Suthar Pokhraj P, Villanueva Karl, Virmani Sumeet
Department of Diagnostic Radiology and Nuclear Medicine, RUSH University Medical Center, Chicago, USA.
Cureus. 2024 Aug 8;16(8):e66434. doi: 10.7759/cureus.66434. eCollection 2024 Aug.
Introduction The COVID-19 pandemic has profoundly impacted medical practices, including nuclear medicine. To minimize aerosol transmission risks, lung perfusion scintigraphy was preferred over traditional ventilation-perfusion (V/Q) scintigraphy during the pandemic. This study compares lung perfusion scans performed during COVID-19 with V/Q scans from the pre-COVID era. After reviewing this study, the reader will learn about V/Q scintigraphy and lung perfusion. Methods This retrospective observational study, conducted from December 2018 to July 2021, involved 868 patients - 511 in the pre-COVID era and 357 in the post-COVID era - at a single tertiary care center. The pretest probability of pulmonary embolism (PE) was determined using Wells' criteria, and data including demographics, clinical findings, and diagnostic test results (V/Q or lung perfusion scintigraphy) were collected. Results A 30% decline in lung scans was observed during the pandemic. In the pre-COVID era, 68.3% of scans had low, 27.8% had intermediate, and 3.9% had high probability for PE. During the pandemic, perfusion-only scans showed 57.3% low, 32.9% indeterminate, and 9.8% high probability for PE. Among COVID-19-positive patients, 48.9% had intermediate, and 11.1% had high probability scans. The rise in indeterminate and high-probability scans during the pandemic is attributed to COVID-19-related lung changes and hypercoagulability. Conclusion The perfusion component of lung scans is typically sufficient for evaluating acute PE. Omitting the ventilation part of the V/Q scan had minimal impact, with only a 5.1% increase in indeterminate/non-diagnostic scans using perfusion-only modified Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) criteria during the post-COVID-19 era, likely due to underlying lung parenchymal involvement in COVID-19 patients. Additionally, there was a 5.9% rise in high-probability scans, attributed to the hypercoagulability and vascular complications associated with COVID-19.
新冠疫情对包括核医学在内的医疗实践产生了深远影响。为了将气溶胶传播风险降至最低，在疫情期间，肺灌注闪烁扫描比传统的通气-灌注（V/Q）闪烁扫描更受青睐。本研究比较了新冠疫情期间进行的肺灌注扫描与新冠疫情前时代的V/Q扫描。阅读本研究后，读者将了解V/Q闪烁扫描和肺灌注。
这项回顾性观察研究于2018年12月至2021年7月在一家三级医疗中心进行，涉及868例患者，其中新冠疫情前时代511例，新冠疫情后时代357例。使用Wells标准确定肺栓塞（PE）的预测试概率，并收集包括人口统计学、临床发现和诊断测试结果（V/Q或肺灌注闪烁扫描）的数据。
疫情期间观察到肺扫描下降了30%。在新冠疫情前时代，68.3%的扫描PE概率低，27.8%为中等，3.9%为高概率。在疫情期间，仅灌注扫描显示57.3%概率低，32.9%不确定，9.8%概率高。在新冠阳性患者中，48.9%为中等概率，11.1%为高概率扫描。疫情期间不确定和高概率扫描的增加归因于与新冠相关的肺部变化和高凝状态。
肺扫描的灌注部分通常足以评估急性PE。省略V/Q扫描的通气部分影响最小，在新冠疫情后时代，仅使用灌注的改良肺栓塞诊断前瞻性调查II（PIOPED II）标准，不确定/非诊断性扫描仅增加了5.1%，这可能是由于新冠患者潜在的肺实质受累。此外，高概率扫描增加了5.9%，这归因于与新冠相关的高凝状态和血管并发症。
