Kember P G, Euinton H A, Morcos S K
Department of Diagnostic Imaging, Northern General Hospital, Sheffield, UK.
Br J Radiol. 1997 Nov;70(839):1109-11. doi: 10.1259/bjr.70.839.9536900.
Most patients with suspected pulmonary embolism are initially investigated by radio-nuclide ventilation-perfusion (VQ) scanning. Approximately 70% of VQ scans are "indeterminate". Further investigations should be considered in such patients in order to establish a definitive diagnosis. However, these investigations are rarely requested in patients with indeterminate scans in our institution. We therefore decided to review the casenotes of such patients to determine their subsequent management. Over a 9 month period, 131 (32%) out of a total of 413 consecutive VQ scans were reported as indeterminate. The casenotes of 111 of these patients (65 female, 46 male, mean age 65 years, range 17-91 years) were reviewed. 52 of the 111 patients (46%) were treated on clinical grounds without further investigation; 12 patients (11%) had further investigation; and in 39 of the cases (35%) the VQ scan report was misinterpreted. 20 (38%) of the 52 patients managed on clinical grounds were treated for pulmonary embolus with anticoagulation and 26 (50%) were not anticoagulated. Of the 12 patients who were investigated further, nine had lower limb Doppler ultrasound and three had contrast venography. No patients had pulmonary angiography. Of the 39 cases where the VQ report was misinterpreted, the result was misquoted in the casenotes of 37 (95%) as negative for PE and none of these patients were anticoagulated, and in two cases (5%) it was misquoted as positive for PE and anticoagulant therapy was instituted. The misunderstanding was observed in all clinical firms. Such misinterpretation may have significant implications, since 30-40% of patients with indeterminate scans may have had PE. Our findings suggest that clinicians need to be better informed of the significance of an indeterminate VQ scan result.
大多数疑似肺栓塞的患者最初通过放射性核素通气灌注（VQ）扫描进行检查。大约70%的VQ扫描结果为“不确定”。对于此类患者，应考虑进一步检查以明确诊断。然而，在我们机构中，对于扫描结果不确定的患者，很少会要求进行这些进一步检查。因此，我们决定回顾此类患者的病历，以确定他们随后的治疗情况。在9个月的时间里，413例连续的VQ扫描中，有131例（32%）报告为不确定。对其中111例患者（65例女性，46例男性，平均年龄65岁，年龄范围17 - 91岁）的病历进行了回顾。111例患者中有52例（46%）基于临床情况接受了治疗，未进行进一步检查；12例患者（11%）进行了进一步检查；39例（35%）的VQ扫描报告被误读。基于临床情况接受治疗的52例患者中，20例（38%）因肺栓塞接受了抗凝治疗，26例（50%）未接受抗凝治疗。在进行进一步检查的12例患者中，9例进行了下肢多普勒超声检查，3例进行了静脉造影。没有患者进行肺血管造影。在VQ报告被误读的39例病例中，37例（95%）的病历中结果被错误引用为肺栓塞阴性，这些患者均未接受抗凝治疗，2例（5%）被错误引用为肺栓塞阳性并开始了抗凝治疗。在所有临床科室都观察到了这种误解。这种误读可能具有重大影响，因为30 - 40%扫描结果不确定的患者可能患有肺栓塞。我们的研究结果表明，临床医生需要更好地了解VQ扫描结果不确定的意义。
