With an abnormal chest X-ray, is there any point in performing V/Q scintigraphy?

Chilab, S.; Macías, Elena Atienza; Garvie, N. W.

doi:10.1097/00006231-200404000-00073

Cited by 1 publication

(1 citation statement)

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“…Multiple cohort studies have indicated that abnormal CXR findings are no longer an absolute contraindication to the interpretation of V/Q scans, given current technology [15,[25][26][27]. More recently, an audit of V/Q scans has been done, assessing whether the presence of an abnormal CXR was considered an issue in the radiologist's final report [28].…”

Section: Introductionmentioning

confidence: 99%

Ventilation-perfusion scan for diagnosing pulmonary embolism: do chest x-rays matter?

Conrad,

Lau,

Yerkovich

et al. 2024

Nuclear Medicine Communications

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Background Ventilation-perfusion (V/Q) scan coupled with single photon emission computed tomography (SPECT) is commonly used for the diagnosis of pulmonary embolism (PE). An abnormal chest x-ray (CXR) is deemed to hinder the interpretation of V/Q scan and therefore a normal CXR is recommended prior to V/Q scan. Aims To determine if an abnormal CXR impacted on V/Q scan interpretation and subsequent management. Methods A retrospective cohort analysis of all patients who underwent a V/Q scan for diagnosis of suspected acute PE between March 2016 and 2022 was performed. CXR reports were reviewed and classified as normal or abnormal. Low-dose computerised tomography was routinely performed in patients above the age of 70. Data regarding V/Q scan results and subsequent management including initiation of anticoagulation for PE or further diagnostic investigations were collected. Results A total of 340 cases were evaluated. Of the positive V/Q scans (92/340), 98.3% of the normal CXR were anticoagulated compared to 100% of the abnormal CXR group. Of the negative V/Q scans (239/340), no cases were started on anticoagulation and no further investigations were performed across both normal and abnormal CXR groups. Indeterminate results occurred in only 9 cases with no significant difference in management between normal and abnormal CXR groups. Conclusion An abnormal CXR does not affect the reliability of V/Q scan interpretation in the diagnosis of PE when coupled with SPECT. Unless clinically indicated, the mandate by clinical society guidelines for a normal CXR prior to V/Q should be revisited.

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