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Tomographic Imaging in the Diagnosis of Pulmonary Embolism: A Comparison Between V/Q Lung Scintigraphy in SPECT Technique and Multislice Spiral CT

¹ Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
² Department of Diagnostic Radiology, University Hospital Aachen, Aachen, Germany

View larger version (46K): [in a new window]   FIGURE 1. Extraction of planar images from SPECT datasets: planar views were assembled by adding 3 consecutive SPECT projections each, with the corresponding projections indicated.

View larger version (44K): [in a new window]   FIGURE 2. Patient with multiple embolisms in both lungs: segmental mismatch defect in left lung was detected by both SPECT (A and B) and planar scintigraphy (C and D). Defects are marked by arrows in B and D. However, subsegmental mismatch defects in right lung were only diagnosed by SPECT (B). CT angiography found thrombotic clots in branches of middle lobe artery and both lower lobe arteries (E, arrows). V = ventilation scan; Q = perfusion scan; R = right; A = anterior; L = left.

View larger version (49K): [in a new window]   FIGURE 3. Patient with subsegmental embolisms in both lungs: mismatch defects were diagnosed by SPECT (A and B) but could not be seen on planar scans (C and D). Defects are marked by arrows in B. CT angiography found thrombotic clots in subsegmental branches of middle lobe artery (not shown) and in both lower lobe arteries (E, arrows). V = ventilation scan; Q = perfusion scan; R = right; A = anterior; L = left.

View larger version (61K): [in a new window]   FIGURE 4. Patient with severe case of chronic obstructive pulmonary disease (COPD) and pulmonary emphysema. Large emphysematic bullae in right upper lobe (E) led to false-positive diagnosis in V/Q scintigraphy (B and D, mismatch defects marked by arrows). No pulmonary embolism was diagnosed in course of consensus meeting. CT was true-negative. Inhomogeneous distribution of ventilation agent is typical for patients with COPD (A and C). V = ventilation scan; Q = perfusion scan; R = right; A = anterior; L = left.

View larger version (20K): [in a new window]   FIGURE 5. Comparison between planar V/Q scintigraphy and SPECT with regard to number of match and mismatch defects detected on segmental and subsegmental levels. Asterisks indicate significant differences (2 test).