Thromb Haemost 2000; 83(03): 412-415
DOI: 10.1055/s-0037-1613829
Review Article
Schattauer GmbH

Value of Chest X-ray Combined with Perfusion Scan versus Ventilation/Perfusion Scan in Acute Pulmonary Embolism

Marco R. de Groot
1   Department of Vascular Medicine, Academic Medical Center, Amsterdam
,
Franktien Turkstra
1   Department of Vascular Medicine, Academic Medical Center, Amsterdam
,
Marinus van Marwijk Kooy
3   Department of Internal, Sophia Hospital, Zwolle, The Netherlands
,
Ad H. J. Oostdijk
4   Department of Nuclear Medicine, Sophia Hospital, Zwolle, The Netherlands
,
Edwin J. R. van Beek
2   Department of Radiology, Academic Medical Center, Amsterdam
,
Harry R. Büller
1   Department of Vascular Medicine, Academic Medical Center, Amsterdam
› Author Affiliations
Further Information

Publication History

Received 20 September 1999

Accepted after revision 16 November 1999

Publication Date:
14 December 2017 (online)

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Summary

BackgroundThe main purpose of ventilation scanning, as adjunct to perfusion lung scintigraphy, in acute pulmonary embolism is to allow for the classification of segmental perfusion defects as mismatched, which is generally accepted as proof for the presence of pulmonary embolism. We examined whether this function of the ventilation scan could be replaced by the chest X-ray.MethodsIn 389 consecutive patients with suspected pulmonary embolism and at least one segmental perfusion defect we classified the ventilation/perfusion (V/Q) scan and chest X-ray/perfusion (X/Q) scan as either mismatched or matched. Furthermore we analyzed whether this comparison was different in subgroups of patients with concomitant congestive heart failure or chronic obstructive pulmonary disease.Results Overall agreement between the X/Q and V/Q scan diagnostic category was found in 341 of 389 patients (88%; 95% CI 84-92%). The positive predictive value for obtaining a mismatched V/Q scan result in case of a mismatched X/Q scan result was 86% (95% CI 81-90%). If the X/Q scan yielded only matched defects the V/Q scan resulted in the same classification in 90% (95% CI 85-95%). Analysis of the small subgroup of patients with chronic obstructive pulmonary disease showed that a mismatched X/Q scan was confirmed by V/Q scanning in 21 of 34 cases (62%; 95% CI 45-78%).ConclusionThis study shows that in the great majority of patients with clinically suspected acute pulmonary embolism combination of chest X-ray with perfusion scintigraphy reliably replaced ventilation/perfusion scintigraphy in defining (mis)-matching of segmental perfusion defects. These results need confirmation before the chest X-ray can fully obviate the use of ventilation scintigraphy.