Prospective evaluation of the negative predictive value of V/Q SPECT using 99mTc-Technegas

Objective To verify the negative predictive value of pulmonary ventilation/perfusion scintigraphy with single photon emission computed tomography (V/Q SPECT) in ruling out pulmonary thromboembolism. Methods V/Q, SPECT using Tc-99m-Technegas was performed on 584 patients to rule out pulmonary thromboembolism between October 2004 and July 2005. Pulmonary thromboembolism was defined as any clear-cut vascular mismatch, regardless of size. Indeterminate scans were defined as cases having matching vascular type defects with a corresponding X-ray abnormality, or cases with equivocal mismatches. Other patterns were considered negative for pulmonary thromboembolism. Outcome data was gathered > 3 months after the scan. Absence of pulmonary thromboembolism was defined as any patient still alive at least 3 months after the scan, with no anticoagulation treatment and no proof of pulmonary thromboembolism by other techniques, either at the time of the scan or during follow-up, or death by other causes. Results One hundred and eight patients (19%) had a positive pulmonary thromboembolism reading, 18 (3%) an indeterminate study, and 458 (78%) patients had a negative reading for pulmonary thromboembolism. There were 189 patients with an abnormal chest X-ray. The mean follow-up time was 165 days. Of the 458 patients classified as negative for pulmonary thromboembolism, patients receiving chronic anticoagulation for other causes were excluded from follow-up (n = 53), which left 405 patients for final analysis. There were no pulmonary thromboembolism-related deaths in the negative group. Six patients were identified as false negatives. The negative predictive value is estimated at 98.5%. Conclusion SPECT pulmonary scintigraphy using Tc-99m-Technegas demonstrates a high negative predictive value and a low indeterminate rate. Nucl Med Commun 28:667-672 (c) 2007 Lippincott Williams & Wilkins.