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The European Association of Nuclear Medicine

EANM guidelines for ventilation/perfusion scintigraphy – Part 1

Bajc M, et al. Eur J Nucl Med Mol Imaging 2009; 36: 1356-1370

EANM guidelines for ventilation/perfusion scintigraphy – Part 2

Bajc M, et al. Eur J Nucl Med Mol Imaging 2009; 36: 1528-1538

The Canadian Association of Nuclear Medicine

CANM Guidelines for ventilation/perfusion (V/P SPECT) in pulmonary embolism


Technegas Functional Lung Imaging
Ventilation SPECT/CT using Technegas to quantify pulmonary function

Pulmonary study
Ventilation-perfusion (V/Q) SPECT using Technegas to detect pulmonary embolism



Beyond PE clinical uses - results from clinical studies

Airflow limitation assessment in chronic airway diseases
Images were kindly provided by the Hunter New England Imaging (HNEI) at John Hunter Hospital and clinical data by the Hunter Medical Research Institute (HMRI)

Monitoring treatment response in asthmatic patients
Images and clinical data were kindly provided by the Woolcock Institute of Medical Research

Lung function evaluation before lung volume reduction surgery
Images were kindly provided by Macquarie Medical Imaging (MMI) and clinical data by Macquarie Respiratory & Sleep department at Macquarie University

Literature highlights

Edition 1 – May 2017
COPD, a new indication for using Technegas ventilation-perfusion (V/Q) SPECT?

View this edition

Edition 3 – October 2017
Economical value of hybrid SPECT/CT in pulmonary embolism diagnosis

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Edition 2 – August 2017
Ventilation-perfusion (V/Q) SPECT/CT as first-line modality for pulmonary embolism diagnosis

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Edition 4 – December 2018
Summary of the Lancet Commissions report on redefining airways diseases

View this edition

Clinical References

V/Q scanning using SPECT and SPECT/CT
Roach PJ, et al. J Nucl Med 2013; 54(9): 1588-1596

Technegas is an ideal agent for ventilation SPECT because of its small particle size (30–60 nm), resulting in greater alveolar penetration and less central deposition than a nebulizer-produced aqueous radioaerosol such as 99mTc-DTPA

EANM guidelines for ventilation/perfusion scintigraphy: Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography
Bajc M, et al. Eur J Nucl Med Mol Imaging 2009; 36(8): 1356-1370

Using 99mTc-Technegas has minimized the problem of hotspots in patients with obstructive lung disease and is according to clinical experience better than the best liquid aerosols.

Current status of ventilation-perfusion scintigraphy for suspected pulmonary embolism
Metter DF, et al. AJR Am J Roentgenol 2017; 208(3): 489-494

Ventilation imaging is most often performed in conjunction with lung perfusion to characterize perfusion defects as a matched, mismatched or reverse mismatched.

The optimal tracer for ventilation studies is Technegas, an ultra fine dispersion of 99mTc-labeled carbon. Despite that Technegas is not approved for use in the United States, it is used in 79% of ventilation imaging studies performed in Canada and is also commonly used in Europe. Its main advantage is greater percentage deposition in the alveolar spaces and less undesirable adherence to the central airways, compared with droplet radioaerosols.

Identifying the heterogeneity of COPD by V/P SPECT: a new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease
Bajc M, et al. Int J of Chron Obstruct Pulmon Dis 2017; 12: 1579-1587

V/Q SPECT, using Technegas as the ventilation imaging agent, could diagnose and grade severity of COPD and also estimate preserved lung function in 94 patients. Moreover, V/Q SPECT appears to be a unique tool to reveal the heterogeneity of COPD caused by pulmonary comorbidities such as pulmonary embolism, left heart failure, lung tumor and pneumonia. The characteristics of these comorbidities suggest their significant impact in symptoms, their influence on prognosis and their response to treatment.

Applications of Ventilation-Perfusion Scintigraphy in Surgical Management of Chronic Obstructive Lung Disease and Cancer
Tulchinsky M, et al. Semin Nucl Med 2017; 47(6): 671-679

V/Q scintigraphy has affirmed its critical place in the evaluation of patients with lung cancer preparing for lung resection.

Enhanced by the advancements in hybrid imaging and computer processing, the V/Q scan examination continues to be reinvented and updated to keep pace with the needs of modern medicine.

Radionuclide diagnosis of pulmonary embolism
Hess S, et al. Adv Exp Med Biol 2017; 906: 49-65

Among the traditional imaging modalities for diagnosing pulmonary embolism (PE), the choice has narrowed to V/Q scan and CTPA. However, V/Q scan is preferred over CTPA for follow-up of PE particularly in young women in order to avoid the excessive breast radiation exposure associated with CTPA.

SPECT V/Q for the diagnosis of pulmonary embolism: protocol for a systematic review and meta-analysis of diagnostic accuracy and clinical outcome
Le Roux PY, et al. BMJ Open 2018; 8(4): e022024

In recent years, the technology around V/Q scintigraphy has rapidly evolved allowing the introduction of SPECT, a new method of scintigraphic acquisition. SPECT V/Q has been reported to improve the diagnostic performances of the test and significantly decrease the proportion of non-diagnostic studies. [...] SPECT V/Q imaging has many proponents within the nuclear medicine community and has already largely replaced planar V/Q scintigraphy in daily practice for the diagnosis of pulmonary embolism (PE).

SPECT-CT/VQ versus CTPA for diagnosing pulmonary embolus and other lung pathology: Pre-existing lung disease should not be a contraindication
Bhatia KD, et al. J Med Imaging Radiat Oncol 2016; 60(4): 492-497

Pre-existing lung disease should not be a relative contraindication to the use of V/Q SPECT-CT. This modality has a sensitivity of 100% and specificity of 94% with lower radiation doses compared to CTPA.

Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension: a clinical practice guideline
Mehta S, et al. Can Respir J 2010; 17(6): 301-334

We recommend nuclear V/Q lung scanning instead of CTPA as a screening test to rule out the possibility of CTEPH in patients diagnosed with PH. A normal V/Q scan effectively rules out the possibility of CTEPH.

Value of (99m)Tc-Technegas SPECT/CT for Localization of Alveolar-pleural Fistulas
Derlin T, et al. Nucl Med Mol Imaging 2016; 50(2): 164-165

99mTc-Technegas ventilation scintigraphy is an established and well-studied tool for imaging of lung ventilation and combined SPECT/CT has been shown to improve overall diagnostic accuracy in many areas of pulmonary nuclear medicine.