Bajc M, et al. Eur J Nul Med Mol Imaging 2009; 36: 1356-1370
Bajc M, et al. Eur J Nul Med Mol Imaging 2009; 36: 1528-1538
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.
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).
Pre-existing lung disease should not be a relative contraindication to the use of V/Q SPECT-CT. This modality has a sensitivity of 100% and specificity of 94% with lower radiation doses compared to CTPA.
We recommend nuclear V/Q lung scanning instead of CTPA as a screening test to rule out the possibility of CTEPH in patients diagnosed with PH. A normal V/Q scan effectively rules out the possibility of CTEPH.
99mTc-Technegas ventilation scintigraphy is an established and well-studied tool for imaging of lung ventilation and combined SPECT/CT has been shown to improve overall diagnostic accuracy in many areas of pulmonary nuclear medicine.
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.
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.
We recommend that SPECT/CT based quantification be used for all lung cancer patients undergoing pre-therapy evaluation of regional lung function.
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.