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How to Use a Gestalt Interpretation for Ventilation-Perfusion Lung Scintigraphy

Petronella J. Hagen, MD1, Ieneke J.C. Hartmann, MD2,3, Otto S. Hoekstra, MD, PhD4,5, Marcel P.M. Stokkel, MD, PhD3, Gerrit J.J. Teule, MD, PhD4 and Martin H. Prins, MD, PhD6 ANTELOPE Study Group

1 Department of Pulmonary Medicine, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
2 Department of Radiology, University Medical Center, Utrecht, The Netherlands
3 Department of Nuclear Medicine, University Medical Center, Utrecht, The Netherlands
4 Department of Nuclear Medicine, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
5 Department of Clinical Epidemiology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
6 Department of Clinical Epidemiology and Medical Technology Assessment, Academic Hospital Maastricht, Maastricht, The Netherlands



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  		FIGURE 1. A 35-y-old patient with acute dyspnea and pleuritic chest pain. V/Q scintigraphy shows 1 segmental perfusion defect with mismatch. (A) Perfusion scintigraphy. (B) Ventilation scintigraphy.

 


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  		FIGURE 2. Intraobserver variability of observer 1 and interobserver variability of observers 1 and 2 of 3 different gestalt interpretations. (A) Gestalt interpretation of perfusion scintigraphy and chest radiography. (B) Gestalt interpretation of perfusion scintigraphy, chest radiography, and clinical information. (C) Gestalt interpretation of V/Q scintigraphy, chest radiography, and clinical information. •, Intraobserver variability of observer 1; {triangleup}, interobserver variability of observers 1 and 2.

 


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  		FIGURE 3. ROC curves of observers 1–3 of 3 different gestalt interpretations. (A) Gestalt interpretation of perfusion scintigraphy and chest radiography. (B) Gestalt interpretation of perfusion scintigraphy, chest radiography, and clinical information. (C) Gestalt interpretation of V/Q scintigraphy, chest radiography, and clinical information. Solid line, observer 1; dotted line, observer 2; dashed-dotted line, observer 3.

 




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