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


Clinical References

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."

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.

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-CT/VQ versus CTPA for diagnosing pulmonary embolus and other lung pathology: Pre-existing lung disease should not be a contraindication
Bhatia KD, et al. J Med Imaging Radiat Oncol 2016; 60(4): 492-497

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.

Value of (99m)Tc-Technegas SPECT/CT for Localization of Alveolar-pleural Fistulas
Derlin T, et al. Nucl Med Mol Imaging 2016; 50(2): 164-165

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.

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.

Endoscopic Lung Volume Reduction in COPD: Improvements in Gas Transfer Capacity Are Associated With Improvements in Ventilation and Perfusion Matching
Hsu K, et al. J Bronchology Interv Pulmonol. 2018; 25(1): 48-53

Endoscopic lung volume reduction results in improved gas transfer capacity for at least 12 months. This may be explained by the ventilation-perfusion (V/Q) redistribution to the nontargeted and less emphysematous lung with improved VQ matching.