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Semin Vasc Med 2001; 01(2): 155-164
DOI: 10.1055/s-2001-18483
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Pulmonary Embolism: Imaging Modalities-V/Q Scan, Spiral (Helical) CT, and MRI

Philip Costello1 2 , Krishanu B. Gupta2
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Department of Radiology, Brigham and Women's Hospital Boston, Massachusetts
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Publication History

Publication Date:
16 November 2001 (online)

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ABSTRACT

Ventilation-perfusion (V/Q) imaging has been used as the screening test for pulmonary embolism (PE) for many years with diagnostic algorithms developed as a result of the Prospective Investigation of Pulmonary Embolism Diagnosis study. The primary conclusions were that high probability V/Q scans were reliable indicators for PE and normal or near-normal scans were reliable in the exclusion of PE. With the increasing availability of spiral (helical) computed tomography (CT) and many studies showing a high degree of accuracy for PE, there is much support for the replacement of V/Q by spiral CT. This article reviews the literature concerning V/Q scanning, spiral (helical) CT, and the future potential for magnetic resonance in the diagnosis of PE.

KEYWORD

Pulmonary embolism - CT - MR - V/Q imaging

REFERENCES

  • 1 PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: results of the prospective investigation of pulmonary embolism diagnosis (PIOPED).  JAMA . 1990;  263 2753-2759
    Google Scholar
  • 2 Gottschalk A, Sostman H D, Coleman R E. Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations.  J Nucl Med . 1993;  34(7) 1119-1126
    PubMedGoogle Scholar
  • 3 Corbus H F, Seitz J P, Larson R K. Diagnostic usefulness of lung SPET in pulmonary thromboembolism: an outcome study.  Nucl Med Commun . 1997;  18(10) 897-906
    PubMedGoogle Scholar
  • 4 Benotti J R, Dalen J E. The natural history of pulmonary embolism.  Clin Chest Med . 1984;  5 403-410
    PubMedGoogle Scholar
  • 5 Carson J L, Kelley M A, Duff A. The clinical course of pulmonary embolism.  N Engl J Med . 1992;  326 1240-1245
    CrossrefPubMedGoogle Scholar
  • 6 Jacobson A F, Patel N, Lewis D H. Clinical outcome of patients with intermediate probability lung scans during six-month follow-up.  J Nucl Med . 1997;  38(10) 1593-1596
    PubMedGoogle Scholar
  • 7 Stein P D, Henry J W, Relyea B. Untreated patients with pulmonary embolism. Outcome, clinical, and laboratory assessment.  Chest . 1995;  107(4) 931-935
    PubMedGoogle Scholar
  • 8 Godwin J D, Webb W R, Gamsu G, Ovenfors C O. Computed tomography of pulmonary embolism.  AJR Am J Roentgenol . 1980;  135 691-695
    PubMedGoogle Scholar
  • 9 Vock P, Soucek M, Daepp M, Kalender W A. Lung: spiral volumetric CT with single breath-hold technique.  Radiology . 1990;  176 864-867
    PubMedGoogle Scholar
  • 10 Costello P, Dupuy D E, Ecker C P, Tello R. Spiral CT of the thorax with reduced volume of contrast material: a comparative study.  Radiology . 1992;  185 663-666
    PubMedGoogle Scholar
  • 11 Remy-Jardin M, Remy J, Wattine L, Giraud F. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique-comparison with pulmonary angiography.  Radiology . 1992;  185 381-387
    PubMedGoogle Scholar
  • 12 Remy-Jardin M, Remy J. Spiral CT angiography of the pulmonary circulation.  Radiology . 1999;  212 615-636
    PubMedGoogle Scholar
  • 13 Ferretti G R, Bosson J L, Buffaz P D. Acute pulmonary embolism: role of helical CT in 164 patients with intermediate probability at ventilation-perfusion scintigraphy and normal results at duplex US of the legs.  Radiology . 1997;  205 453-458
    PubMedGoogle Scholar
  • 14 Remy-Jardin M, Remy J, Artaud D, Deschildre F, Fribourg M, Beregi J P. Spiral CT of pulmonary embolism: technical considerations and interpretive pitfalls.  J Thorac Imaging . 1997;  12 103-117
    PubMedGoogle Scholar
  • 15 Teigen C L, Maus T P, Sheedy P I I F, Johnson C M, Stanson A W, Welch J J. Pulmonary embolism: diagnosis with electron beam CT.  Radiology . 1993;  188 839-845
    PubMedGoogle Scholar
  • 16 Greaves S M, Hart E M, Brown K, Young D A, Batra P, Aberle D R. Pulmonary thromboembolism: spectrum of findings on CT.  AJR Am J Roentegnol . 1995;  165 1359-1363
    PubMedGoogle Scholar
  • 17 Coche E E, Muller N L, Kim K I, Wiggs B R, Mayo J R. Acute pulmonary embolism: ancillary findings at spiral CT.  Radiology . 1998;  207 753-758
    PubMedGoogle Scholar
  • 18 Goodman L R, Curtin H H, Mewissen M W. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography.  AJR Am J Roentgenol . 1995;  164 1369-1374
    PubMedGoogle Scholar
  • 19 Remy-Jardin M, Remy J, Deschildre F. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy.  Radiology . 1996;  200 699-706
    PubMedGoogle Scholar
  • 20 Teigen C L, Maus T P, Sheedy P I I F. Pulmonary embolism: diagnosis with contrast enhanced electron beam CT and comparison with pulmonary angiography.  Radiology . 1995;  194 313-319
    PubMedGoogle Scholar
  • 21 van Rossum B A, Pattynama P M, Ton E R. Pulmonary embolism: validation of spiral CT angiography in 149 patients.  Radiology . 1996;  201 467-470
    PubMedGoogle Scholar
  • 22 van Erkel R A, van Rossum B A, Bioem J L, Kievit J, Pattynama P MT. Spiral CT angiography for suspected pulmonary embolism: a cost-effectiveness analysis.  Radiology . 1996;  201 29-36
    PubMedGoogle Scholar
  • 23 Drucker E A, Rivitz S M, Shepard J A. Acute pulmonary embolism: assessment of helical CT for diagnosis.  Radiology . 1998;  209 235-241
    PubMedGoogle Scholar
  • 24 Mayo J R, Remy-Jardin M, Müller N L. Pulmonary embolism: prospective comparison of spiral CT with ventilation-perfusion scintigraphy.  Radiology . 1997;  205 447-452
    PubMedGoogle Scholar
  • 25 Qanadli S D, El Hajjam M, Mesurolle B. Pulmonary embolism detection: prospective evaluation of dual-section helical CT versus selective pulmonary arteriography in 157 patients.  Radiology . 2000;  217 447-455
    PubMedGoogle Scholar
  • 26 Garg K, Welsh C H, Feyerabend A J. Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning-correlation with pulmonary angiographic results or clinical outcome.  Radiology . 1998;  208 201-208
    PubMedGoogle Scholar
  • 27 Remy-Jardin M, Remy J, Artaud D. Peripheral pulmonary arteries: optimization of the spiral CT acquisition protocol.  Radiology . 1997;  204 157-163
    PubMedGoogle Scholar
  • 28 Ghaye B, Szapiro D, Delannoy V, Mastora I, Remy J, Remy-Jardin M J. How far does multidetector CT allow the analysis of peripheral pulmonary arteries?.  <~>A comparative study with thin collimation single detector CT [abstract]. Radiology . 2000;  217(P) 508
    PubMedGoogle Scholar
  • 29 Hull R D, Raskob G E, Ginsberg J S. A noninvasive strategy for the treatment of patients with suspected pulmonary embolism.  Arch Intern Med . 1994;  154 289-297
    CrossrefPubMedGoogle Scholar
  • 30 Cross J JL, Kemp P M, Walsh C G. A randomized trial of spiral CT and ventilation perfusion scintigraphy for the diagnosis of pulmonary embolism.  Clin Radiol . 1998;  53 177-182
    PubMedGoogle Scholar
  • 31 Kim K, Muller N L, Mayo J R. Clinically suspected pulmonary embolism: utility of spiral CT.  Radiology . 1999;  210 693-697
    CrossrefPubMedGoogle Scholar
  • 32 Katz D S, Jorgensen M J, Rubin G D. Detection and follow-up of important extra-arterial lesions with helical CT angiography.  Clin Radiol . 1999;  54(5) 294-300
    CrossrefPubMedGoogle Scholar
  • 33 Herold C, Remy-Jardin M, Grenier P H. Prospective evaluation of pulmonary embolism: initial results of the European Multicenter Trial (ESTIPEP) (abstract).  Radiology . 1998;  209 235-241
    PubMedGoogle Scholar
  • 34 Blachere H, Latrabe V, Montaudon M. Pulmonary embolism revealed on helical CT angiography: comparison with ventilation-perfusion radionuclide lung scanning.  AJR Am J Roentgenol . 2000;  174 1041-1047
    PubMedGoogle Scholar
  • 35 Garg K, Sieler H, Welsh C H. Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment.  AJR Am J Roentgenol . 1999;  172 1627-1631
    PubMedGoogle Scholar
  • 36 Loomis N N, Yoon H C, Moran A G, Miller F J. Clinical outcomes of patients after a negative spiral CT pulmonary arteriogram in the evaluation of acute pulmonary embolism.  J Vasc Interv Radiol . 1999;  10(6) 707-712
    PubMedGoogle Scholar
  • 37 Goodman L R. 1999 plenary session: Friday imaging symposium: CT diagnosis of pulmonary embolism and deep venous thrombosis.  RadioGraphics . 2000;  20(4) 1201-1205
    PubMedGoogle Scholar
  • 38 Hatabu H, Gefter W B, Kressel H Y, Axel, Lenkinski R E. Pulmonary vasculature: high-resolution MR imaging. Work in progress.  Radiology . 1989;  171(2) 391-395
    PubMedGoogle Scholar
  • 39 Grist T M, Sostman H D, MacFall J R. Pulmonary angiography with MR imaging: preliminary clinical experience.  Radiology . 1993;  189(2) 523-530
    PubMedGoogle Scholar
  • 40 Rubin G D, Herfkens R J, Pelc N J. Single breath-hold pulmonary magnetic resonance angiography. Optimization and comparison of three imaging strategies.  Invest Rad . 1994;  29(8) 766-792
    PubMedGoogle Scholar
  • 41 Isoda H, Ushimi T, Masui T. Clinical evaluation of pulmonary 3D time-of-flight MRA with breath holding using contrast media.  J Comput Assist Tomogr . 1995;  19(6) 911-919
    PubMedGoogle Scholar
  • 42 Meaney J F, Weg J G, Chenevert T L, Stafford-Johnson D, Hamilton B H, Prince M R. Diagnosis of pulmonary embolism with magnetic resonance angiography.  New Engl J Med . 1997;  336(20) 1422-1427
    CrossrefPubMedGoogle Scholar
  • 43 Prince M R, Arnoldus C, Frisoli J K. Nephrotoxicity of high dose gadolinium compared with iodinated contrast.  J Magn Reson Imaging . 1996;  6 162-166
    CrossrefPubMedGoogle Scholar
  • 44 Hatabu H, Gaa J, Kim D, Li W, Prasad P V, Edelman R R. Pulmonary perfusion: qualitative assessment with dynamic contrast-enhanced MRI using ultra-short TE and inversion recovery turbo FLASH.  Magn Reson Med . 1966;  36(4) 503-508
    PubMedGoogle Scholar
  • 45 Bergin C J, Glover G M, Pauly J. Magnetic resonance imaging of lung parenchyma.  J Thorac Imaging . 1993;  8(1) 12-17
    PubMedGoogle Scholar
  • 46 Mayo J R, MacKay A, Muller N L. MR imaging of the lungs: value of short TE spin-echo pulse sequences.  AJR Am J Roentgenol . 1992;  159(5) 951-956
    PubMedGoogle Scholar
  • 47 Bergin C J, Pauly J M, Macovski A. Lung parenchyma: projection reconstruction MR imaging.  Radiology . 1991;  179(3) 777-781
    CrossrefPubMedGoogle Scholar
  • 48 Hatabu H, Tadamura E, Levin D L. Quantitative assessment of pulmonary perfusion with dynamic contrast-enhanced MRI.  Magn Reson Med . 1999;  42(6) 1033-1038
    PubMedGoogle Scholar
  • 49 Berthezene Y, Croisille P, Wiart M. Prospective comparison of MR lung perfusion and lung scintigraphy.  J Magn Reson Imaging . 1999;  9(1) 61-68
    CrossrefPubMedGoogle Scholar
  • 50 Berthezene Y, Vexler V, Clement O. Contrast-enhanced MR imaging of the lung: assessments of ventilation and perfusion.  Radiology . 1992;  183(3) 667-672
    PubMedGoogle Scholar
  • 51 Albert M S, Cates G D, Driehuys B. Biological magnetic resonance imaging using laser-polarized 129Xe.  Nature . 1994;  370(6486) 199-201
    CrossrefPubMedGoogle Scholar
  • 52 Middleton H, Black R D, Saam B. MR imaging with hyperpolarized 3He gas.  Magn Reson Med . 1995;  33(2) 271-275
    PubMedGoogle Scholar
  • 53 Edelman R R, Hatabu H, Tadamura E, Li W, Prasad P V. Noninvasive assessment of regional ventilation in the human lung using oxygen-enhanced magnetic resonance imaging.  Nat Med . 1996;  2(11) 1236-1239
    CrossrefPubMedGoogle Scholar
  • 54 Chen Q, Jakob P M, Griswold M A, Levin D L, Hatabu H, Edelman R R. Oxygen enhanced MR ventilation imaging of the lung.  Magma . 1998;  7(3) 153-161
    PubMedGoogle Scholar
  • 55 Evans A J, Sostman H D, Witty L A. Detection of deep venous thrombosis: prospective comparison of MR imaging and sonography.  J Magn Reson Imaging . 1996;  6(1) 44-51
    PubMedGoogle Scholar
  • 56 Evans A J, Sostman H D, Knelson M H. Detection of deep venous thrombosis: prospective comparison of MR imaging with contrast venography.  AJR Am J Roentgenol . 1993;  161(1) 131-139
    Google Scholar
  • 57 Bluemke D A, Wolf R L, Tani I, Tachiki S, McVeigh E R, Zerhouni E A. Extremity veins: evaluation with fast-spin-echo MR venography.  Radiology . 1997;  204(2) 562-565
    PubMedGoogle Scholar
  • 58 Gotway M B, Edinburgh K J, Feldstein V A, Lehman J, Reddy G P, Webb W R. Imaging evaluation of suspected pulmonary embolism.  Curr Probl Diagn Radiol . 1999;  28(5) 129-184
    PubMedGoogle Scholar
  • 59 Moody A R, Pollock J G, O'Connor A R, Bagnall M. Lower-limb deep venous thrombosis: direct MR imaging of the thrombus.  Radiology . 1998;  209(2) 349-355
    PubMedGoogle Scholar
  • 60 Ruehm S G, Wiesner W, Debatin J F. Pelvic and lower extremity veins: contrast-enhanced three-dimensional MR venography with a dedicated vascular coil-initial experience.  Radiology . 2000;  215(2) 421-427
    CrossrefPubMedGoogle Scholar
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