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Ventilation-Perfusion Lung Scanning in the Evaluation of Pulmonary Hypertension

Division of Nuclear Medicine, Department of Radiology and Pulmonary and Critical Care Division, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania

Correspondence: For correspondence or reprints contact: Abass Alavi, MD, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.

ABSTRACT

The objective of this study was to define the sensitivity, specificity and accuracy of ventilation-perfusion (V/Q) lung scanning in distinguishing chronic thromboembolic pulmonary hypertension (PHT) from other nonembolic causes of PHT. Methods: The V/Q lung scans from 75 patients in whom a confirmed cause of PHT was established were retrospectively reviewed. Twenty-five patients (33%) had chronic thromboembolic PHT, whereas 35 patients(47%) and 15 patients (20%) suffered from primary PHT and secondary nonthromboembolic PHT, respectively. Results: A high-probability V/Q scan interpretation had a sensitivity of 96% and a specificity of 94% for detecting patients with thromboembolic PHT. The combination of high-and intermediate probability V/Q scan interpretations had a sensitivity of 100% for detecting patients with thromboembolic PHT; however, the specificity decreased to 86%. Of the 35 patients with primary PHT, all but one patient had low-probability V/Q scan interpretations. Conclusion: In this series, a low-probability V/Q scan interpretation effectively excluded the diagnosis of chronic thromboembolic PHT. In patients with an intermediate- or high-probability V/Q scan interpretation, pulmonary angiography was required to confirm the diagnosis of chronic thromboembolism PHT and determine whether surgical intervention was indicated. The V/Q lung scan appears to be a highly sensitive test for chronic thromboembolism in the diagnostic evaluation of patients with PHT. However, its role needs to be defined further by application to a prospectively recruited cohort of patients with PHT.

Key Words: pulmonary embolism • radionuclide imaging • pulmonary hypertension • diagnosis • technetium-99m-macroaggregated albumin

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