Correspondence (letter to the editor): Don't Forget Scintigraphy in Pulmonary Embolism

In their review article (1) the authors recommended a diagnostic algorithm for the scenario of suspected embolism of the pulmonary artery. Lung ventilation and perfusion scintigraphy is mentioned only as an aside, and the authors say that multidetector computed tomography has taken over as the gold standard imaging method. They back up their statement with a 2008 guideline from the European Society of Cardiology (2). However, in the cited guideline, the value of scintigraphy is explained in a rather more differentiated manner. The guideline emphasizes in particular the high negative predictive value of a normal perfusion scintigram. A prospective multicenter study, which is often cited as a justification for the use of spiral computed tomography (CT), has also again confirmed the safety of diagnostic algorithms while using scintigraphy (3). We would also ask that more attention be paid to the possible contraindications and side effects of the contrast media required for CT scanning (renal failure, hyperthyroidism, contrast medium allergy). These may even be life threatening. Scintigraphy is a valuable alternative, but the way the information is presented runs the risk that it is all but forgotten about. Mentioning technical progress in nuclear medical imaging with three-dimensional assessment of perfusion and ventilation—also when using the SPECT/CT technique—may exceed the remit of the review article. However, all these contribute to making the procedure safe. The effective dose usually does not matter in an emergency situation. CT and scintigraphy do not differ much in that setting. But the dose to parts of the body should be considered, as well as the dose to the breast in young women and that to the uterus in pregnant women in their third trimester. Even though the review article aimed to provide a simple algorithm of diagnostic procedures, we hope to have made a valuable contribution to the material.