Nucpaedia
Nucpaedia
General NM · Pulmonary

Pulmonary Nuclear Medicine

Snapshot

Lung scintigraphy maps where air and pulmonary arterial blood go. Its core job is pulmonary embolism: V/Q SPECT, read holistically, diagnoses PE with a mismatch of at least one segment or two subsegments and is non-diagnostic in only 1–4% of studies. It is the screening test of choice for CTEPH, the preferred first test in pregnancy when the chest radiograph is normal, and the source of split lung function before resection. ⁹⁹ᵐTc-MAA also quantifies right-to-left shunts and the lung shunt fraction before radioembolisation.

V/Q SPECTFirst choice for PE when the chest X-ray is normal
≥1 seg / ≥2 subsegMismatch that makes the diagnosis
96–97%V/Q sensitivity for CTEPH

Which test should I use?

Pick a clinical scenario for the suggested first-line test and alternative.

Tracers at a glance

Tap any tracer for its mechanism, timing and use — these entries recur across the site.

Clinical topics

Acute PE and V/Q SPECT

Who to image, EANM holistic criteria, patterns and reporting.

Suspected PE in pregnancy

Pregnancy-adapted algorithms, perfusion-first protocol, doses, breastfeeding.

Pre-resection lung quantification

ppoFEV₁ and ppoDLCO, planar zones vs SPECT/CT lobes, valve target selection.

CTEPH and chronic PE

Definitions, V/Q screening, follow-up after PE, referral and mimics.

Other lung applications

Right-to-left shunt, lung shunt fraction, transplant, congenital, DTPA, radiotherapy.

V/Q imaging: full article

The long-form, fully referenced article on ventilation/perfusion imaging.

Sources

Key guidelines and evidence behind this chapter.

  1. Bajc M, et al. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging. 2019;46:2429–51.
  2. Parker JA, et al. SNM practice guideline for lung scintigraphy 4.0. J Nucl Med Technol. 2012;40:57–65.
  3. Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2020;41:543–603.
  4. Humbert M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43:3618–731.
  5. Leung AN, et al. An official ATS/STR clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. Am J Respir Crit Care Med. 2011;184:1200–8.
  6. Brunelli A, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidence-based clinical practice guidelines, 3rd ed. Chest. 2013;143(5 Suppl):e166S–e190S.
  7. Tunariu N, et al. Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med. 2007;48:680–4.
  8. Weber M, et al. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging. 2022;49:1682–99.
← BackHome