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EANM guidelines for ventilation/perfusion scintigraphy

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

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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.

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Abbreviations

COPD:

Chronic obstructive pulmonary disease

MAA:

Macroaggregated human albumin

MDCT:

Multidetector computed tomography of the pulmonary arteries

PA:

Contrast-enhanced pulmonary angiography

PE:

Pulmonary embolism

V/PPLANAR :

Ventilation/perfusion scintigraphy with planar imaging

V/PSCAN :

Ventilation/perfusion scintigraphy

V/PSPECT :

Ventilation/perfusion single photon emission computed tomography

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Acknowledgments

We would like to thank the EANM Dosimetry Committee for the contribution and Medan Rehani, chair of the Task Group on Radiation Protection IAEA for sharing his knowledge and for fruitful discussions.

Conflicts of interest

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Authors and Affiliations

  1. Department of Clinical Physiology, Lund University Hospital, S-221 85, Lund, Sweden

    M. Bajc & B. Jonson

  2. University Medical Unit & Nuclear Medicine, Glasgow Royal Infirmary, Glasgow, G31 2ER, Scotland, UK

    J. B. Neilly

  3. Department of Medical and Surgical Critical Care, University of Florence, Italy, Viale Morgagni 85, 50134, Florence, Italy

    M. Miniati

  4. University Hospital Rostock, Clinic for Nuclear Medicine, Gertrudenplatz 1, 18057, Rostock, Germany

    C. Schuemichen

  5. Department of Nuclear Medicine, Centre Hospitalo Universitaire Henri Mondor, Université Paris 12, 94000, Créteil, France

    M. Meignan

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  1. M. Bajc
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  2. J. B. Neilly
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Correspondence to M. Bajc.

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Bajc, M., Neilly, J.B., Miniati, M. et al. EANM guidelines for ventilation/perfusion scintigraphy. Eur J Nucl Med Mol Imaging 36, 1528–1538 (2009). https://doi.org/10.1007/s00259-009-1169-y

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