Diagnosis of pericardial effusions from routine gated blood-pool imaging.

Gated blood-pool scintigraphy (GBPS) is often obtained as the initial test to evaluate symptoms suggestive of left ventricular dysfunction. Since large pericardial effusions may also cause such symptoms, the ability to recognize them on routine GBPS is of clinical importance. Characteristic features of the "halo" sign surrounding the cardiac blood pool were developed, based on the GBPS of patients with known pericardial effusions. These criteria were then applied blindly to 154 consecutive patients who underwent both GBPS and echocardiography. All five patients with large effusions (approximately greater than 500 ml) were correctly identified by GBPS (sensitivity 100%); for patients with moderate effusions (approximately 150-500 ml), the sensitivity was only 33% (3/9). There were three false positives (specificity 98%). We conclude that large pericardial effusions can be identified with high sensitivity and specificity on routine GBPS. Although echocardiography remains the method of choice for the diagnosis of effusions, inspection for characteristics suggesting their presence on GBPS should be part of routine interpretations.