Vinayakamoorthy Vidhiya, Geary Susan, Ganatra Rakesh
Department of Nuclear Medicine, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Nucl Med Commun. 2010 Feb;31(2):112-20. doi: 10.1097/MNM.0b013e3283304a29.
To identify UK practice in the diagnosis of suspected pulmonary embolism with particular reference to the pregnant population and to determine whether the 2003 British Thoracic Society (BTS) guidelines had influenced practice.
A postal survey was performed of all 249 nuclear medicine departments in the UK identified from the British Nuclear Medicine Society database.
One hundred and one responses were received (41%). Ninety-eight centres (97%) performed scintigraphy with 17 using perfusion only imaging. A median of six (range: 1-27) scintigraphic scans were performed weekly. Ninety-seven centres had computed tomography (CT) capabilities although 11 centres only had single slice CT capability. A median of seven (range: 1-50) CT pulmonary angiographies (CTPAs) were performed weekly. Seventy-two centres used a diagnostic algorithm; 73 centres performed D-dimers routinely and 86 used probability criteria for reporting ventilation/perfusion (V/Q) scans. CTPA was performed in the majority of the cases with an abnormal chest radiograph. In pregnancy, 37 centres routinely performed D-dimers, 80 centres performed a scintigraphic based investigation as a first line test while 12 preferred CTPA. Of the 33 centres (34%) that indicated that the BTS guidelines had changed their practice, 30 (91%) commented that the demand for CTPA had increased and 29 (88%) felt that the service had been improved.
There continues to be widely varying practice throughout the UK despite the BTS guidelines. There is a shift in practice towards CTPA and variation in the approach to diagnosis in pregnancy. The survey highlights the need to standardize the diagnostic algorithm for suspected pulmonary embolism, especially in pregnancy.
确定英国在疑似肺栓塞诊断方面的实践情况，尤其关注孕妇群体，并确定2003年英国胸科学会（BTS）指南是否对实践产生了影响。
对从英国核医学学会数据库中识别出的英国所有249个核医学科室进行了邮寄调查。
共收到101份回复（41%）。98个中心（97%）进行了闪烁扫描，其中17个仅使用灌注成像。每周进行闪烁扫描的中位数为6次（范围：1 - 27次）。97个中心具备计算机断层扫描（CT）能力，不过11个中心仅具备单层CT能力。每周进行CT肺动脉造影（CTPA）的中位数为7次（范围：1 - 50次）。72个中心使用诊断算法；73个中心常规进行D - 二聚体检测，86个中心使用概率标准报告通气/灌注（V/Q）扫描。大多数胸部X光片异常的病例都进行了CTPA。在孕期，37个中心常规进行D - 二聚体检测，80个中心将基于闪烁扫描的检查作为一线检测方法，而12个中心更倾向于CTPA。在表示BTS指南改变了其实践的33个中心（34%）中，30个（91%）称对CTPA的需求增加了，29个（88%）认为服务得到了改善。
尽管有BTS指南，但英国各地的实践仍存在很大差异。实践正朝着CTPA转变，孕期的诊断方法也存在差异。该调查强调了标准化疑似肺栓塞诊断算法的必要性，尤其是在孕期。
