Update Ventilations- und Perfusions-SPECT/CT in der Lungenemboliediagnostik und der funktionellen Quantifizierung mit Fallbeispielen

Zusammenfassung

In den letzten Themenheften zur Lungenszintigrafie sind ein Übersichtsartikel über die nuklearmedizinische „state of the art“ Lungenemboliediagnostik, ein Beitrag fokussierend auf neuere technische Aspekte der Ventilations- und Perfusions-SPECT/CT sowie der Stellenwert der Ventilations- und Perfusions-SPECT/CT in der AWMF-Leitlinie zur Diagnostik und Therapie der Venenthrombose und Lungenembolie erschienen. Die bisherigen Möglichkeiten der Quantifizierung und die Entwicklung bzw. Erleichterung der Auswertung mittels spezieller Softwarelösungen sind in den vergangenen Ausgaben bereits vorgestellt worden.

Im aktuellen Heft wollen wir uns auf neuere Erkenntnisse zur Ventilations- und Perfusions-SPECT/CT inklusive Weiterentwicklungen der Quantifizierungsmöglichkeiten konzentrieren, aber auch den Einsatz des Verfahrens in Zeiten der COVID-19 Pandemie beleuchten.

Einleitend erfolgt noch einmal ein kurzer Abriss der Technik sowie die additive Wertigkeit der low-dose CT im Rahmen der SPECT/CT, dazu stellen wir einzelne Fallbeispiele vor.

Nachfolgend geben wir einen Überblick über den aktuellsten wissenschaftlichen Stand zu der Ventilations- und Perfusions-SPECT/CT im Kontext von COVID-19.

Das Thema Quantifizierung wird unter Berücksichtigung eines neuen Algorithmus basierend auf dem Einsatz von künstlicher Intelligenz kurz dargestellt.

Abstract

In the previous issues of the “Nuklearmediziner” on lung scintigraphy, a review article on "state of the art" pulmonary embolism diagnostics in nuclear medicine, an article focusing on newer technical aspects of ventilation and perfusion SPECT/CT, and the significance of ventilation and perfusion SPECT/CT in the AWMF guideline on the diagnosis and therapy of venous thrombosis and pulmonary embolism were published. The possibilities of quantification and the development or facilitation of evaluation by means of special software solutions have already been presented in the previous issues.

In the current issue, we want to focus on recent findings on ventilation and perfusion SPECT/CT including further developments of quantification possibilities, but also highlight the use of the technique in times of the COVID-19 pandemic.

By way of introduction, we will once again briefly outline the technology as well as the additive value of low-dose CT in the context of SPECT/CT, and we will present individual case examples.

In the following, we will give an overview of the most current scientific status regarding ventilation and perfusion SPECT/CT in the context of COVID-19.

The topic of quantification is briefly presented in consideration of a new algorithm based on the use of artificial intelligence.

Schlüsselwörter

Ventilations-SPECT - Perfusions-SPECT - SPECT/CT - Lungenembolie - Quantifizierung - Künstliche Intelligenz

Keywords

Ventilation-SPECT - Perfusion-SPECT - SPECT/CT - Pulmonary embolism - Quantification - Artificial Intelligence

Publikationsverlauf

Artikel online veröffentlicht:
08. April 2021

• Literatur

• 1 Wagner Jr. H, Sabiston Jr. DC, Iio M. et al. Regional pulmonary blood flow in man by radiosiotope scanning. JAMA 1964; 187: 601-603
• 2 Schümichen C, Schmidt M, Krause T. Lungenszintigraphie (Version 3) [Lung scintigraphy]. Nuklearmedizin 2018; 57: 74-91
• 3 Bajc M, Schümichen C, Grüning T. et al. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging 2019; 46: 2429-2451
• 4 Kan Y, Yuan L, Meeks JK. et al. The accuracy of V/Q SPECT in the diagnosis of pulmonary embolism: a meta-analysis. Acta Radiol 2015; 56: 565-572
• 5 Krause BJ, Bartenstein P, Freudenberg LS. et al. Coronavirus SARS-CoV-2: Empfehlungen für die nuklearmedizinische Versorgung in nuklearmedizinischen Kliniken/Abteilungen mit Therapiestation und Praxen, Instituten sowie Ordinationen. Nuklearmedizin 2020; 59: e1-e4
• 6 Jögi J, Jonson B, Ekberg M. et al. Ventilation-perfusion SPECT with 99mTc-DTPA versus Technegas: a head-to-head study in obstructive and nonobstructive disease. J Nucl Med 2010; 51: 735-741
• 7 Schaefer WM, Meyer A, Knollmann D. Lung ventilation/perfusion SPECT for diagnosing pulmonary embolism. Is the required minimal P/V count rate ratio fulfilled in routine situation? Results from a multicentre survey. Nuklearmedizin 2015; 54: 217-222
• 8 Gutte H, Mortensen J, Jensen CV. et al. Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT: head-to-head comparison with multidetector CT angiography. J Nucl Med 2009; 50: 1987-1992
• 9 Le Roux PY, Robin P, Delluc A. et al. Additional value of combining low-dose computed tomography to V/Q SPECT on a hybrid SPECT-CT camera for pulmonary embolism diagnosis. Nucl Med Commun 2015; 36: 922-930
• 10 Zuckier LS, Moadel RM, Haramati LB. et al. Diagnostic Evaluation of Pulmonary Embolism During the COVID-19 Pandemic. J Nucl Med 2020; 61: 630-631
• 11 SFMN. Recommandations pour la réalisation de la scintigraphie pulmonaire dans le contexte d’épidémie due au virus Covid-19 [Internet]. https://www.sfmn.org/drive/CNP/CODIV-19/Recommandations_GT-ExplorationsPulmonaires30-03-2020.pdf Available from (Accessed 09 Nov 2020):
• 12 Buscombe JR, Notghi A, Croasdale J. et al. Council and Officers of British Nuclear Medicine Society. COVID-19: guidance for infection prevention and control in nuclear medicine. Nucl Med Commun 2020; 41: 499-504
• 13 Vöö S, Dizdarevic S. Single photon emission computed tomography lung perfusion imaging during the COVID-19 pandemic: does nuclear medicine need to reconsider its guidelines?. Nucl Med Commun 2020; 41: 991-993
• 14 Le Roux PY, Le Gal G, Salaun PY. Lung scintigraphy for pulmonary embolism diagnosis during the COVID-19 pandemic: does the benefit-risk ratio really justify omitting the ventilation study?. Eur J Nucl Med Mol Imaging 2020; 47: 2499-2500
• 15 Lu Y, Macapinlac HA. Perfusion SPECT/CT to diagnose pulmonary embolism during COVID-19 pandemic. Eur J Nucl Med Mol Imaging 2020; 47: 2064-2065
• 16 Cobes N, Guernou M, Lussato D. et al. Ventilation/perfusion SPECT/CT findings in different lung lesions associated with COVID-19: a case series. Eur J Nucl Med Mol Imaging 2020; 47: 2453-2460
• 17 Toney LK, Wanner M, Miyaoka RS. et al. Improved prediction of lobar perfusion contribution using technetium-99m-labeled macroaggregate of albumin single photon emission computed tomography/computed tomography with attenuation correction. J Thorac Cardiovasc Surg 2014; 148: 2345-2352
• 18 Knollmann D, Meyer A, Noack F. et al. Preoperative assessment of relative pulmonary lobar perfusion fraction in lung cancer patients. A rather simple three-dimensional CT-based vs. planar image-derived quantification. Nuklearmedizin 2015; 54: 178-182
• 19 Nicolas G, Chirindel A, Cachovan M. et al. Quantitative and anatomical assessment of lung perfusion with 99mTc-MAA SPECT/CT in emphysema and lung cancer patients. J Nucl Med 2018; 59: 516
• 20 Chirindel A, Cachovan M, Vija A. et al. 3D-Quantitated lung perfusion 99mTc-MAA SPECT/CT: Impact on intended management in comparison to planar (2D) lung perfusion scan in lung cancer patients. J Nucl Med 2019; 60: 299
• 21 Genseke P, Wetz C, Wallbaum T. et al. Pre-operative quantification of pulmonary function using hybrid-SPECT/low-dose-CT: A pilot study. Lung Cancer 2018; 118: 155-160
• 22 Knollmann D, Avondo J, Meyer A. et al. CT-based 3D quantification of relative pulmonary lobe perfusion from SPECT in preoperative lung cancer patients: Comparing a manual and a semi-automatic approach. J Nucl Med 2016; 57: 173