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Radionuclide Diagnosis of Pulmonary Embolism

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Thrombosis and Embolism: from Research to Clinical Practice

Part of the book series: Advances in Experimental Medicine and Biology ((AIM,volume 906))

Abstract

Diagnostic imaging plays an integral role in the diagnostic workup of suspected pulmonary embolism, and several modalities have been employed over the years. In recent years, the choice has been narrowed to either computer tomographic or radionuclide based methods, i.e. computer tomographic angiography (CTA) and ventilation-perfusion scintigraphy (V/Q-scan). Both methods display advantages and shortcomings, and while we provide some insights into CTA and alternative methods, the paper’s main focus is a review of the V/Q-scan. We discuss basic considerations, interpretation criteria, clinical value, and controversies of conventional planar lung scintigraphy as well as the more contemporary 3-dimensional imaging technique of single photon emission tomography (SPECT) with or without CT.

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References

  • Bajc M, Neilly JB, Miniati M, Schuemichen C, Meignan M, Jonson B (2009a) EANM guidelines for ventilation/perfusion scintigraphy: part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging 36(8):1356–1370

    Article  CAS  PubMed  Google Scholar 

  • Bajc M, Neilly JB, Miniati M, Schuemichen C, Meignan M, Jonson B (2009b) EANM guidelines for ventilation/perfusion scintigraphy: Part 2. Algorithms and clinical considerations for diagnosis of pulmonary emboli with V/P(SPECT) and MDCT. Eur J Nucl Med Mol Imaging 36(9):1528–1538

    Article  CAS  PubMed  Google Scholar 

  • Bajc M, Neilly B, Miniati M, Mortensen J, Jonson B (2010) Methodology for ventilation/perfusion SPECT. Semin Nucl Med 40(6):415–425

    Article  PubMed  Google Scholar 

  • Bajc M, Miniati M, Jogi J, Stein PD (2013) Perfusion SPECT in patients with suspected pulmonary embolism. Eur J Nucl Med Mol Imaging 40(9):1432–1437

    Article  PubMed  Google Scholar 

  • Bajc M, Olsson B, Gottsater A, Hindorf C, Jogi J (2015) V/P SPECT as a diagnostic tool for pregnant women with suspected pulmonary embolism. Eur J Nucl Med Mol Imaging 42(8):1325–1330

    Article  PubMed  PubMed Central  Google Scholar 

  • Ciofetta G, Piepsz A, Roca I, Fisher S, Hahn K, Sixt R et al (2007) Guidelines for lung scintigraphy in children. Eur J Nucl Med Mol Imaging 34(9):1518–1526

    Article  PubMed  Google Scholar 

  • Freeman LM, Stein EG, Sprayregen S, Chamarthy M, Haramati LB (2008) The current and continuing important role of ventilation-perfusion scintigraphy in evaluating patients with suspected pulmonary embolism. Semin Nucl Med 38(6):432–440

    Article  PubMed  Google Scholar 

  • Goodman LR, Stein PD, Matta F, Sostman HD, Wakefield TW, Woodard PK et al (2007) CT venography and compression sonography are diagnostically equivalent: data from PIOPED II. AJR Am J Roentgenol 189(5):1071–1076

    Article  PubMed  Google Scholar 

  • Gottschalk A, Sostman HD, Coleman RE, Juni JE, Thrall J, McKusick KA et al (1993) Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations. J Nucl Med 34(7):1119–1126

    CAS  PubMed  Google Scholar 

  • Gottschalk A, Stein PD, Sostman HD, Matta F, Beemath A (2007) Very low probability interpretation of V/Q lung scans in combination with low probability objective clinical assessment reliably excludes pulmonary embolism: data from PIOPED II. J Nucl Med 48(9):1411–1415

    Article  PubMed  Google Scholar 

  • Gutte H, Mortensen J, Jensen CV, Johnbeck CB, von der Recke P, Petersen CL et al (2009) Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT: head-to-head comparison with multidetector CT angiography. J Nucl Med 50(12):1987–1992

    Article  PubMed  Google Scholar 

  • Hagen PJ, Hartmann IJ, Hoekstra OS, Stokkel MP, Teule GJ, Prins MH (2002) How to use a gestalt interpretation for ventilation-perfusion lung scintigraphy. J Nucl Med 43(10):1317–1323

    PubMed  Google Scholar 

  • Hagen PJ, Hartmann IJ, Hoekstra OS, Stokkel MP, Postmus PE, Prins MH et al (2003) Comparison of observer variability and accuracy of different criteria for lung scan interpretation. J Nucl Med 44(5):739–744

    PubMed  Google Scholar 

  • Hess S, Madsen PH, Jorgensen HB, Hoilund-Carlsen PF (2005) Diagnostic imaging in acute pulmonary embolism. The use of spiral computed tomography, lung scintigraphy and echocardiography. Ugeskr Laeger 167(41):3870–3875

    PubMed  Google Scholar 

  • Hess S, Madsen PH, Basu S, Hoilund-Carlsen PF, Alavi A (2012) Potential role of FDG PET/CT imaging for assessing venous thromboembolic disorders. Clin Nucl Med 37(12):1170–1172

    Article  PubMed  Google Scholar 

  • Hess S, Blomberg BA, Zhu HJ, Hoilund-Carlsen PF, Alavi A (2014) The pivotal role of FDG-PET/CT in modern medicine. Acad Radiol 21(2):232–249

    Article  PubMed  Google Scholar 

  • Hess S, Madsen PH, Iversen ED, Frifelt JJ, Hoilund-Carlsen PF, Alavi A (2015) Efficacy of FDG PET/CT imaging for venous thromboembolic disorders: preliminary results from a prospective, observational pilot study. Clin Nucl Med 40(1):e23–e26

    Article  PubMed  Google Scholar 

  • Houshmand S, Salavati A, Hess S, Ravina M, Alavi A (2014) The role of molecular imaging in diagnosis of deep vein thrombosis. Am J Nucl Med Mol Imaging 4(5):406–425

    PubMed  PubMed Central  Google Scholar 

  • Kan Y, Yuan L, Meeks JK, Li C, Liu W, Yang J (2015) The accuracy of V/Q SPECT in the diagnosis of pulmonary embolism: a meta-analysis. Acta Radiol (Stockholm, Sweden: 1987) 56(5):565–572

    Google Scholar 

  • Kember PG, Euinton HA, Morcos SK (1997) Clinicians’ interpretation of the indeterminate ventilation-perfusion scan report. Br J Radiol 70(839):1109–1111

    Article  CAS  PubMed  Google Scholar 

  • Laurence IJ, Redman SL, Corrigan AJ, Graham RN (2012) V/Q SPECT imaging of acute pulmonary embolus – a practical perspective. Clin Radiol 67(10):941–948

    Article  CAS  PubMed  Google Scholar 

  • Le Roux PY, Palard X, Robin P, Delluc A, Abgral R, Querellou S et al (2014) Safety of ventilation/perfusion single photon emission computed tomography for pulmonary embolism diagnosis. Eur J Nucl Med Mol Imaging 41(10):1957–1964

    Article  PubMed  Google Scholar 

  • Lesser BA, Leeper KV Jr, Stein PD, Saltzman HA, Chen J, Thompson BT et al (1992) The diagnosis of acute pulmonary embolism in patients with chronic obstructive pulmonary disease. Chest 102(1):17–22

    Article  CAS  PubMed  Google Scholar 

  • Ling IT, Naqvi HA, Siew TK, Loh NK, Ryan GF (2012) SPECT ventilation perfusion scanning with the addition of low-dose CT for the investigation of suspected pulmonary embolism. Intern Med J 42(11):1257–1261

    Article  CAS  PubMed  Google Scholar 

  • Madsen PH, Hess S, Jorgensen HB, Hoilund-Carlsen PF (2005) Diagnostic imaging in acute pulmonary embolism in Denmark. A survey. Ugeskr Laeger 167(41):3875–3877

    PubMed  Google Scholar 

  • Mamlouk MD, vanSonnenberg E, Gosalia R, Drachman D, Gridley D, Zamora JG et al (2010) Pulmonary embolism at CT angiography: implications for appropriateness, cost, and radiation exposure in 2003 patients. Radiology 256(2):625–632

    Article  PubMed  Google Scholar 

  • Marmolin ES, Moller L, Johansen A, Madsen PH, Hess S (2009) Therapeutic consequences of lung scintigraphy in patients with intermediate probability of pulmonary embolism. Ugeskr Laeger 171(19):1594–1597

    PubMed  Google Scholar 

  • Miles S, Rogers KM, Thomas P, Soans B, Attia J, Abel C et al (2009) A comparison of single-photon emission CT lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism. Chest 136(6):1546–1553

    Article  PubMed  Google Scholar 

  • Miniati M, Pistolesi M, Marini C, Di Ricco G, Formichi B, Prediletto R et al (1996) Value of perfusion lung scan in the diagnosis of pulmonary embolism: results of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED). Am J Respir Crit Care Med 154(5):1387–1393

    Article  CAS  PubMed  Google Scholar 

  • Mortensen J, Gutte H (2014) SPECT/CT and pulmonary embolism. Eur J Nucl Med Mol Imaging 41(Suppl 1):S81–S90

    Article  PubMed  Google Scholar 

  • Nielsen AL, Thomassen A, Hess S, Alavi A, Hoilund-Carlsen PF (2013) Deep venous thrombosis and pulmonary embolism detected by FDG PET/CT in a patient with bacteremia. Clin Nucl Med 38(4):276–277

    Article  PubMed  Google Scholar 

  • PIOPED Investigators (1990) Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 263(20):2753–2759

    Article  Google Scholar 

  • Ravina M, Hess S, Chauhan MS, Jacob MJ, Alavi A (2014) Tumor Thrombus: ancillary findings on FDG PET/CT in an oncologic population. Clin Nucl Med 39(9):767–771

    Article  PubMed  Google Scholar 

  • Roach PJ, Bailey DL, Schembri GP, Thomas PA (2010) Transition from planar to SPECT V/Q scintigraphy: rationale, practicalities, and challenges. Semin Nucl Med 40(6):397–407

    Article  PubMed  Google Scholar 

  • Roach PJ, Schembri GP, Bailey DL (2013) V/Q scanning using SPECT and SPECT/CT. J Nucl Med 54(9):1588–1596

    Article  CAS  PubMed  Google Scholar 

  • Rondina MT, Lam UT, Pendleton RC, Kraiss LW, Wanner N, Zimmerman GA et al (2012) (18)F-FDG PET in the evaluation of acuity of deep vein thrombosis. Clin Nucl Med 37(12):1139–1145

    PubMed  PubMed Central  Google Scholar 

  • Sasahra AA (1973) The urokinase pulmonary embolism trial. A national cooperative study. Circulation 47(2 Suppl):II1–108

    Google Scholar 

  • Siegel A, Holtzman SR, Bettmann MA, Black WC (2004) Clinicians’ perceptions of the value of ventilation-perfusion scans. Clin Nucl Med 29(7):419–425

    Article  PubMed  Google Scholar 

  • Sostman HD, Gottschalk A (1992) Prospective validation of the stripe sign in ventilation-perfusion scintigraphy. Radiology 184(2):455–459

    Article  CAS  PubMed  Google Scholar 

  • Sostman HD, Stein PD, Gottschalk A, Matta F, Hull R, Goodman L (2008a) Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Radiology 246(3):941–946

    Article  PubMed  Google Scholar 

  • Sostman HD, Miniati M, Gottschalk A, Matta F, Stein PD, Pistolesi M (2008b) Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med 49(11):1741–1748

    Article  PubMed  Google Scholar 

  • Stein PD, Gottschalk A (1994) Critical review of ventilation/perfusion lung scans in acute pulmonary embolism. Prog Cardiovasc Dis 37(1):13–24

    Article  CAS  PubMed  Google Scholar 

  • Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD et al (2006) Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. Am J Med 119(12):1048–1055

    Article  PubMed  Google Scholar 

  • Stein PD, Freeman LM, Sostman HD, Goodman LR, Woodard PK, Naidich DP et al (2009) SPECT in acute pulmonary embolism. J Nucl Med 50(12):1999–2007

    Article  PubMed  Google Scholar 

  • Ueda H, Iio M, Kaihara S (1964) Determination of regional pulmonary blood flow in various cardiopulmonary disorders. Study and application of Macroaggregated Albumin (Maa) labelled with I-131 (I). Jpn Heart J 190:431–444

    Article  Google Scholar 

  • Wagner HN Jr, Lopez-Majano V, Langan JK, Joshi RC (1968) Radioactive xenon in the differential diagnosis of pulmonary embolism. Radiology 91(6):1168–1174

    Article  PubMed  Google Scholar 

  • Worsley DF, Kim CK, Alavi A, Palevsky HI (1993) Detailed analysis of patients with matched ventilation-perfusion defects and chest radiographic opacities. J Nucl Med 34(11):1851–1853

    CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

    Søren Hess M.D.

  2. Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, Esbjerg, Denmark

    Søren Hess M.D.

  3. Department of Medicine, Division of Respiratory Medicine, Vejle Hospital, Vejle, Denmark

    Poul Henning Madsen M.D.

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  1. Søren Hess M.D.
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  2. Poul Henning Madsen M.D.
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Correspondence to Søren Hess M.D. .

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Editors and Affiliations

  1. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden

    Md. Shahidul Islam

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Hess, S., Madsen, P.H. (2016). Radionuclide Diagnosis of Pulmonary Embolism. In: Islam, M. (eds) Thrombosis and Embolism: from Research to Clinical Practice. Advances in Experimental Medicine and Biology(), vol 906. Springer, Cham. https://doi.org/10.1007/5584_2016_105

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  • DOI: https://doi.org/10.1007/5584_2016_105

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22107-6

  • Online ISBN: 978-3-319-22108-3

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