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Reply: Scintigraphy or Multidetector CT Angiography for Suspected Pulmonary Embolism?

Montefiore Medical Center
Bronx, New York

REPLY: I am most appreciative of Dr. Bury's kind comments about my views on the use of ventilation–perfusion scintigraphy versus multidetector CT angiography for the study of pulmonary embolic disease. It appears as if we are in accord on most issues; most importantly, the overuse of CT angiography with its associated excessive radiation exposure, particularly to the female breast. The use of the plain chest radiograph for determining which modality to apply has worked quite well.

The one area where we appear to have some difference is how to handle the patient with chronic obstructive pulmonary disease who may have only minimal radiographic changes of "overinflation and a subtle increase in bronchovascular markings." The frequent ventilation–perfusion scintigraphy result of multiple matched defects that troubles Dr. Bury has not been a problem for us. This combination of findings clearly falls into the low-probability category. To my knowledge, we have not had any problem or adverse feedback from our clinicians in calling these studies low probability. An ongoing retrospective review of over 1,200 ventilation–perfusion studies that were performed in 2007 shows that we gave an "intermediate" or "indeterminate" interpretation in less than 5% of our examinations.

I would like to refer Dr. Bury and other interested parties to a recent prospective comparison of ventilation–perfusion scintigraphy and CT angiography by Anderson et al. that showed a similar outcome for the 2 procedures (1). This comparison should also be of great assistance to nuclear medicine physicians and radiologists who are trying to convince their clinicians to cut down on the excessive use of CT angiography in studying patients with suspected pulmonary embolic disease.

FOOTNOTES

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

References

1. Anderson DR, Kahn SR, Rodger MA, et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA. 2007;298:2743–2753.[Abstract/Free Full Text]

This Article Full Text (PDF) All Versions of this Article: jnumed.108.050450v1 49/5/864-a    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Freeman, L. M. Search for Related Content PubMed PubMed Citation Articles by Freeman, L. M.