V / Q-Szintigrafie zur Diagnostik der Lungenembolie – I. Durchführung und Beurteilung

Zusammenfassung

Die V / Q-Szintigrafie ist auch heute noch zur Diagnostik der Lungenembolie hervorragend geeignet. Die Kombination von Ventilations- und Perfusionsszintigrafie ist in dieser Abfolge die Regel. Geeignete Tracer für die Ventilationsszintigrafie sind Technegas und Krypton-81m und erst in zweiter Linie ein Feuchtaerosol. Als Mindestanforderung sollten 6–8 planare Projektionen aufgenommen werden. Optimal ist die Akquisition in SPECT-Technik. Korrelat der Lungenembolie ist ohne diagnostische Einschränkung der regionale Perfusionsausfall bei erhaltener Ventilation (V / Q-Mismatch). Eine Befundung nach PIOPED-Kriterien ist abzulehnen. Auf teilokkludierende Emboli ist zukünftig verstärkt zu achten, da sie auch Einfluss auf die Prognose haben. Relevante Nebendiagnosen betreffen die Atemwegsobstruktion (V / Q-Match bei wirksamem Euler-Liljestrand-Reflex) sowie den funktionellen Rechts-Links-Shunt (V / Q-Reverse-Mismatch bei gestörtem Euler-Liljestrand-Reflex).

Abstract

V / Q scintigraphy remains even today exceptionally well-suited for diagnosis of pulmonary embolism. The combination of ventilation and perfusion scintigraphy in this sequence is standard. Suitable tracers for ventilation scintigraphy are Technegas and Krypton-81m, with wet aerosols as second-choice alternatives. Acquisition in SPECT-technique is optimal. Regional perfusion defects with maintained ventilation (V / Q mismatch) correlate to pulmonary embolism without diagnostic limitations. Evaluation by means of PIOPED criteria should be rejected. Increased attention should be paid to partially-occluding embolisms, since they also influence the prognosis. Relevant alternative diagnoses refer to respiratory tract obstruction (V / Q match with intact v. Euler-Liljestrand reflex) and functional right-left shunt (V / Q reverse mismatch with impaired v. Euler-Liljestrand reflex).

Schlüsselwörter

Lungenemboliediagnostik - V / Q-Szintigrafie - PIOPED-Kriterien - teilokkludierende Emboli

Key words

lung embolism diagnosis - V / Q scintigraphy - PIOPED criteria - partially-occluding emboli

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