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Correlation of Pulmonary Photoscan and Angiogram as Measures of the Severity of Pulmonary Embolic Involvement

Veterans Administration Hospital, West Roxbury, Massachusetts
Harvard Medical School, Boston, Massachusetts

Correspondence: For reprints contact: Kevin M. McIntyre, V.A. Hospital, 1400 V.F.W. Parkway, West Roxbury, Mass. 02132.

ABSTRACT

The observation that the hemodynamic impact of pulmonary embolism usually is directly proportionate to the extent of embolic obstruction by angiography and the extent of the perfusion defect by lung scan has emphasized the importance of an accurate assessment of the magnitude of embolic involvement. This may prove to be particularly true in patients with underlying heart or lung disease in whom the contribution of embolism to the hemodynamic abnormality may be very difficult to define. The extent of embolic involvement as assessed by pulmonary photoscanning was compared to the assessment by selective pulmonary angiography in patients free of underlying cardiopulmonary disease. The two techniques correlated reasonably well in this group of patients (r = 0.712; p < 0.01) . There was significant variability among individual patients, however. When large central emboli were present and produced complete obstruction, the correlation between scan and angiogram was very close. When large central emboli were present but failed to obstruct the distal vessel completely, the perfusion scan underestimated the defect seen angiographically. When small, distal embolism occurred, whether single or multiple, the angiogram underestimated the extent of embolic involvement. When overall embolic involvement was extensive (greater than 40% angiographic obstruction), the angiographic assessment was greater; with lesser degrees of obstruction, the scan assessment was greater. It was concluded that, although the overall correlation between the two techniques was good, either technique could significantly underestimate the magnitude of embolic involvement so that the use of both techniques may be essential to determine the extent of embolic involvement with reasonable accuracy.

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