Transition from Planar to SPECT V/Q Scintigraphy: Rationale, Practicalities, and Challenges
Section snippets
SPECT Versus Planar V/Q Scintigraphy
The published literature supporting the superiority of SPECT imaging is relatively limited. Furthermore, there are even fewer data directly comparing planar imaging with SPECT imaging in this setting. This is largely attributable to the use of less than ideal ventilation agents in the United States, where the inert gas 133Xe has been the predominant ventilation agent used in V/Q scintigraphy. SPECT requires a constant distribution of radiopharmaceutical in the lungs, and 99mTc-based agents,
Barriers to Adopting SPECT Imaging
Despite these improvements in diagnostic accuracy, relatively few centers have transitioned to SPECT methodology for V/Q imaging.21 This is despite SPECT (and increasingly SPECT/CT) being routinely used in most Nuclear Medicine departments for many other indications in routine clinical practice. This suggests that there are significant barriers which must be overcome for this transition to successfully occur. These include:
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familiarity and experience with planar imaging;
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unfamiliarity with 3D
How to Make the Transition to SPECT
Given that the aforementioned barriers described are either perceived, rather than real, or are easily surmountable, departments and practices not currently performing SPECT need to consider how to implement the change to SPECT. For departments with reporting specialists well trained in cross-sectional anatomy, replacing planar with SPECT imaging would seem to be readily feasible. For some others, a transition period may be preferred where both datasets are acquired in patients able to tolerate
Conclusions
Although planar V/Q scanning has been used for many years in the evaluation of PE, it will struggle to stay relevant in clinical practice, particularly in the era of rapidly evolving technology, such as CTPA, if it is performed in the same way that it was 30 years ago.58 SPECT imaging has been shown to offer numerous advantages over planar imaging and it is imperative that the test is performed optimally if its diagnostic accuracy is to be maximized. In the same way that SPECT has replaced
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Cited by (34)
Pulmonary ventilation/perfusion single photon emission tomography - Initial experience of a Nuclear Medicine Department
2016, Revista Portuguesa de PneumologiaCitation Excerpt :V/QS-SPECT has the same conceptual basis of V/QS-planar, the only difference being that in V/QS-SPECT tomographic reconstructions of pulmonary ventilation and perfusion are acquired, allowing the evaluation of axial, coronal and sagittal planes. This technique has a solid experimental support,17 appears to have higher diagnostic sensitivity than V/QS-planar18,19 and does not seem to imply additional resource consumption.20 Besides, it compares favourably to computerized tomography pulmonary angiography.21,22,23
Contribution of V/Q SPECT to planar scintigraphy in the diagnosis of pulmonary embolism
2014, Revista Espanola de Medicina Nuclear e Imagen MolecularCitation Excerpt :As a consequence the contribution of the V/Q SPECT to diagnosis of PE was reported by demonstrating an increase of the diagnostic yield of the V/Q scintigraphy.6–8 Nevertheless, despite the described advantages, the technique is not of general use in the daily clinical practice, perhaps because not sufficient evidence is available and hence, as suggested by some authors,9–11 more research needs to be done to confirm the value of V/Q SPECT in the hospital clinical setting. Therefore, the aim of the present study was to evaluate the feasibility of V/Q SPECT and to analyze its diagnostic yield compared to the V/Q planar scintigraphy when applied in a routinely way to patients with clinical suspicion of PE.