The significance of single V-P mismatches found in Kr-81m/Tc-99m lung scans
Ventilation-perfusion lung scans demonstrating two or more areas of V-P mismatch (MM) are considered by most nuclear medicine physicians to indicate a high probability of pulmonary embolism (PE). Considerable disagreement exists, however, with regard to the significance of a single area of segmental (S) or subsegmental (SS) MM. The authors reviewed the studies of 22 patients suspected of having PE reviewed the studies of 22 patients suspected of having PE whose lung scans demonstrated a single area of V-P MM and whose diagnosis was confirmed by pulmonary angiography. All V scans were multi-view studies performed with Kr-81m. P scans were performed either with Tc-99m macroaggregated albumin or human albumin microspheres. P defects greater than 75% of the size of a brochopulmonary segment (BPS) were reported as S; defects between 25% and 75% of a BPS were reported as SS. The area of V-P MM was found in the lower lobes in 13 patients, the middle lobe or lingula in 6, and the upper lobes in 3. Of 17 patients with a VP MM and a clear chest x-ray, 4 of 10 patients with a SS MM had PE, as did 4 of 6 patients with a S MM; one patient with a single regional (R) area of V-P MM did not have PE. An additional 5 cases demonstrated a single area of V-P MM and an x-ray opacity of comparable size in the same location; three of these 5 patients had PE. Thus, 11 of the total 22 patients had PE (S:6/9, R:0/2, SS:5/11. The data demonstrate an intermediate level of probability of PE in all subgroups with a single V-P MM, and suggest that V-P lung scans showing a single area of V-P MM should be reported as indeterminate for PE.
- Research Organization:
- Columbia Univ., New York, NY
- OSTI ID:
- 6856184
- Report Number(s):
- CONF-850611-; TRN: 87-010652
- Journal Information:
- J. Nucl. Med.; (United States), Vol. 26:5; Conference: 32. annual meeting of the Society of Nuclear Medicine, Houston, TX, USA, 2 Jun 1985
- Country of Publication:
- United States
- Language:
- English
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