Advertisement

Lung Scintigraphy in Pulmonary Embolism

  • Giuliano Mariani
  • Laura Bruselli

Abstract

As recently reviewed [1, 2, 3, 4], lung scintigraphy has long been the mainstay for diagnosing acute pulmonary embolism (PE), whether based on the ventilation/perfusion study, as in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) approach [5, 6], or on perfusion only as in the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED) approach [7]. Nevertheless, advanced imaging technologies, most notably, multidetector-row CT pulmonary angiography (MDCT-PA), are now challenging the concept of lung scintigraphy as the first-line approach when diagnosing acute PE (APE) [8, 9, 10, 11]. On the other hand, the issue is especially relevant considering the fact that APE is a relatively common cardiovascular emergency that, if not timely diagnosed and adequately treated, may cause sudden death or acute life-threatening right-ventricular failure [12, 13]. In the long term, untreated PE can also be a common cause of chronic pulmonary hypertension, a complication that can be avoided with efficient therapies readily and widely available, such as heparin or thrombolytic agents in the acute phase and oral anticoagulants for long-term secondary prevention [14, 15, 16, 17]. The clinical problem is even more complicated because of the stringent requirement of employing an adequate diagnostic approach when APE is suspected on clinical ground [18] and because this condition often occurs with nonspecific or atypical presentations and thus remains a serious underlying challenge in the diagnostic pathway of any cardiovascular emergency.

Keywords

Pulmonary Embolism Perfusion Defect Acute Pulmonary Embolism Pretest Probability Lung Scintigraphy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Freeman LM, Stein EG, Sprayregen S et al (2008) The current and continuing important role of ventilation-perfusion scintigraphy in evaluating patients with suspected pulmonary embolism. Semin Nucl Med 38:432–440PubMedCrossRefGoogle Scholar
  2. 2.
    Miniati M, Sostman HD, Gottschalk A et al (2008) Perfusion lung scintigraphy for the diagnosis of pulmonary embolism: A reappraisal and review of the prospective investigative study of pulmonary embolism diagnosis methods. Semin Nucl Med 38:450–461PubMedCrossRefGoogle Scholar
  3. 3.
    Sostman HD, Miniati M, Gottschalk A et al (2008) Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med 49:1741–1748PubMedCrossRefGoogle Scholar
  4. 4.
    Stein PD, Sostman HD, Bounameaux H et al (2008) Challenges in the diagnosis of acute pulmonary embolism. Am J Med 121:565–571PubMedCrossRefGoogle Scholar
  5. 5.
    PIOPED Investigators (1990) Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). JAMA 263:2753–2759CrossRefGoogle Scholar
  6. 6.
    Sostman HD, Stein PD, Gottschalk A et al (2008) Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Radiology 246:941–946PubMedCrossRefGoogle Scholar
  7. 7.
    Miniati M, Pistolesi M, Marini C 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 154:1387–1393PubMedCrossRefGoogle Scholar
  8. 8.
    British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group (2003) British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 58:470–483CrossRefGoogle Scholar
  9. 9.
    Coche E, Vlassenbroek A, Roelants V et al (2005) Evaluation of biventricular ejection fraction with ECG-gated 16-slice CT: preliminary findings in acute pulmonary embolism in comparison with radionuclide ventriculography. Eur Radiol 15:1432–1440PubMedCrossRefGoogle Scholar
  10. 10.
    Broder J, Warshauer DM (2006) Increasing utilization of computed tomography in the adult emergency department. Emerg Radiol 13:25–30PubMedCrossRefGoogle Scholar
  11. 11.
    Kluge A, Luboldt W, Bachmann G (2006) Acute pulmonary embolism to the subsegmental level: Diagnostic accuracy of three MRI techniques compared with 16-MDCT. AJR Am J Roentgenol 187:7–14CrossRefGoogle Scholar
  12. 12.
    Douketis JD, Kearon C, Bates S, Duku EK, Ginsberg JS (1998) Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA 279:458–462PubMedCrossRefGoogle Scholar
  13. 13.
    Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353(9162): 1386–1389PubMedCrossRefGoogle Scholar
  14. 14.
    Konstantinides S, Geibel A, Heusel G et al (2002) Management Strategies and Prognosis of Pulmonary Embolism-3 Trial Investigators. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 347:1143–1150PubMedCrossRefGoogle Scholar
  15. 15.
    Lang IM (2004) Chronic thromboembolic pulmonary hypertension: not so rare after all. N Engl J Med 350:2236–2238PubMedCrossRefGoogle Scholar
  16. 16.
    Pengo V, Lensing AW, Prins MH et al (2004) Thromboembolic Pulmonary Hypertension Study Group. Incidence of chronic pulmonary hypertension after pulmonary embolism. N Engl J Med 350:2257–2264PubMedCrossRefGoogle Scholar
  17. 17.
    Becattini C, Agnelli G, Pesavento L et al (2006) Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest 130:172–175PubMedCrossRefGoogle Scholar
  18. 18.
    Remy-Jardin M, Pistolesi M, Goodman LR et al (2007) Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society. Radiology 245:315–329PubMedCrossRefGoogle Scholar
  19. 19.
    Miniati M, Monti S (2009) Should lung scan be abandoned for pulmonary embolism diagnosis in the age of multislice spiral CT? No. Intern Emerg Med 4:193–194PubMedCrossRefGoogle Scholar
  20. 20.
    Reid JH, Coche EE, Inoue T et al (2009) Is the lung scan alive and well? Facts and controversies in defining the role of lung scintigraphy for the diagnosis of pulmonary thromboembolism in the era of multidetector CT. Eur J Nucl Med Mol Imaging 36:505–521PubMedCrossRefGoogle Scholar
  21. 21.
    Bajc M, Neilly JB, Miniati M et al (2009) EANM guidelines for ventilation/perfusion scintigraphy. Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging 36:1356–1370PubMedCrossRefGoogle Scholar
  22. 22.
    Bajc M, Neilly JB, Miniati M et al (2009) EANM guidelines for ventilation/perfusion scintigraphy. Part 2. Algorithms and clinical considerations for diagnosis of pulmonary emboli with V/PSPECT and MDCT Eur J Nucl Med Mol Imaging 36:1528–1538PubMedCrossRefGoogle Scholar
  23. 23.
    Bajc M, Neilly B, Miniati M et al (2010) Methodology for ventilation/perfusion SPECT. Semin Nucl Med 40:415–425PubMedCrossRefGoogle Scholar
  24. 24.
    Roach PJ, Gradinscak DJ, Schembri CP et al (2010) SPECT/CT in V/Q scanning. Semin Nucl Med 40:455–466PubMedCrossRefGoogle Scholar
  25. 25.
    Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29:2276–2315PubMedCrossRefGoogle Scholar
  26. 26.
    Kelly J, Hunt BJ (2003) The utility of pretest probability assessment in patients with clinically suspected venous thromboembolism. J Thromb Haemost 1:1888–1896PubMedCrossRefGoogle Scholar
  27. 27.
    Miniati M, Monti S, Bottai M (2003) A structured clinical model for predicting the probability of pulmonary embolism. Am J Med 114:173–179PubMedCrossRefGoogle Scholar
  28. 28.
    McLean RG, Carolan M, Bui C et al (2004) Comparison of new clinical and scintigraphic algorithms for the diagnosis of pulmonary embolism. Brit J Radiol 77:372–376PubMedCrossRefGoogle Scholar
  29. 29.
    Stein PD, Woodard PK, Weg JG et al (2007) Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. Radiology 242:15–21PubMedCrossRefGoogle Scholar
  30. 30.
    Pistolesi M (2008) Challenges in the diagnosis of acute pulmonary embolism. Am J Med 121:565–571PubMedCrossRefGoogle Scholar
  31. 31.
    Tunariu N, Gibbs SJR, Win Z et al (2007) Ventilation-perfusion scintigraphy is more sentitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med 48:680–684PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • Giuliano Mariani
    • 1
  • Laura Bruselli
    • 2
  1. 1.Regional Center of Nuclear MedicineUniversity of Pisa Medical SchoolPisaItaly
  2. 2.Nuclear Medicine Division, Department of Oncology, Transplantation and Advanced Technologies in MedicineUniversity of PisaPisaItaly

Personalised recommendations