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Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging 9/2009

01.09.2009 | Guidelines

EANM guidelines for ventilation/perfusion scintigraphy

Part 2. Algorithms and clinical considerations for diagnosis of pulmonary emboli with V/PSPECT and MDCT

verfasst von: M. Bajc, J. B. Neilly, M. Miniati, C. Schuemichen, M. Meignan, B. Jonson

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 9/2009

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Abstract

As emphasized in Part 1 of these guidelines, the diagnosis of pulmonary embolism (PE) is confirmed or refuted using ventilation/perfusion scintigraphy (V/PSCAN) 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/PSCAN and better for tomography (V/PSPECT). V/PSPECT 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/PSPECT gives an effective radiation dose of 1.2–2 mSv. For V/PSPECT, 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/PSPECT 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.
Literatur
1.
Zurück zum Zitat Bajc M, Neilly B, Miniati M, Schuemichen C, Meignan M, Jonson B. EANM guidelines for ventilation/perfusion scintigraphy, Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging 2009; 2009. Submitted. Bajc M, Neilly B, Miniati M, Schuemichen C, Meignan M, Jonson B. EANM guidelines for ventilation/perfusion scintigraphy, Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging 2009; 2009. Submitted.
3.
Zurück zum Zitat Westmark N. On the roentgen diagnosis of lung embolism. Acta Radiol 1938;19:358–72. Westmark N. On the roentgen diagnosis of lung embolism. Acta Radiol 1938;19:358–72.
4.
Zurück zum Zitat Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 1999;159:864–71.PubMed Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 1999;159:864–71.PubMed
7.
Zurück zum Zitat The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990;263:2753–9. doi:10.1001/jama.263.CrossRef The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990;263:2753–9. doi:10.​1001/​jama.​263.CrossRef
8.
Zurück zum Zitat 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 Diagnosis (PISA-PED). Am J Respir Crit Care Med 1996;154:1387–93.PubMed 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 Diagnosis (PISA-PED). Am J Respir Crit Care Med 1996;154:1387–93.PubMed
10.
11.
Zurück zum Zitat van Belle A, Buller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006;295:172–9. doi:10.1001/jama.295.2.172.PubMedCrossRef van Belle A, Buller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006;295:172–9. doi:10.​1001/​jama.​295.​2.​172.PubMedCrossRef
12.
Zurück zum Zitat Labas P, Ohradka B, Vladimir J, Cambal M. The home treatment of deep vein thrombosis with low molecular weight heparin, forced mobilisation and compression. Int Angiol 2000;19:303–7.PubMed Labas P, Ohradka B, Vladimir J, Cambal M. The home treatment of deep vein thrombosis with low molecular weight heparin, forced mobilisation and compression. Int Angiol 2000;19:303–7.PubMed
13.
Zurück zum Zitat Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 2006;144:165–71.PubMed Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 2006;144:165–71.PubMed
16.
Zurück zum Zitat Miniati M, Monti S, Bauleo C, Scoscia E, Tonelli L, Dainelli A, et al. A diagnostic strategy for pulmonary embolism based on standardised pretest probability and perfusion lung scanning: a management study. Eur J Nucl Med Mol Imaging 2003;30:1450–6. doi:10.1007/s00259-003-1253-7.PubMedCrossRef Miniati M, Monti S, Bauleo C, Scoscia E, Tonelli L, Dainelli A, et al. A diagnostic strategy for pulmonary embolism based on standardised pretest probability and perfusion lung scanning: a management study. Eur J Nucl Med Mol Imaging 2003;30:1450–6. doi:10.​1007/​s00259-003-1253-7.PubMedCrossRef
17.
Zurück zum Zitat Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000;83:416–20.PubMed Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000;83:416–20.PubMed
19.
Zurück zum Zitat Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 2001;135:98–107.PubMed Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 2001;135:98–107.PubMed
20.
Zurück zum Zitat Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med 2004;140:589–602.PubMed Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med 2004;140:589–602.PubMed
22.
24.
Zurück zum Zitat Wolf SJ, McCubbin TR, Nordenholz KE, Naviaux NW, Haukoos JS. Assessment of the pulmonary embolism rule-out criteria rule for evaluation of suspected pulmonary embolism in the emergency department. Am J Emerg Med 2008;26:181–5. doi:10.1016/j.ajem.2007.04.026.PubMedCrossRef Wolf SJ, McCubbin TR, Nordenholz KE, Naviaux NW, Haukoos JS. Assessment of the pulmonary embolism rule-out criteria rule for evaluation of suspected pulmonary embolism in the emergency department. Am J Emerg Med 2008;26:181–5. doi:10.​1016/​j.​ajem.​2007.​04.​026.PubMedCrossRef
26.
Zurück zum Zitat Goldhaber SZ, Haire WD, Feldstein ML, Miller M, Toltzis R, Smith JL, et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 1993;341:507–11. doi:10.1016/0140-6736(93) 90274-K.PubMedCrossRef Goldhaber SZ, Haire WD, Feldstein ML, Miller M, Toltzis R, Smith JL, et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 1993;341:507–11. doi:10.​1016/​0140-6736(93) 90274-K.PubMedCrossRef
27.
Zurück zum Zitat British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003;58:470–83. doi:10.1136/thorax.58.6.470.CrossRef British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003;58:470–83. doi:10.​1136/​thorax.​58.​6.​470.CrossRef
28.
Zurück zum Zitat Barghouth G, Yersin B, Boubaker A, Doenz F, Schnyder P, Delaloye AB. Combination of clinical and V/Q scan assessment for the diagnosis of pulmonary embolism: a 2-year outcome prospective study. Eur J Nucl Med 2000;27:1280–5. doi:10.1007/s002590000284.PubMedCrossRef Barghouth G, Yersin B, Boubaker A, Doenz F, Schnyder P, Delaloye AB. Combination of clinical and V/Q scan assessment for the diagnosis of pulmonary embolism: a 2-year outcome prospective study. Eur J Nucl Med 2000;27:1280–5. doi:10.​1007/​s002590000284.PubMedCrossRef
29.
Zurück zum Zitat Bajc M, Albrechtsson U, Olsson CG, Olsson B, Jonson B. Comparison of ventilation/perfusion scintigraphy and helical CT for diagnosis of pulmonary embolism; strategy using clinical data and ancillary findings. Clin Physiol Funct Imaging 2002;22:392–7. doi:10.1046/j.1475-097X.2002.00448.x.PubMedCrossRef Bajc M, Albrechtsson U, Olsson CG, Olsson B, Jonson B. Comparison of ventilation/perfusion scintigraphy and helical CT for diagnosis of pulmonary embolism; strategy using clinical data and ancillary findings. Clin Physiol Funct Imaging 2002;22:392–7. doi:10.​1046/​j.​1475-097X.​2002.​00448.​x.PubMedCrossRef
32.
Zurück zum Zitat Lemb M, Pohlabeln H. Pulmonary thromboembolism: a retrospective study on the examination of 991 patients by ventilation/perfusion SPECT using Technegas. Nucl Med (Stuttg) 2001;40:179–86. Lemb M, Pohlabeln H. Pulmonary thromboembolism: a retrospective study on the examination of 991 patients by ventilation/perfusion SPECT using Technegas. Nucl Med (Stuttg) 2001;40:179–86.
33.
Zurück zum Zitat Reinartz P, Schirp U, Zimny M, Sabri O, Nowak B, Schafer W, et al. Optimizing ventilation-perfusion lung scintigraphy: parting with planar imaging. Nucl Med (Stuttg) 2001;40:38–43. Reinartz P, Schirp U, Zimny M, Sabri O, Nowak B, Schafer W, et al. Optimizing ventilation-perfusion lung scintigraphy: parting with planar imaging. Nucl Med (Stuttg) 2001;40:38–43.
34.
Zurück zum Zitat Reinartz P, Wildberger JE, Schaefer W, Nowak B, Mahnken AH, Buell U. Tomographic imaging in the diagnosis of pulmonary embolism: a comparison between V/Q lung scintigraphy in SPECT technique and multislice spiral CT. J Nucl Med 2004;45:1501–8.PubMed Reinartz P, Wildberger JE, Schaefer W, Nowak B, Mahnken AH, Buell U. Tomographic imaging in the diagnosis of pulmonary embolism: a comparison between V/Q lung scintigraphy in SPECT technique and multislice spiral CT. J Nucl Med 2004;45:1501–8.PubMed
35.
Zurück zum Zitat Sostman HD, Miniati M, Gottschalk A, Matta F, Stein PD, Pistolesi M. Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med 2008;49:1741–8. doi:10.2967/jnumed.108.052217.PubMedCrossRef Sostman HD, Miniati M, Gottschalk A, Matta F, Stein PD, Pistolesi M. Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med 2008;49:1741–8. doi:10.​2967/​jnumed.​108.​052217.PubMedCrossRef
37.
Zurück zum Zitat Moores LK, Jackson WL Jr, Shorr AF, Jackson JL. Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography. Ann Intern Med 2004;141:866–74.PubMed Moores LK, Jackson WL Jr, Shorr AF, Jackson JL. Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography. Ann Intern Med 2004;141:866–74.PubMed
41.
Zurück zum Zitat van Beek EJ, Kuyer PM, Schenk BE, Brandjes DP, ten Cate JW, Buller HR. A normal perfusion lung scan in patients with clinically suspected pulmonary embolism. Frequency and clinical validity. Chest 1995;108:170–3. doi:10.1378/chest.108.1.170.PubMedCrossRef van Beek EJ, Kuyer PM, Schenk BE, Brandjes DP, ten Cate JW, Buller HR. A normal perfusion lung scan in patients with clinically suspected pulmonary embolism. Frequency and clinical validity. Chest 1995;108:170–3. doi:10.​1378/​chest.​108.​1.​170.PubMedCrossRef
43.
Zurück zum Zitat Palmer J, Bitzen U, Jonson B, Bajc M. Comprehensive ventilation/perfusion SPECT. J Nucl Med 2001;42:1288–94.PubMed Palmer J, Bitzen U, Jonson B, Bajc M. Comprehensive ventilation/perfusion SPECT. J Nucl Med 2001;42:1288–94.PubMed
44.
45.
Zurück zum Zitat ICRP. Radiation dose to patients from radiopharmaceuticals, publication 53. Oxford, New York: ICRP; 1988. p. 121. ICRP. Radiation dose to patients from radiopharmaceuticals, publication 53. Oxford, New York: ICRP; 1988. p. 121.
46.
Zurück zum Zitat ICRP. Radiation dose to patients from radiopharmaceuticals (addendum 2 to ICRP 53). Ann ICRP 1998;28:1–126. ICRP. Radiation dose to patients from radiopharmaceuticals (addendum 2 to ICRP 53). Ann ICRP 1998;28:1–126.
47.
49.
Zurück zum Zitat Burrage JW, Causer DA. Comparison of scatter doses from a multislice and a single slice CT scanner. Australas Phys Eng Sci Med 2006;29:257–9.PubMedCrossRef Burrage JW, Causer DA. Comparison of scatter doses from a multislice and a single slice CT scanner. Australas Phys Eng Sci Med 2006;29:257–9.PubMedCrossRef
52.
Zurück zum Zitat Valentin J; International Commission on Radiation Protection. Managing patient dose in multi-detector computed tomography (MDCT). ICRP Publication 102. Ann ICRP 2007;37:1–79. Valentin J; International Commission on Radiation Protection. Managing patient dose in multi-detector computed tomography (MDCT). ICRP Publication 102. Ann ICRP 2007;37:1–79.
53.
Zurück zum Zitat Hurwitz LM, Reiman RE, Yoshizumi TT, Goodman PC, Toncheva G, Nguyen G, et al. Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: implications for cancer induction. Radiology 2007;245:742–50. doi:10.1148/radiol.2453062046.PubMedCrossRef Hurwitz LM, Reiman RE, Yoshizumi TT, Goodman PC, Toncheva G, Nguyen G, et al. Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: implications for cancer induction. Radiology 2007;245:742–50. doi:10.​1148/​radiol.​2453062046.PubMedCrossRef
55.
Zurück zum Zitat Hurwitz LM, Yoshizumi TT, Goodman PC, Nelson RC, Toncheva G, Nguyen GB, et al. Radiation dose savings for adult pulmonary embolus 64-MDCT using bismuth breast shields, lower peak kilovoltage, and automatic tube current modulation. AJR Am J Roentgenol 2009;192:244–53. doi:10.2214/AJR.08.1066.PubMedCrossRef Hurwitz LM, Yoshizumi TT, Goodman PC, Nelson RC, Toncheva G, Nguyen GB, et al. Radiation dose savings for adult pulmonary embolus 64-MDCT using bismuth breast shields, lower peak kilovoltage, and automatic tube current modulation. AJR Am J Roentgenol 2009;192:244–53. doi:10.​2214/​AJR.​08.​1066.PubMedCrossRef
56.
Zurück zum Zitat U-King-Im JM, Freeman SJ, Boylan T, Cheow HK. Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy. Eur Radiol 2008;18:2709–15.PubMedCrossRef U-King-Im JM, Freeman SJ, Boylan T, Cheow HK. Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy. Eur Radiol 2008;18:2709–15.PubMedCrossRef
57.
Zurück zum Zitat Andreou AK, Curtin JJ, Wilde S, Clark A. Does pregnancy affect vascular enhancement in patients undergoing CT pulmonary angiography? Eur Radiol 2008;18:2716–22.PubMedCrossRef Andreou AK, Curtin JJ, Wilde S, Clark A. Does pregnancy affect vascular enhancement in patients undergoing CT pulmonary angiography? Eur Radiol 2008;18:2716–22.PubMedCrossRef
58.
Zurück zum Zitat Schaefer-Prokop C, Prokop M. CTPA for the diagnosis of acute pulmonary embolism during pregnancy. Eur Radiol 2008;18:2705–8.PubMedCrossRef Schaefer-Prokop C, Prokop M. CTPA for the diagnosis of acute pulmonary embolism during pregnancy. Eur Radiol 2008;18:2705–8.PubMedCrossRef
60.
Zurück zum Zitat Olsson CG, Bitzen U, Olsson B, Magnusson P, Carlsson MS, Jonson B, et al. Outpatient tinzaparin therapy in pulmonary embolism quantified with ventilation/perfusion scintigraphy. Med Sci Monit 2006;12:PI9–13.PubMed Olsson CG, Bitzen U, Olsson B, Magnusson P, Carlsson MS, Jonson B, et al. Outpatient tinzaparin therapy in pulmonary embolism quantified with ventilation/perfusion scintigraphy. Med Sci Monit 2006;12:PI9–13.PubMed
Metadaten
Titel
EANM guidelines for ventilation/perfusion scintigraphy
Part 2. Algorithms and clinical considerations for diagnosis of pulmonary emboli with V/PSPECT and MDCT
verfasst von
M. Bajc
J. B. Neilly
M. Miniati
C. Schuemichen
M. Meignan
B. Jonson
Publikationsdatum
01.09.2009
Verlag
Springer-Verlag
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 9/2009
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-009-1169-y

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