Eflatun YÜCEDAĞ, Ayhan UYSAL, Oktay BURMA, İbrahim Murat ÖZGÜLER, Mehmet Cengiz ÇOLAK, Tansel Ansal BALCI

Comparison of ventilation/perfusion scintigraphy and multi-detector computerized tomography in diagnosis of asymptomatic pulmonary embolism after deep vein thrombosis

Amaç: Pulmoner tromboemboli (PTE) sistemik venöz sistemde oluşan pıhtıların pulmoner vasküler yatağa göçü ile ortaya çıkan klinik tabloya verilen isimdir. Akut derin ven trombozu (DVT) sonrası ortalama %40-60 oranında asemptomatik PTE görülmekte ve bu durum sessiz klinik seyir nedeniyle fark edilmemektedir. Bu çalışmamızda akut alt ekstremite DVT\'sine bağlı gelişen asemptomatik PTE tanısında hala günümüzde önemli bir yer tutan ventilasyon-perfüzyon (V/P) sintigrafisi ile son yıllarda kullanılmaya başlanan multi-detektor bilgisayarlı tomografinin (MDBT) sensitivite ve spesifitesini karşılaştırmayı amaçladık. Yöntemler: Çalışma alt ekstremite akut DVT nedeniyle kliniğimize yatırılarak tedavisi planlanan 25 hastada gerçekleştirildi. Gebeler, nüks DVT vakaları, müracaat esnasında semptomatik PTE tablosu olanlar, vena kavaya uzanım gösteren trombüsü olanlar, önceden geçirilmiş PTE öyküsü olanlar çalışmaya dahil edilmedi. Hastalarda DVT tanısı renkli doppler USG ile konulup, D-dimer testiyle teyit edildi. Hastalara yatışının 1.ve 8. günlerinde V/P sintigrafisi ve MDBT yapılarak asemptomatik PTE varlığı araştırıldı. Bulgular: Pulmoner tromboemboli açısından asemptomatik olan 25 DVT hastasının 24\'ünde D-dimer normalin üstünde ölçüldü. MDBT ile 10 hastaya PTE tanısı konuldu. Akut DVT\'ye bağlı %40 oranında asemptomatik PTE geliştiği tespit edildi. Sonuç: Multi-detektor bilgisayarlı tomografi tanı değeri açısından V/P sintigrafisinden daha faydalı bulundu.

Anahtar Kelimeler:

Pulmoner, Emboli, Sintigrafi, Tomografi

Comparison of ventilation/perfusion scintigraphy and multi-detector computerized tomography in diagnosis of asymptomatic pulmonary embolism after deep vein thrombosis

Objective: Pulmonary thromboembolism (PTE) named due to migration of clots formed in systemic venous system to pulmonary vascular bed is a serious clinical table. After acute DVT, asymptomatic PTE is seen about 40-60% and this situation can not be discovered because of silent clinical course. In this study, we aimed to compare sensivity and spesifity of multi detector computerized tomography (MDCT), which is used extensively in recent years, with ventilation-perfusion (V/P) scintigraphy which is used formerly for diagnosis of asymptomatic PTE developed after acute lower extremity DVT. Methods: The study was carried out 25 patients who were admitted to our clinic and treated for lower extremity acute DVT. Pregnants, and cases with recurrent DVT, presence of symptomatic PTE during admission, thrombosis extending to vena cava, and history of passed PTE were excluded from the study. DVTs in patients were diagnosed by color doppler, and confirmed by D-dimer test. After patients\'s admission, V/P scintigraphy and MDCT were used to detects asymptomatic PTE at 1st and 8 th day of the admission. Results: D-dimer was measured as higher in 24 of 25 patients with asemptomatic PTE. Ten patients were diagnosed by MDCT. Development of asymptomatic PTE related to acute DVT was determined as 40%. Conclusion: In terms of diagnostic value, MDCT was found more useful than V/P scintigraphy.

Keywords:

Pulmonary, embolism, scintigraphy, tomography,

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Deitcher SR, Carman TL. Deep Venous Thrombosis and Pulmonary Embolism. Curr treatment options. Cardiovasc Med 2002;4:223-38.
Exter PL, Klok FA, Huisman VM . Diagnosis of pulmonary embolism: Advances and pitfalls. Best Pract Res Clin Hae- matol 2012;25:295-302
The PIOPED Investigators: Value of the ventilation/perfu- sion scan in acute pulmonary embolism. Results of the pro- spective investigation of pulmonary embolism diagnosis. JAMA 1990;263:2753-59.
Worsley DF, Alavi A. Comprehensive analysis of the results of the PIOPED study. Prospective Investigation of Pulmonary Embolism Diagnosis Study. J Nucl Med 1995;36:2380-87.
Remy-Jardin M, Louvegny S, Remy J, et al. Acute central thromboembolic disease: posttherapeutic pollow-up with spiral CT angiography. Radioloji 1997;203:173-180.
Yavuz C. A genetical approach to deep venous thrombosis. J Clin Exp Invest 2012;3:303-306.
Dalen JE. Pulmonary embolism: what have we learned since Virchow? Natural history, pathophysiology and diagnosis. Chest 2002;122:1440-1456.
Tschersich HU. Diagnosis acute deep venous trombosis of the lower extremites: prospective evaluation of color Doppler flow imaging versus venography. Radiology 1995;19:289.
Remy-Jardin M, Remy J, Wattinne L, et al. Central pulmo- nary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique-comparison with pulmonary angiography. Radiology 1992;185:381-87.
Coche E, Verschuren F, Keyeux A, et al. Diagnosis of acute pulmonary embolism outpatients: comparison of thin-colli- mation multi-detector row spiral CT and planar ventilation- perfusion scintigraphy. Radiology 2003;229:757-65.
Blachere H, Latrabe V, Montaudon M, et al. Pulmonary embolism revealed on helical CT angiography: comparison with ventilation-perfusion radionuclide lung scanning. AJR 2000;174:1041–47.
Kavanagh EC, O’Hare A, Hargaden G, et al. Risk of Pulmo- nary embolism After Negative MDCT Pulmonary Angiog- raphy Findings. AJR 2004;182:499-504.
Thomsen HS, Morcos SK. Management of acute adverse reactions to contrast media. Eur Radiol 2004;14:476-81.
Smith TP. Pulmonary embolism; what’s wrong with this di- agnosis? AJR 2000;174:1489–97.
Oger E, Leroyer C, Bressolette L, et al. Evaluation of a new, rapid and quantitative D-dimer test in patients with suspected pulmonary embolism. Am J Respir Crit Care Med 1998;158:65-70.
Kadakal F, Çetinkaya E, Yıldız P, et al. Klinik olarak yük- sek olasılıklı pulmoner emboli olgularında tanı. Solunum Hastalıkları 2000;11:140-43.
Mos IC, Klok FA, Kroft LJ, et al. Safety of ruling out acute pulmonary embolism by normal computed tomography pulmonary angiography in patients with an indication for computed tomography: systematic review and meta-analy- sis. J Thromb Haemost 2009; 9: 1491-98.
Darwish HS, Qamar SR. Paddlewheel multi-slice heli- cal computed tomography reformation in the detection of pulmonary embolism. An initial experience. Saudi Med J 2013;9:896-900.
Glaser JE, Chamarthy M, Haramati LB, et al. Successful and safe implementation of a trinary interpretation and reporting strategy for V/Q lung scintigraphy. J Nucl Med. 2011;52:1508-12.
M.S Karakaş, S.C Özbek, A Er, et al. Right heart thrombus entrapped in patent foramen ovale with pulmonary embo- lism in a patient with primary hypercoagulable state. J Clin Exp Invest. 2012;39:440-4.
Nawaid A, Koottalai S, Harmesh M. V/Q Scanning: A Useful Alternative to Pulmonary CT Angiography - Let’s Not For- get It. American Journal of Roentgenology. 2011;196:107.
Onyedika C, Joseph E, Leonard M. Pulmonary Embolism: Role of Ventilation-Perfusion Scintigraphy. Semin Nu- clMed 2013;43:82-87 .
Chandra S, Sarkar PK, Chandra D, et al. Finding an alterna- tive diagnosis does not justify increased use of CT-pulmo- nary angiography. BMC Pulm Med. 2013;13:9.
Şen HS, Abakay Ö. Pulmoner tromboembolide güncel tanı ve tedavi. J Clin Exp Invest 2013;4:405-410.