Clinical

Guidelines

EANM guidelines for ventilation/perfusion scintigraphy – Part 1

Bajc M, et al. Eur J Nul Med Mol Imaging 2009; 36: 1356-1370

EANM guidelines for ventilation/perfusion scintigraphy – Part 2

Bajc M, et al. Eur J Nul Med Mol Imaging 2009; 36: 1528-1538

Education

Clinical References

The Economic Value of Hybrid Single-Photon Emission Computed Tomography with Computed Tomography Imaging in Pulmonary Embolism Diagnosis
Toney LK, et al. Acad Emerg Med 2017; 24(9):1110-1123

Compared to the currently available scanning technologies for diagnosing suspected PE, SPECT/CT appears to confer superior economic value, primarily via improved sensitivity and specificity and low non-diagnostic rates. In turn, the improved diagnostic accuracy accords this modality the lowest ratio of expenses attributable to potentially avoidable complications, misdiagnosis and underdiagnosis.

Ventilation defect typical for COPD is frequent among patients suspected for pulmonary embolism but does not prevent the diagnosis of PE by V/P SPECT
Nasr A, et al. EC Pulmonology and Respiratory Medicine. 2017; 4(3): 85-91

The introduction of the tomographic technique and the implementation of Technegas as a novel ventilation agent facilitated imaging of pulmonary embolism in comparison with planar imaging and particularly in COPD patients together with the new interpretation criteria.

Reproducibility of lobar perfusion and ventilation quantification using a SPECT/CT segmentation software in lung cancer patients
Provost K, et al. J Nucl Med Technol. 2017; 45(3): 185-192

We recommend that SPECT/CT based quantification be used for all lung cancer patients undergoing pre-therapy evaluation of regional lung function.

V/Q scanning using SPECT and SPECT/CT
Roach PJ, et al. J Nucl Med 2013; 54(9): 1588-1596

Technegas is an ideal agent for ventilation SPECT because of its small particle size (30–60 nm), resulting in greater alveolar penetration and less central deposition than a nebulizer-produced aqueous radioaerosol such as 99mTc-DTPA

Current status of ventilation-perfusion scintigraphy for suspected pulmonary embolism
Metter DF, et al. AJR Am J Roentgenol 2017; 208(3): 489-494

Ventilation imaging is most often performed in conjunction with lung perfusion to characterize perfusion defects as a matched, mismatched or reverse mismatched.

The optimal tracer for ventilation studies is Technegas, an ultra fine dispersion of 99mTc-labeled carbon. Despite that Technegas is not approved for use in the United States, it is used in 79% of ventilation imaging studies performed in Canada and is also commonly used in Europe. Its main advantage is greater percentage deposition in the alveolar spaces and less undesirable adherence to the central airways, compared with droplet radioaerosols.

EANM guidelines for ventilation/perfusion scintigraphy: Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography
Bajc M, et al. Eur J Nucl Med Mol Imaging 2009; 36(8): 1356-1370

Using 99mTc-Technegas has minimized the problem of hotspots in patients with obstructive lung disease and is according to clinical experience better than the best liquid aerosols

Identifying the heterogeneity of COPD by V/P SPECT: a new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease
Bajc M, et al. Int J of Chron Obstruct Pulmon Dis 2017; 12: 1579-1587

V/Q SPECT, using Technegas as the ventilation imaging agent, could diagnose and grade severity of COPD and also estimate preserved lung function in 94 patients. Moreover, V/Q SPECT appears to be a unique tool to reveal the heterogeneity of COPD caused by pulmonary comorbidities such as pulmonary embolism, left heart failure, lung tumor and pneumonia. The characteristics of these comorbidities suggest their significant impact in symptoms, their influence on prognosis and their response to treatment.

Applications of Ventilation-Perfusion Scintigraphy in Surgical Management of Chronic Obstructive Lung Disease and Cancer
Tulchinsky M, et al. Semin Nucl Med 2017; 47(6): 671-679

V/Q scintigraphy has affirmed its critical place in the evaluation of patients with lung cancer preparing for lung resection.

Enhanced by the advancements in hybrid imaging and computer processing, the V/Q scan examination continues to be reinvented and updated to keep pace with the needs of modern medicine.

Radionuclide diagnosis of pulmonary embolism
Hess S, et al. Adv Exp Med Biol 2017; 906: 49-65

Among the traditional imaging modalities for diagnosing pulmonary embolism (PE), the choice has narrowed to V/Q scan and CTPA. However, V/Q scan is preferred over CTPA for follow-up of PE particularly in young women in order to avoid the excessive breast radiation exposure associated with CTPA.

SPECT V/Q for the diagnosis of pulmonary embolism: protocol for a systematic review and meta-analysis of diagnostic accuracy and clinical outcome
Le Roux PY, et al. BMJ Open 2018; 8(4): e022024

In recent years, the technology around V/Q scintigraphy has rapidly evolved allowing the introduction of SPECT, a new method of scintigraphic acquisition. SPECT V/Q has been reported to improve the diagnostic performances of the test and significantly decrease the proportion of non-diagnostic studies. [...] SPECT V/Q imaging has many proponents within the nuclear medicine community and has already largely replaced planar V/Q scintigraphy in daily practice for the diagnosis of pulmonary embolism (PE).

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