New Guidelines for PE VQ Scanning

Figure: PE, pulmonary embolism, VQ, scanning, Canadian Association of Nuclear Medicine, D-dimer, SPECT, CTPA, ventilationBy EMedHome.com The Canadian Association of Nuclear Medicine recently released best practice guidelines for VQ scanning in pulmonary embolism. (J Med Imaging Radiat Sci. 2024;55[1]:158; https://tinyurl.com/mwja5hwb.) These recommendations provide a concise, updated summary of key aspects of diagnosing acute PE. D-dimer has high sensitivity but low specificity for PE, and it is not needed if the pretest probability for PE is other than low. A negative D-dimer has a high negative predictive value. A ventilation/perfusion SPECT nuclear medicine scan has at least the same or better accuracy for PE as CTPA, but it has a much lower radiation dose, especially for breast exposure. A fetal dose is roughly equivalent for V/P SPECT and MD-CTPA. A breast dose is much higher with MD-CTPA than V/P SPECT. Consider V/P SPECT for children and pregnant women as the first investigation for suspected PE due to better sensitivity, lower radiation, and no adverse reactions. A perfusion-only study might suffice, with an optional ventilation study the next day if needed, because ventilation co-morbidities are unlikely. V/P SPECT should be used in pregnant women with comorbidities or a history of smoking. Interpretation in probabilistic terms is not appropriate and must be avoided. All exams should be interpreted as either PE present or PE absent or using clear terms. PE is diagnosed when at least one lobar or segmental vascular type mismatched defect (perfusion defect with preserved ventilation) or two subsegmental vascular mismatches is present, regardless of other findings. PE is excluded when perfusion is normal or if there are only matched defects (regardless of morphology), nonvascular mismatches, or reverse mismatches (perfusion preserved but ventilation absent). This clinical pearl first appeared on www.EMedHome.com. Subscribers receive a new clinical pearl by email every Wednesday. Visit our website for videos from emergency medicine experts (http://tinyurl.com/EMedHomeVideos) and podcasts from Amal Mattu, MD, and other noted emergency physicians from EMedHome.com (http://tinyurl.com/MattuEMCast). EMedHome.com on EM-News.com This Month's Video W. Gannon Sungar, DO: Strangulation Injuries: http://tinyurl.com/EMedHomeVideos. Dr. Sungar is an associate program director at the Denver Health Residency in Emergency Medicine and an assistant professor of emergency medicine at the University of Colorado School of Medicine in Aurora, CO. This Month's Podcast Amal Mattu, MD, and colleagues: AHA Updates on Adult ACLS and Pulmonary Embolism: http://tinyurl.com/MattuEMCast. Dr. Mattu is one of the premier speakers in emergency medicine and a professor of emergency medicine and the vice chair of emergency medicine at the University of Maryland School of Medicine in Baltimore.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.