V / Q-Szintigrafie zur Diagnostik der Lungenembolie – III. Vergleich mit der Mehrzeilen-Spiral-CT

Zusammenfassung

Die V / Q-Szintigrafie erweist sich im Vergleich mit der moderneren Mehrzeilen-Spiral-CT beim Nachweis der akuten Lungenembolie in vielen Bereichen als ebenbürtig und bezüglich der Sensitivität sogar überlegen. Die Mehrzeilen-Spiral-CT erkennt zentrale Emboli mit hoher Sensitivität und Spezifität, beim Nachweis peripherer Emboli bestehen trotz methodischer Verbesserungen (Steigerung bis auf 64 Zeilen) noch Defizite. Insbesondere gemessen am Outcome ist die Sensitivität insgesamt immer noch zu gering (ca.75 %), die Ursache hierfür liegt weniger in der Abbildungsqualität als in der Befundung. Die V / Q-Szintigrafie weist Defizite beim Erkennen zentraler Emboli auf, die entweder gar keine hämodynamischen Auswirkungen haben oder nur teilokkludierend sind. Gemessen am Outcome ist die Sensitivität insgesamt dennoch hervorragend, die Anzahl symptomatischer sowie tödlicher Folgeembolien bei szintigrafisch unauffälligen, unbehandelten Patienten tendiert zu Null. Ausschlaggebend für die Prognose sind somit Emboli mit hämodynamischen Auswirkungen in der Primärdiagnostik. Anders als die V / Q-Szintigrafie erkennt die Mehrzeilen-Spiral-CT auch extrapulmonale Erkrankungen als Alternativdiagnosen, unter anderem die Aortendissektion. Das Risiko einer Tumorinduktion als Folge der Strahlenexposition ist nach einer Mehrzeilen-Spiral-CT um mehr als eine Größenordnung höher als bei der V / Q-Szintigrafie.

Abstract

V / Q scintigraphy can be seen to be equal in many areas to the more modern multislice-helical CT in detecting acute pulmonary embolism and even to be superior with respect to sensitivity. Multislice-helical CT recognizes central emboli with high sensitivity and specificity, but deficits still remain in detecting peripheral embolisms, despite methodical improvements (increase up to 64 slices). Especially measured on the outcome, the overall sensitivity is still too low (ca. 75 %), the reason for this lies less in the image quality than in the evaluation. V / Q scintigraphy has deficits in detecting central emboli which either have no hemodynamic effects or are only partially occluding. Measured on the outsome, the overall sensitivity is still excellent, the number of symptomatic and fatal late embolisms in scintigraphically normal, untreated patients tends toward zero. Decisive for the prognosis are thus embolisms with hemodynamic effects in primary diagnostics. Unlike V / Q scintigraphy, multislice-helical CT also recognizes extrapulmonary diseases as alternative diagnoses, among these aortic dissection. The risk of tumor induction following radiation exposure is higher with multislice-helical CT than with V / Q scintigraphy by more than one order of magnitude.

Schlüsselwörter

Lungenembolie - V / Q-Szintigrafie - Mehrzeilen-Spiral-CT - Sensitivität - Spezifität - Risiken

Key words

klung embolism - V / Q scintigraphy - multislice-helical-CT - sensitivity - specificity - risks

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