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Lung Scan Interpretation: A Physiologic, User-Friendly Approach

Department of Diagnostic Imaging, Saint Joseph Hospital, Denver, Colorado

Correspondence: For reprints contact: Wm. C. Klingensmith III, MD, 3333 S. Bannock St., Ste 600, Englewood, CO 80110.

ABSTRACT

A physiologically-oriented, user-friendly algorithm for interpretation of ventilation-perfusion (/) lung scans was compared to the widely used Biello criteria. The physiologic algorithm relies primarily on the observer's degree of certainty that a / mismatch is present rather than on the size (relative to a whole segment) and number of / mismatches. One hundred five patients who had undergone a ventilation study with ¹³³Xe gas, a perfusion study with ^99mTc-MAA and pulmonary angiography were reviewed. Each / lung scan was interpreted once with the physiologic algorithm and once with the Biello criteria by two observers. Fifty-nine percent of the 105 studies were classified as indeterminate with the physiologic algorithm versus 62% with the Biello criteria. The prevalence of pulmonary embolism in the high probability, indeterminate, low probability and normal categories for the physiologic algorithm were 60%, 26%, 7% and 0%, respectively; and for the Biello criteria were 50%, 31%, 11% and 0%, respectively. Analysis of the data with receiver-operating-characteristic curves indicated that the physiologic algorithm performed better than the Biello criteria (p < 0.05). In addition, the physiologic algorithm has the advantages of being more intuitive and easier to remember. We conclude that further evaluation of the physiologic approach for the interpretation of / lung scans is warranted.