Seminars in Nuclear Medicine
Volume 38, Issue 6 , Pages 450-461 , November 2008

Perfusion Lung Scintigraphy for the Diagnosis of Pulmonary Embolism: A Reappraisal and Review of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis Methods

  • Massimo Miniati, MD, PhD

      Affiliations

    • Department of Critical Care, Section of Respiratory Medicine, University of Florence, Florence, Italy
    • ,
  • H. Dirk Sostman, MD

      Affiliations

    • Office of the Dean, Weill Cornell Medical College and Methodist Hospital, Houston, TX
    • Corresponding Author InformationAddress reprint requests to H. Dirk Sostman, MD, Methodist Hospital, 6565 Fannin St, Houston, TX 77030
    • ,
  • Alexander Gottschalk, MD

      Affiliations

    • Department of Radiology, Michigan State University, East Lansing, MI
    • ,
  • Simonetta Monti, MD, PhD

      Affiliations

    • CNR Institute of Clinical Physiology, Pisa, Italy
    • ,
  • Massimo Pistolesi, MD

      Affiliations

    • Department of Critical Care, Section of Respiratory Medicine, University of Florence, Florence, Italy

References 

  1. Moser KM, Harsanyi P, Rius-Garriga G, et al. Assessment of pulmonary photoscanning and angiography in experimental pulmonary embolism. Circulation. 1969;39:663–674
  2. Gilday DL, Poulose KP, DeLand FH. Accuracy of detection of pulmonary embolism by lung scanning correlated with pulmonary angiography. Radiology. 1972;115:137–143
  3. Tow DE, Simon AL. A comparative analysis of pulmonary perfusion scans with pulmonary angiograms. Am Heart J. 1976;92:700–706
  4. Kipper MS, Moser KM, Kortman KE, et al. Long-term follow-up in patients with suspected pulmonary embolism and a normal lung scan. Chest. 1982;82:411–415
  5. Hull RD, Raskob GE, Coates G, et al. Clinical validity of a normal perfusion lung scan in patients with suspected pulmonary embolism. Chest. 1990;97:23–26
  6. Alderson PO, Doppman JL, Diamond SS, et al. Ventilation-perfusion lung imaging and selective pulmonary angiography in dogs with experimental pulmonary embolism. J Nucl Med. 1978;19:164–171
  7. Tetalman MR, Hoffer PB, Heck LL, et al. Perfusion lung scan in normal volunteers. Radiology. 1973;106:593–594
  8. Secker-Walker RH, Siegel BA. The use of nuclear medicine in the diagnosis of lung disease. Radiol Clin North Am. 1973;11:215–241
  9. Wagner HN, Lopez-Majano V, Langan JK, et al. Radioactive xenon in the differential diagnosis of pulmonary embolism. Radiology. 1968;91:1168–1174
  10. DeNardo GL, Goodwin DA, Ravasini R, et al. The ventilatory lung scan in the diagnosis of pulmonary embolism. N Engl J Med. 1970;282:1334–1336
  11. McNeil BJ, Holman L, Adelstein J. The scintigraphic definition of pulmonary embolism. JAMA. 1974;227:753–756
  12. Alderson PO, Rujanavech N, Secker-Walker RH, et al. The role of 133-xenon ventilation studies in the scintigraphic detection of pulmonary embolism. Radiology. 1976;120:633–640
  13. Alderson PO, Biello DR, Sachariah KG, et al. Scintigraphic detection of pulmonary embolism in patients with obstructive pulmonary disease. Radiology. 1981;138:661–666
  14. Biello DR, Mattar AG, McKnight RC, et al. Ventilation-perfusion studies in suspected pulmonary embolism. AJR. 1979;133:1033–1037
  15. Carter WD, Brady TM, Keyes JW, et al. Relative accuracy of two diagnostic schemes for detection of pulmonary embolism by ventilation-perfusion scintigraphy. Radiology. 1982;145:447–451
  16. The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. JAMA. 1990;263:2753–2759
  17. Gottschalk A, Sostman HD, Juni JE, et al. Ventilation-perfusion scintigraphy in the PIOPED study (Evaluation of the scintigraphic criteria and interpretations). J Nucl Med. 1993;34:1119–1126
  18. Sullivan DC, Coleman RE, Mills SR, et al. Lung scan interpretation: Effect of different observers and different criteria. Radiology. 1983;149:803–807
  19. Sostman HD, Coleman RE, Newman GE, et al. Experience with revised PIOPED criteria for V-Q scans in a clinically selected population. Radiology. 1994;193:103–107
  20. Stein PD, Gottschalk A, Henry JW, et al. Stratification of patients according to prior cardiopulmonary disease and probability assessment based on the number of mismatched segmental equivalent perfusion defects. Chest. 1993;104:1461–1467
  21. Stein PD, Henry JW, Gottschalk A. Mismatched vascular defects. Chest. 1993;104:1468–1472
  22. Worsley DF, Kim CK, Alavi A, et al. Detailed analysis of patients with matched ventilation-perfusion defects and chest radiographic opacities. J Nucl Med. 1993;34:1851–1853
  23. Hull RD, Hirsch J, Carter CJ, et al. Pulmonary angiography, ventilation lung scanning and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med. 1983;98:891–899
  24. Gottschalk A, Stein PD, Sostman HD, et al. Very low probability interpretation of ventilation-perfusion lung scans in combination with low probability clinical assessment reliably excludes pulmonary embolism: Data from PIOPED II. J Nucl Med. 2007;48:1411–1415
  25. Forbes KP, Reid JH, Murchison JT. Do preliminary chest X-ray findings define the optimum role of pulmonary scintigraphy in suspected pulmonary embolism?. Clin Radiol. 2001;56:397–400
  26. Goldberg SN, Palmer EL, Scott JA, et al. Pulmonary embolism: prediction of the usefulness of initial ventilation–perfusion scanning with chest radiographic findings. Radiology. 1994;193:801–805
  27. Stein PD, Alavi A, Gottschalk A, et al. Usefulness of non-invasive diagnostic tools for diagnosis of acute pulmonary embolism in patients with a normal chest radiograph. Am J Cardiol. 1991;67:1117–1120
  28. Sostman HD, Stein PD, Gottschalk A, et al. Sensitivity and specificity of ventilation–perfusion scintigraphy for acute pulmonary embolism in PIOPED II. Radiology. 2008;246:941–946
  29. Anderson DR, Kahn SR, Rodger MA, et al. Computerized tomographic pulmonary angiography versus ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. J Am Med Assoc. 2007;298:2743–2753
  30. Miniati M, Pistolesi M, Marini C, et al. Value of perfusion lung scan in the diagnosis of pulmonary embolism: Results of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED). Am J Respir Crit Care Med. 1996;154:1387–1393
  31. Stein PD, Terrin ML, Gottschalk A, et al. Value of ventilation/perfusion scans compared to perfusion scans alone in acute pulmonary embolism. Am J Cardiol. 1992;69:1239–1241
  32. Wells PS, Anderson DR, Rodger MA, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: Management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med. 2001;135:98–107
  33. Allgood RJ, Wolfe WG, Ebert PA, et al. Effects of carbon dioxide on bronchoconstriction after pulmonary artery occlusion. Am J Physiol. 1968;214:772–775
  34. Austin JMH, Sagel SS. Alterations of airway caliber after pulmonary embolization in the dog. Invest Radiol. 1972;7:135–139
  35. Levy SE, Simmons DH. Redistribution of alveolar ventilation following pulmonary thromboembolism in the dog. J Appl Physiol. 1974;36:60–68
  36. Dantzker DR, Wagner PD, Tornabene VW, et al. Gas exchange after pulmonary thromboembolization in dogs. Circ Res. 1978;42:92–103
  37. Santolicandro A, Prediletto R, Fornai E, et al. Mechanisms of hypoxemia and hypocapnia in pulmonary embolism. Am J Respir Crit Care Med. 1995;152:336–347
  38. Giuntini C. Ventilation/perfusion scan and dead space in pulmonary embolism: Are they useful for the diagnosis?. Q J Nucl Med. 2001;45:281–286
  39. Comroe JH. The main function of the pulmonary circulation. Circulation. 1966;33:146–158
  40. Worsley DF, Alavi A, Aronchick JM, et al. Chest radiographic findings in patients with acute pulmonary embolism: Observations from the PIOPED study. Radiology. 1993;189:133–136
  41. Glenny RW, Lamm WJE, Albert RK, et al. Gravity is a minor determinant of pulmonary blood flow distribution. J Appl Physiol. 1991;71:620–629
  42. Glenny RW. Blood flow distribution in the lung. Chest. 1998;114:8S–16S
  43. Parker F, Weiss S. The nature and significance of the structural changes in the lungs in mitral stenosis. Am J Pathol. 1936;12:573–598
  44. Smith RC, Burchell HB, Edwards JE. Pathology of the pulmonary vascular tree (IV. Structural changes in the pulmonary vessels in chronic left ventricular failure). Circulation. 1954;10:801–808
  45. Giuntini C, Pistolesi M, Miniati M. Pulmonary venous hypertension—mechanisms and consequences. In:  Wagenvoort CA,  Denolin H editor. Pulmonary Circulation (Advances and Controversies). Amsterdam: Elsevier Science Publisher; 1989;p. 131–147
  46. Gilday DL, James AE. Lung scan patterns in pulmonary embolism versus those in congestive heart failure and emphysema. Am J Roentgenol Radium Ther Nucl Med. 1972;115:739–750
  47. Moses DC, Silver TM, Bookstein JJ. The complementary roles of chest radiography, lung scanning, and selective pulmonary angiography in the diagnosis of pulmonary embolism. Circulation. 1974;49:179–188
  48. Viegi G, Matteelli G, Angino A, et al. The proportional Venn diagram of obstructive lung disease in the Italian general population. Chest. 2004;126:1093–1101
  49. Miniati M, Monti S, Stolk J, et al. Value of chest radiography in phenotyping chronic obstructive pulmonary disease. Eur Respir J. 2008;31:509–515
  50. Miniati M, Monti S, Bauleo C, et al. A diagnostic strategy for pulmonary embolism based on standardised pretest probability and perfusion lung scanning: a management study. Eur J Nucl Med Mol Imaging. 2003;30:1450–1456
  51. Miniati M, Monti S, Bottai M. A structured clinical model for predicting the probability of pulmonary embolism. Am J Med. 2003;114:173–179
  52. Miniati M, Monti S, Bottai M, et al. Survival and restoration of pulmonary perfusion in a long-term follow-up of patients after acute pulmonary embolism. Medicine (Baltimore). 2006;85:253–262
  53. Greenspan RH, Ravin CE, Polansky SM, et al. Accuracy of the chest radiograph in diagnosis of pulmonary embolism. Invest Radiol. 1982;17:539–543

PII: S0001-2998(08)00078-0

doi: 10.1053/j.semnuclmed.2008.06.001

Seminars in Nuclear Medicine
Volume 38, Issue 6 , Pages 450-461 , November 2008

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