Does lung perfusion scintigraphy continue to have a role in the clinical management of patients suspected of pulmonary embolism in the CT pulmonary angiography era?
- 167 Downloads
Acute pulmonary embolism (PE) is a life-threatening disorder with high mortality. A prompt diagnosis and treatment is essential for reducing the mortality rate. The purpose of the study is to evaluate if lung perfusion scintigraphy (LPS) continues to have a role in the clinical management of patients suspected of pulmonary embolism in the CT pulmonary angiography (CTPA) era.
For this study, 1183 patients who had been subjected to LPS were retrospectively evaluated and classified into the following groups: A (positive LPS), B (negative LPS) and C (indeterminate LPS). Patients were further classified into A1 (‘PE likely’ and LPS-negative), B1 (PE unlikely and LPS-positive) and C1 (PE likely and indeterminate LPS) by combining the LPS findings and the clinical pretest probability (cpp). Subgroups A1, B1 and C1 underwent additional CTPA.
Groups A, B, and C included 1086/1183, 69/1183 and 28/1183 patients, respectively. The proportion of patients with inconsistent cpp LPS findings who underwent additional CTPA was 106/1183 patients: subgroup A1 (n = 73), B1 (n = 21), and C1 (n = 12). In subgroup A1, CTPA was negative in 61/73, non-diagnostic in 12/73 and positive in 0/73 patients. In subgroup B1, CTPA excluded PE in 2/21, non-diagnostic in 3/21 and positive in 16/21 patients. In group C1, CTPA was negative in 8/12, positive in 2/12 and non-diagnostic in 2/12 patients.
In the CTPA era, LPS continues to have a role in the clinical management of patients suspected of PE.
KeywordsLung perfusion scintigraphy CT pulmonary angiography Pulmonary embolism
Compliance with ethical standards
Conflict of interest
No potential conflicts of interest were disclosed.
- 5.Moheimani F, Jackson DE. Venous thromboembolism: classification, risk factors, diagnosis, and management. ISRN Hematol 2011:124610.Google Scholar
- 10.Miniati M, Pistolesi M, Marini C, Di Ricco G, Formichi B, Prediletto R, et al. Value of perfusion lung scan in the diagnosis of pulmonary embolism: results of the prospective investigative study of acute pulmonary embolism (PISA-PED). Am J Respir Crit Care Med. 1996;154:1387–93.CrossRefGoogle Scholar
- 17.Richman PB, Courtney DM, Friese J, Matthews J, Field A, Petri R, et al. Prevalence and significance of non thromboembolic findings on chest computed tomography angiography performed to rule out pulmonary embolism: a multicenter study of 1.025 emergency department patients. Acad Emerg Med. 2004;11:642–47.CrossRefGoogle Scholar
- 21.Cook JV, Kyriov J. Radiation from CT and perfusion scanning in pregnancy. Br Med J. 2005;6:331–50.Google Scholar
- 22.Task Group on Control of Radiation Dose in Computed Tomography. A report of the international commission on radiologic protection. Ann ICRP. 2000;30:7–45.Google Scholar
- 30.Ibanez-Bravo S, Banzo I, Quirce R, Martínez-Rodríguez I, Jiménez-Bonilla J, Martínez-Amador N, et al. Ventilation/perfusion SPECT lung scintigraphy and computed tomography pulmonary angiography in patients with clinical suspicion of pulmonary embolism. Rev Esp Med Nucl Image Mol. 2016;35:215–2.Google Scholar