Skip to main content

Advertisement

SpringerLink
Log in

Single-Photon Emission Computed Tomography in the Screening for Postoperative Pulmonary Embolism

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

The aim of the study was to evaluate the usefulness of serial lung perfusion scintigraphy prospectively using single-photon emission computed tomographic image (SPECT) in screening for pulmonary embolism (PE) after elective surgery for gastrointestinal malignancy. PE was examined pre- and postoperatively with SPECT. Diagnosis of PE was based on segmental perfusion defect visualization in at least two of three planes on a SPECT image compared with preoperative SPECT images. Final diagnosis was determined by detection of embolus with multidetector helical CT (MDCT). No perioperative anticoagulant was used. Thirty-four patients were enrolled. One patient was excluded because of thrombophilia. In preoperative scans, nonsegmental defects were detected in 11 and a segmental defect in 1 patient, who was then diagnosed as PE preoperatively. Among 21 patients with normal preoperative SPECT, 2 had nonsegmental and 5 had segmental defects postoperatively. Among 11 patients with nonsegmental preoperative SPECT, 7 had nonsegmental and 4 had segmental defects postoperatively. Postoperative segmental defects were differentiated by their shape only and there was no need to compare pre- and postoperative SPECT. MDCT confirmed four patients with PE among nine with segmental defects postoperatively. Our results of screening for PE by visualization at least two planes of SPECT images suggest that postoperative SPECT scan is suitable for the diagnosis of postoperative PE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hauch O, Jorgensen LN, Khattar SC, Teglbjaerg CS, Wahlin AB, Rathenborg P, Wille-Jorgensen P (1990) Fatal pulmonary embolism associated with surgery. An autopsy study. Acta Chir Scand 156:747–749

    CAS  Google Scholar 

  2. Hyers TM (1999) Venous thromboembolism. Am J Respir Crit Care Med 159:1–14

    PubMed  CAS  Google Scholar 

  3. Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA Jr, Wheeler HB (2001) Prevention of venous thromboembolism. Chest 119:132S–175S

    Article  PubMed  CAS  Google Scholar 

  4. Tapson VF, Carroll BA, Davidson BL, Elliott CG, Fedullo PF, Hales CA, Hull RD, Hyers TM, Leeper KJ, Morris TA, Moser KM, Raskob GE, Shure D, Sostman HD, Taylor TB (1999) The diagnostic approach to acute venous thromboembolism. Clinical practice guideline. American Thoracic Society. Am J Respir Crit Care Med 160:1043–1066

    PubMed  CAS  Google Scholar 

  5. Task Force on Pulmonary Embolism, European Society of Cardiology (2000) Guidelines on diagnosis and management of acute pulmonary embolism. Eur Heart J 21:1301–1336

    Article  Google Scholar 

  6. Schoepf UJ, Costello P (2004) CT angiography for diagnosis of pulmonary embolism: state of the art. Radiology 230:329–337

    PubMed  Google Scholar 

  7. Schuemichen C (2005) Pulmonary embolism: Is multislice CT the method of choice? Against. Eur J Nucl Med Mol Imaging 32:107–112

    Article  Google Scholar 

  8. PIOPED Investigators (1990) Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 263:2753–2759

    Article  Google Scholar 

  9. Gottschalk A, Juni JE, Sostman HD, Coleman RE, Thrall J, McKusick KA, Froelich JW, Alavi A (1993) Ventilation-perfusion scintigraphy in the PIOPED study. Part I. Data collection and tabulation. J Nucl Med 34:1109–1118

    PubMed  CAS  Google Scholar 

  10. Gottschalk A, Sostman HD, Coleman RE, Juni JE, Thrall J, McKusick KA, Froelich JW, Alavi A (1993) Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations. J Nucl Med 34:1119–1126

    PubMed  CAS  Google Scholar 

  11. Miniati M, Pistolesi M, Marini C, Di Ricco G, Formichi B, Prediletto R, Allescia G, Tonelli L, Sostman HD, Giuntini C (1996) Value of perfusion lung scan in the diagnosis of pulmonary embolism: results of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED). Am J Respir Crit Care Med 154:1387–1393

    PubMed  CAS  Google Scholar 

  12. Collart JP, Roelants V, Vanpee D, Lacrosse M, Trigaux JP, Delaunois L, Gillet JB, De Coster P, Vander Borght T (2002) Is a lung perfusion scan obtained by using single photon emission computed tomography able to improve the radionuclide diagnosis of pulmonary embolism? Nucl Med Commun 23:1107–1113

    Article  PubMed  Google Scholar 

  13. Reinartz P, Wildberger JE, Schaefer W, Nowak B, Mahnken AH, Buell U (2004) Tomographic imaging in the diagnosis of pulmonary embolism: a comparison between V/Q lung scintigraphy in SPECT technique and mutislice spiral CT. J Nucl Med 45:1501–1508

    PubMed  Google Scholar 

  14. Magnussen JS, Chicco P, Palmer AW, Bush V, Mackey DW, Storey G, Magee M, Bautovich G, Van der Wall H (1999) Single-photon emission tomography of a computerised model of pulmonary embolism. Eur J Nucl Med 26:1430–1438

    Article  PubMed  CAS  Google Scholar 

  15. Palla A, Tumeh SS, Nagel JS, Meyerovitz MF, Goldhaber SZ, Holman BL (1988) Detection of pulmonary perfusion defects by single photon emission computed tomography (SPECT). J Nucl Med Allied Sci 32:27–32

    PubMed  CAS  Google Scholar 

  16. Bergqvist D, Efsing HO, Hallbook T, Lindhagen A (1980) Analysis of preoperative and postoperative lung scintigraphy in patients undergoing elective hip surgery. VASA 9:311–315

    PubMed  CAS  Google Scholar 

  17. Foley M, Maslack MM, Rothman RH, Casey MP, Lugano EM, Parry CE, Balderston RA, Booth RJ (1989) Pulmonary embolism after hip or knee replacement: postoperative changes on pulmonary scintigrams in asymptomatic patients. Radiology 172:481–485

    PubMed  CAS  Google Scholar 

  18. Touya JJ, Corbus HF, Savala KM, Habibe MN (1986) Single photon emission computed tomography in the diagnosis of pulmonary thromboembolism. Semin Nucl Med 16:306–336

    Article  PubMed  CAS  Google Scholar 

  19. Hata T, Ikeda M, Yamamoto H, Ikenaga M, Ohue M, Nagano H, Sekimoto M, Nakamori S, Sakon M, Monden M (2004) Asymptomatic deep venous thrombosis and pulmonary embolism diagnosed before pancreas cancer operation [In Japanese]: report of a case. Jpn J Gastroenterol Surg 37:1877–1882

    Google Scholar 

  20. Dorr LD, Sakimura I, Mohler JG (1979) Pulmonary emboli followed total hip arthroplasty: incidence study. J Bone Joint Surg Am 61:1083–1087

    PubMed  CAS  Google Scholar 

  21. Keenan AM, Palevsky HI, Steinberg ME, Hartman KM, Alavi A, Lotke PA (1991) An evaluation of preoperative and postoperative ventilation and perfusion lung scintigraphy in the screening for pulmonary embolism after elective orthopedic surgery. Clin Nucl Med 16:13–19

    Article  PubMed  CAS  Google Scholar 

  22. Walker I, Aukland P, Hirsh J, Coates G, Cockshott P, Taylor R, Hull R (1981) The low specificity of postoperative perfusion lung scan defects. Can Med Assoc J 124:153–158

    PubMed  CAS  Google Scholar 

  23. Kiil J, Jensen FT (1978) Pulmonary embolism associated with elective surgery, detected by ventilation-perfusion scintigraphy. Acta Chir Scand 144:427–430

    PubMed  CAS  Google Scholar 

  24. Tetalman MR, Hoffer PB, Heck LL, Kunzman A, Gottschale A (1973) Perfusion lung scan in normal volunteers. Radiology 106:593–594

    PubMed  CAS  Google Scholar 

  25. Allgood RJ, Cook JH, Weedn RJ, Speed HK, Whitcomb WH, Greenfield LJ (1970) Prospective analysis of pulmonary embolism in the postoperative patients. Surgery 68:116–122

    PubMed  CAS  Google Scholar 

  26. Chicco P, Magnussen JS, Mackey DJ, Murray IPC, Van der Wall H (1997) Recognition of subsegmental scintigraphic defects in virtual lungs scintigraphy. Nucl Med Commun 18:728–733

    Google Scholar 

  27. Bajc M, Bitzen U, Olsson B, Perez de Sa V, Palmer J, Jonson B (2002) Lung ventilation/perfusion SPECT in the artificially embolized pig. J Nucl Med 43:640–647

    PubMed  Google Scholar 

  28. Corbus HF, Seitz JP, Larson RK, Stobbe DE, Wooten W, Sayre JW, Chavez RD, Unguez CE (1997) Diagnostic usefulness of lung SPET in pulmonary thromboembolism: an outcome study. Nucl Med Commun 18:897–906

    Article  PubMed  CAS  Google Scholar 

  29. Eng J, Krishnan JA, Segal JB, Bolger DT, Tamariz LJ, Streiff MB, Jenckes MW, Bass EB (2004) Accuracy of CT in the diagnosis of pulmonary embolism: a systematic literature review. AJR Am J Roentgenol 183:1819–1827

    PubMed  Google Scholar 

  30. Goodman LR (2005) Small pulmonary emboli: What do we know? Radiology 234:654–658

    PubMed  Google Scholar 

  31. Tamariz LJ, Eng J, Segal JB, Krishnan JA, Bolger DT, Streiff MB, Jenckes MW, Bass EB (2004) Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism: a systematic review. Am J Med 117:676–684

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by Grant-in-Aid for Research 14770615 from the Ministry of Education, Science, Sports and Culture, Japan, to M.I. It was presented at the 39th Annual Meeting of the American Society of Clinical Oncology and 18th UICC International Cancer Congress.

Author information

Authors and Affiliations

  1. Department of Surgery, Department of Surgery (E2), Graduate School of Medicine, Osaka University, 2–2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Taishi Hata, Masataka Ikeda, Rei Suzuki, Masayoshi Yasui, Ichiro Takemasa, Hirofumi Yamamoto, Mitsugu Sekimoto & Morito Monden

  2. Department of Surgery, Osaka National Hospital, Osaka, Japan

    Shoji Nakamori & Masakazu Ikenaga

  3. Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan

    Tonsok Kim & Takamichi Murakami

  4. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Masayuki Ohue

  5. Department of Surgery, Nishinomiya Municipal Hospital, Hyogo, Nishinomiya, Japan

    Masato Sakon

Authors
  1. Taishi Hata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masataka Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shoji Nakamori
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rei Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tonsok Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masayoshi Yasui
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ichiro Takemasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masakazu Ikenaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hirofumi Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Masayuki Ohue
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takamichi Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Mitsugu Sekimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Masato Sakon
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Morito Monden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masataka Ikeda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hata, T., Ikeda, M., Nakamori, S. et al. Single-Photon Emission Computed Tomography in the Screening for Postoperative Pulmonary Embolism. Dig Dis Sci 51, 2073–2080 (2006). https://doi.org/10.1007/s10620-006-9410-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-006-9410-z

Keywords

Search

Navigation