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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Prof. Dr. C. Schümichen
Universität Rostock · Klinik und Poliklinik für Nuklearmedizin
Gertrudenplatz 1
18057 Rostock
Phone: +49 / 3 81 / 4 94 91 01
Fax: +49 / 3 81 / 4 94 91 02
Email: carl.schuemichen@med.uni-rostock.de
