Optimizing ventilation-perfusion lung scintigraphy: Parting with planar imaging

Summary

Aim of the study was to introduce and verify a ventilation-perfusion (V/Q) acquisition protocol that incorporates new developments in scintigraphy in order to allow for a more balanced comparison with other diagnostic procedures. Methods: In 103 patients suspect of having pulmonary embolism, V/Q scans were acquired exclusively with SPECT technique. Ventilation was done with ultrafine aerosol. Planar images in eight directions were reconstructed through addition of three consecutive SPECT projections. Three referees examined the scans in regard to type, localization, and extent of V/Q defects. Results: Using this protocol, significantly more defects, especially of subsegmental size, were detected (p <0.Q1). Sensitivity, and diagnostic accuracy were also significantly improved (p <0.01) to 0.96, and 0.99, respectively. Furthermore, kappa values were increased up to 0.82 - a relevant enhancement in the ability to precisely localize V/Q defects. Conclusion: In conclusion this protocol provides high-resolution tomographic scans as well as high-quality planar images within a short acquisition time. Due to the significant increase in lesion detection, sensitivity, diagnostic accuracy, and anatomical localization of defects, it is a substantial improvement in the diagnosis of pulmonary embolism that will put V/Q scintigraphy on a par with other tomographic methods.

Zusammenfassung

Ziel der Studie ist die Einführung und Evaluierung eines Ventilations-Perfusions-Akquisitionsprotokolles (V/Q), das neue technische Entwicklungen berücksichtigt und auf diese Weise einen ausgewogeneren Vergleich mit anderen tomographischen Verfahren erlaubt. Methodik: Bei 103 Patienten mit Verdacht auf Lungenembolie wurden V/Q-Akquisitionen ausschließlich in SPECT-Technik angefertigt. Die Ventilationsstudien erfolgten dabei unter Verwendung eines ultrafeinen Aerosols. Durch Addition von jeweils drei aufeinander folgenden SPECT-Projektionen wurden planare Bilder in acht Ansichten rekonstruiert. Drei Gutachter untersuchten die Studien hinsichtlich des Typs, der Lokalisation und des Ausmaßes von Defekten. Ergebnisse: Im Vergleich zur planaren Szintigraphie konnte durch Verwendung dieses Protokolles eine signifikant höhere Anzahl an Defekten detektiert werden (p < 0,01). Ebenso wurden sowohl die Sensitivität als auch die diagnostische Genauigkeit signifikant gesteigert (p <0,01). Darüber hinaus konnten Kappa-Werte von bis zu 0,82 ermittelt werden - ein Beleg für die deutlich verbesserte Lokalisierbarkeit von V/Q-Defekten in der SPECT-Akquisilion. Schlussfolgerung: Das vorliegende Protokoll liefert sowohl hochauflösende SPECT-Studien als auch planare Bilder von guter Qualität innerhalb einer verkürzten Akquisitionszeit. Aufgrund der signifikant gesteigerten Läsionsdetektions-rate, Sensitivität, diagnostischen Genauigkeit und anatomischen Lokalisierbarkeit von Befunden stellt es eine substanzielle Verbesserung innerhalb der Diagnostik der Lungenembolie dar, wodurch ein ausgewogenerer Vergleich moderner bildgebender Verfahren ermöglicht wird.

Keywords

Single photon emission computed tomography - SPECT - pulmonary embolism - lung scintigraphy

Schlüsselwörter

Single-Photon-Emission-Computed-Tomography - SPECT - Lungenembolie - Lungenszintigraphie

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