Department of Nuclear Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA.
J Nucl Med. 2011 Oct;52(10):1508-12. doi: 10.2967/jnumed.111.090753. Epub 2011 Jul 29.
For the past 4 decades, ventilation-perfusion (V/Q) scan interpretation for pulmonary embolism (PE) was performed using probability-based assessments, which were neither well-received nor well-understood by many clinicians. Recently, we combined normal, very low probability, and low-probability interpretations in emergency department patients and found a false-negative (FN) rate of 1.2% on follow-up. Afterward, we transitioned to a new trinary interpretative strategy: no PE, PE present, and nondiagnostic. In this series, we compared the outcomes of the traditional and trinary interpretative strategies.
We retrospectively identified all patients undergoing V/Q scans for the 1 year straddling the shift in interpretive strategy, with traditional interpretation being used between September 18, 2008, and March 17, 2009, and trinary interpretation being used between March 18, 2009, and September 17, 2009. A FN study was defined as development of deep vein thrombosis or PE within 3 months after a negative baseline evaluation.
The traditional interpretation group included 208 male patients (27%) and 570 female patients (73%), with a mean age (±SD) of 50.9 ± 18.4 years. These interpretations (n = 778) were high probability in 4.9% (38), intermediate probability in 5% (39), low probability in 59.5% (463), very low probability in 17.2% (134), and normal in 13.4% (104). The trinary interpretation group included 181 male patients (27%) and 483 female patients (73%), with a mean age of 50.0 ± 18.5 years. These interpretations (664) were positive in 8.4% (56), negative in 88.1% (585), and nondiagnostic in 3.5% (23). The FN rate was 1.14% (8/701; 7 deep vein thrombosis and 1 PE) for pooled normal, very low probability, and low probability in traditional interpretations versus 1.5% (9/585, 5 deep vein thrombosis and 4 PE) in trinary interpretations (P = 0.63). The individual FN rates for the normal, very low probability, and low-probability groups were 0.0%, 0.75%, and 1.51%, respectively (P = 0.36 for normal vs. low probability). Pediatric subgroup analysis showed 19 traditional interpretations: 5.3% high (1); 0 intermediate; and 94.7% (18) low probability, very low probability, and normal. 20 trinary interpretations were positive in 10% (2), nondiagnostic in 5% (1), and negative in 85% (17), with no FNs using either strategy.
A simplified trinary interpretation strategy for V/Q lung scintigraphy provides outcomes similar to traditional probability assessments and facilitates clear communication.
为了研究新型三分类解读策略与传统解读策略的临床应用效果，我们回顾性分析了所有在我院进行通气-灌注（V/Q）扫描的患者。
我们回顾性地分析了所有在 1 年内进行 V/Q 扫描的患者，扫描时间跨越了我们从传统解读策略到新型三分类解读策略的转变。传统解读策略使用的时间段为 2008 年 9 月 18 日至 2009 年 3 月 17 日，新型三分类解读策略使用的时间段为 2009 年 3 月 18 日至 2009 年 9 月 17 日。在本研究中，我们将在阴性基线评估后 3 个月内发生深静脉血栓形成或肺栓塞的病例定义为假阴性（FN）病例。
传统解读策略组包括 208 例男性患者（27%）和 570 例女性患者（73%），平均年龄（±SD）为 50.9±18.4 岁。这些解读结果中，高概率占 4.9%（38 例），中概率占 5%（39 例），低概率占 59.5%（463 例），极低概率占 17.2%（134 例），正常概率占 13.4%（104 例）。新型三分类解读策略组包括 181 例男性患者（27%）和 483 例女性患者（73%），平均年龄为 50.0±18.5 岁。这些解读结果中，阳性占 8.4%（56 例），阴性占 88.1%（585 例），无法解读占 3.5%（23 例）。在传统解读策略中，阴性、极低概率和低概率的 FN 率为 1.14%（8/701；7 例深静脉血栓形成和 1 例肺栓塞），而在新型三分类解读策略中 FN 率为 1.5%（9/585，5 例深静脉血栓形成和 4 例肺栓塞）（P=0.63）。在传统解读策略中，阴性、极低概率和低概率组的 FN 率分别为 0.0%、0.75%和 1.51%（正常与低概率比较，P=0.36）。在儿科亚组分析中，19 个传统解读结果中，高概率占 5.3%（1 例），中概率占 0%，低概率、极低概率和正常概率占 94.7%（18 例）。新型三分类解读策略中，20 个结果为阳性，占 10%（2 例），无法解读，占 5%（1 例），阴性，占 85%（17 例），两种策略均未出现 FN 病例。
新型三分类解读策略在 V/Q 肺闪烁扫描中提供了与传统概率评估相似的结果，并促进了清晰的沟通。
