Ventilation-perfusion lung scans for pulmonary emboli

Bateman, N T; Coakley, A. J.; Croft, D. N.; Lyall, J. R. W.

doi:10.1007/bf00252566

Cited by 15 publications

(7 citation statements)

References 9 publications

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“…In a study with 161 ventilation-perfusion lung scintigrams, RabOl et al [15] found -by using simple criteria such as segmental perfusion-ventilation mismatch -a high reproducibility with a kappa of 0.88. Conflicting results have been obtained in several retrospective and prospective studies using criteria for low, indeterminate and high probability depending on the size and number of perfusion defects, the presence of mismatch and the relation of perfusion defects on chest X-ray [7,11,13,14,20]. It is generally accepted, and has also recently been demonstrated in the PIOPED study, that a highprobability lung scintigram indicates an approximately 85% probability of PE and a high degree of clinical suspicion will augment the predictive value [10].…”

Section: Discussionmentioning

confidence: 99%

“…Comparing the interpretation schemes proposed by Biello et al [8], McNeil [9] and HOPED [10] showed no significant difference between the observer interpretations [18]. Bateman et al [13] used more simple criteria, as the observer was asked to place the scintigram in one of three categories: normal, PE (mismatch with perfusion impaired more than ventilation) or parenchymal lung disease (matching impairment of perfusion and ventilation). The reproducibility for each of three observers varied between 80% and 90% and the observer agreement was 77%.…”

Section: Discussionmentioning

confidence: 99%

“…While pulmonary angiography is considered the most accurate diagnostic method for PE, it is an invasive and expensive procedure with an inherent risk [4], although digital subtraction angiography with its lower rate of complications may be an alternative [5]. However, there has been some disagreement about the importance of subjectivity in the interpretation [11,12], as well as in the inter-and intraobserver variability in reporting V-Q images [7,[13][14][15]. Nevertheless, there remains some uncertainty about the specificity of this test [7], and criteria for interpretation of V-Q scintigraphy have been developed to minimize this problem [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…In the present study simple criteria were used [13]. performed in all patients within 48 h. The scintigrams were mixed randomly with 50 reference lung scintigrams from patients with clinical symptoms suspicious of PE, and the 137 scintigrams were read blindly and independently by two experienced clinical physiologists.…”

Section: Introductionmentioning

confidence: 99%

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Observer variation in the interpretation of ventilation-perfusion lung scintigraphy

et al. 1994

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The diagnosis of pulmonary embolism (PE) remains one of the most difficult in clinical medicine, and the diagnostic value of lung scintigraphy has been questioned. To evaluate the observer variation in the interpretation of ventilation-perfusion lung scanning in the diagnosis of PE, 87 lung scintigrams from consecutive patients with phlebography-proven deep venous thrombosis and without clinical signs of PE were randomly mixed with 50 reference lung scintigrams from patients with PE symptoms. The scintigrams were reevaluated blind by two experienced clinical physiologists. Each observer evaluated each lung scintigram twice and recorded whether the lung scan was normal or abnormal. If it was abnormal, the location and number of segment defects were registered.The intraobserver agreement, including number and location of segments, ranged from 0.77 to 0.85 and for the diagnosis of PE from 0.88 to 0.92 with a kappa of 0.80 -0.84. The values for the interobserver agreement for the diagnosis of PE were 0.73 -0.80 with a kappa of 0.56 -0.67. It is concluded that in the interpretation of ventilation-perfusion lung scintigraphy the use of a simple scheme -deciding whether there is segmental ventilation-perfusion mismatch or not -has a good reproducibility with a high kappa for inter-and intraobserver variation and can serve as a simple routine method for diagnosing PE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Observer variation in the interpretation of ventilation-perfusion lung scintigraphy

et al. 1994

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“…The correspondence among raters is variously stated as 70-94% [90,91]. It can be improved by the use of anatomical lung segment sketches and by specifi c training of raters [92].…”

Section: Agreement With Static Lpsmentioning

confidence: 99%

Ventilation/perfusion lung scintigraphy: what is still needed? A review considering technetium-99m-labeled macro-aggregates of albumin

et al. 2009

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Lung perfusion scintigraphy (LPS) with technetium-99m-labeled macro-aggregates of albumin (Tc-99m-MAA) is well established in the diagnostic of pulmonary embolism (PE). In the last decade, it was shown that single-photon emission computer tomography (SPECT) acquisition of LPS overcame static scintigraphy. Furthermore, there are rare indications for LPS, such as preoperative quantification of regional lung function prior to lung resection or transplantation, optimization of lung cancer radiation therapy, quantification of right-left shunt, planning of intra-arterial chemotherapy, and several rare indications in pediatrics. Moreover, LPS with Tc-99m-MAA is a safe method with low radiation exposure. PE can also be diagnosed by spiral computer tomography (CT), ultrasound, magnetic resonance angiography, or pulmonary angiography (PA, former gold standard). The present review considers all these methods, especially spiral CT, and compares them with LPS with respect to sensitivity and specificity and gives an overview of established and newer publications. It shows that LPS with Tc-99m-MAA represents a diagnostic method of continuing value for PE. In comparison with spiral CT and/or PA, LPS is not to be defeated as mentioned also by the most actual Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II reports. This applies in particular to chronic or recurring embolisms, whereas currently spiral CT may be of greater value for major or life-threatening embolisms. At present, LPS cannot be replaced by other methods in some applications, such as pediatrics or in the quantification of regional pulmonary function in a preoperative context or prior to radiation therapy. LPS still has a place in the diagnostics of PE and is irreplaceable in several rare indications as described earlier.

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Diseases of the Pulmonary System

Bozkurt¹,

Volkan‐Salanci²

2023

Radiology‐Nuclear Medicine Diagnostic Imaging

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Ventilation-perfusion lung scans for pulmonary emboli

Cited by 15 publications

References 9 publications

Observer variation in the interpretation of ventilation-perfusion lung scintigraphy

Observer variation in the interpretation of ventilation-perfusion lung scintigraphy

Ventilation/perfusion lung scintigraphy: what is still needed? A review considering technetium-99m-labeled macro-aggregates of albumin

Diseases of the Pulmonary System

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