Lungenszintigraphie (Version 3)

Carl Schümichen; Matthias Schmidt; Thomas Krause

doi:10.1055/s-0038-1649553

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2018; 57(03): 74-91
DOI: 10.1055/s-0038-1649553

DGN-Handlungsempfehlung (S1-Leitlinie)

Schattauer GmbH

Lungenszintigraphie (Version 3)

Überarbeitet: 2.4.2017, 31.8.2017, 09.11.2017 und 06.04.2018Lung scintigraphy

Carl Schümichen

¹vormals Klinik und Poliklinik für Nuklearmedizin, Universität Rostock

,

Matthias Schmidt

²Klinik für Nuklearmedizin, Universitätsklinikum Köln

,

Thomas Krause

³Universitätsklinik für Nuklearmedizin, Inselspital, Universität Bern

› Author Affiliations

Abstract

Zusammenfassung

In der aktualisierten und erweiterten S1-Leitlinie zur Lungenszintigraphie werden die Vorzüge der Methode beim Nachweis der akuten Lungenembolie (LE) in der Lungenperipherie (subsegmentale LE), bei subakuten und chronischen Grunderkrankungen der Lunge, sowie beim Nachweis der chronischen LE (CTEPH) herausgestellt. Methode der Wahl ist die Ventilations/Perfusions(V/P)-SPECT oder V/P-SPECT/CT mit nochmals gesteigerter Spezifität. Aufgrund der hohen Sensitivität wird, um eine Übertherapie zu vermeiden, ein Schwellenwert eingeführt (V/P-mismatch in mindestens einem Segment oder zwei Subsegmenten). Im Falle eines veränderten Therapieverhaltens (nur Observation anstelle Antikoagulation) kann der Schwellenwert entfallen. Zur klinisch-therapeutischen Wertigkeit von subsementalen LE werden neue Daten präsentiert, die Kapitel offene Fragen wurden erweitert. Die weiteren Indikationen für V/P-SPECT (Nebendiagnosen, Anomalien der Lungenperfusion, Voraussage der postoperativen Lungenfunktion) werden mit neueren Daten hinterlegt.

Summary

The S1 guideline for lung scintigraphy has been updated and extended in order to emphasize the advantages oft the method in detecting acute pulmonary embolism (PE) in the periphery oft the lung (subsegmental PE), in underlying subacute and chronic pulmonary disorders, as well as in detecting chronic LE (CTEPH). Method of choice is ventilation / perfusion (V/P) SPECT or V/P SPECT/CT with even higher specificity. Because of its high sensitivity, a threshold (V/P mismatch in at least one segment or two subsegments) is introduced to avoid overtreatment. In case of a change in the therapeutic approach (observation only instead of anticoaculation) the threshold can be omitted. New data concerning the clinical and therapeutical impact of subsegmental PE are included, the chapters open questions have been extented. Other indications for V/P SPECT (secondary diagnoses, abnormalities in pulmonary perfusion, prediction of postoperative lung function) are presented with new data.

Schlüsselwörter

Leitlinie - Lungenszintigraphie - V/P-SPECT - V/P-SPECT/CT - akute Lungenembolie - CTEPH - Voraussage der postoperativen Lungenfunktion

Keywords

German guidelines - lung scintigraphy - V/P SPECT - V/P SPECT/CT - acute pulmonary embolism - CTEPH - prediction of postoperative lung function

Full Text

References

Literatur

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