Possibilities of Pulmonoscintigraphy in Differential Diagnostics of Acute Pulmonary Scintigraphy Pulmonary Embolism and Chronic Postembolic Pulmonary Hypertension

Purpose. The purpose of the study was to evaluate the capabilities of lung scintigraphy and gated equilibrium radionuclide blood-pool SPECT in the differential diagnostics of acute pulmonary embolism and chronic postembolic pulmonary hypertension. Material and methods. The study included 78 patients, which have been divided into two groups: 62 (79.5%) patients had a verified diagnosis of acute pulmonary embolism and 16 (20.5%) patients - chronic postembolic pulmonary hypertension. Patients underwent a full range of clinical and diagnostic examinations, including ventilation/perfusion scintigraphy and gated equilibrium radionuclide blood-pool SPECT; 12 patients underwent multidetector computed tomographic (MDCT) angiography of the pulmonary arteries. Results. According to ventilation/perfusion lung scintigraphy data, perfusion defects were found in the upper and middle parts of the lungs in patients with acute pulmonary embolism. In these patients, perfusion defects were characterized by clear demarcation and by triangular or wedge-like shape. Localizations of the thrombosed vessels did not correspond to the areas with ventilation abnormalities. The ratio of transverse dimensions of right to left ventricular blood pools (RV/LV) in axial slices did not exceed 1.0. In patients diagnosed with chronic postembolic pulmonary hypertension, the areas of abnormal circulation were diffuse; the boundaries between the diseased areas and the intact pulmonary tissue were not clearly demarcated. In these patients, the RV/LV ratio in axial slices exceeded 1.0. Scintigraphic identification of pulmonary disorders was verified by MDCT pulmonary angiography. Conclusion. The use of scintigraphic methods aimed at assessment of the functional states of the heart and the lungs contributed to the accuracy of complicated differential diagnosis of acute pulmonary embolism and chronic postembolic pulmonary hypertension. Diagnostic information acquired with scintigraphic methods allowed for timely administration of adequate therapy.

тромбоэмболия легочной артерии, хроническая постэмболическая легочная гипертензия, дифференциальная диагностика, пульмоносцинтиграфия, сцинтиграфия, равновесная радионуклидная вентрикулография, томография, pulmonaryembolism, chronic postembolic pulmonary hypertension, differential diagnostics, lungscintigraphy, gatedequilibrium radionuclide ventriculography

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