Nuklearmedizinische Lungenemboliediagnostik – State of the Art

Zusammenfassung

Die nuklearmedizinische Lungenemboliediagnostik ist ein sehr sensitives und spezifisches Verfahren, wenn sie state-of-the-art durchgeführt wird. Hierzu zählen nicht nur der Einsatz der Perfusionsszintigrafie, sondern auch der ­Ventilationsszintigrafie und beides in 3-dimen­sionaler SPECT- oder besser noch in SPECT/CT-Technik.

Leider wird bei vielen Untersuchungen auf die Ventilation verzichtet, was – bedingt durch falsch-positive Befunde – die Spezifität deutlich reduziert oder aber es erfolgen nur planare Darstellungen, was sich negativ auf die Sensitivität ­auswirkt.

Die 3-dimensionale SPECT-Darstellung erlaubt eine überlagerungsfreie Betrachtung aller Lungenabschnitte und auch die Möglichkeit parametrische V/Q-ratio-Daten zu generieren.

Verglichen mit der CTPA liefert die V-/P-SPECT eine zumindest vergleichbare Sensitivität, eine in der Regel deutlich niedrigere Strahlenexposition, wenig technisch suboptimale Studien und keine Kontrastmittel-assoziierten Komplikationen.

Steht dann auch noch ein moderner Hybrid-Scanner als SPECT/CT zur Verfügung, kann die ­V/-P-SPECT um ein koregistriertes Low-dose-CT erweitert werden, was nachweislich die diagnostische Genauigkeit weiter steigert, dabei insbesondere die unklaren Befunde reduziert und so falsch-positive Befunde weitestgehend eliminiert.

Abstract

Ventilation–perfusion scanning is a sensitive and specific tool to investigate pulmonary embolism when it is performed state-of-the-art. For an accurate diagnosis from our point of view not only perfusion but also ventilation scanning is indispensable. Since planar imaging has severe limitations, SPECT – to generate fully 3-dimensional imaging data – or even better SPECT/CT should be used. Using SPECT-technique increases sensitivity and adding low-dose CT from SPECT/CT increases specificity.

Compared with CT pulmonary angiography V-/P-SPECT has at least a similar sensitivity, a lower radiation dose, fewer technically suboptimal studies, and no contrast-related complications. Any nuclear medicine department equipped with a modern hybrid scanner can now perform combined V-/P-SPECT/CT (using low-dose protocols) to further enhance diagnostic accuracy, esp. by avoiding false positive findings.

Schlüsselwörter

Lungenembolie - Ventilation - Perfusion - planar - SPECT - SPET-CT

Key words

pulmonary embolism - ventilation-perfusion scan - planar - SPECT - SPET-CT

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