moreover, to confirm or rule out the diagnosis of PE, perfusion and ventilation studies are required [3]. …”

Diagnosing venous thromboembolism in pregnancy

“…Reporting criteria were those first proposed by Bajc et al 22 and subsequently incorporated into EANM guidelines. 17,18 CT pulmonary angiography Images were acquired using a Lightspeed® VCT XTe CT scanner (GE Healthcare, Little Chalfont, Buckinghamshire, UK). For each scan, a pulmonary angiogram protocol was used, with automatic exposure-controlled milliampere (smart milliampere) varying in the head-to-foot plane.…”

“…16 The European Association of Nuclear Medicine (EANM) have recently produced guidelines 17,18 which have led to a more extensive interest in its use. Whilst there have been considerable studies on the diagnostic performance of "traditional" planar VQ scans, most commonly by the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) trials and their subsequent reanalyses, [19][20][21] available data for VQ SPECT are inhomogeneous in terms of the ventilation tracer used and the reporting criteria.…”

The Economic Value of Hybrid Single‐photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis

“…Multidetector CTPA has since become the primary radiologic tool to establish PE diagnosis in daily clinical practice due to its speed, reliability, accessibility, and relatively acceptable sensitivity and specificity 1. V/Q single‐photon emission computed tomography (V/Q SPECT), which utilizes three‐dimensional nuclear medicine imaging of ventilation and perfusion, is an underutilized but valuable tool to evaluate and quantify the extent of acute PE, as well as establish alternate diagnoses 10. The imaging practice guidelines of the Society of Nuclear Medicine detail the advantage of using SPECT to obtain a three‐dimensional evaluation of the lungs,11 while the European Association of Nuclear Medicine guidelines recommend V/Q SPECT as the preferred modality whenever possible 4.…”