An Evaluation of Preoperative and Postoperative Ventilation and Perfusion Lung Scintigraphy in the Screening for Pulmonary Embolism After Elective Orthopedic Surgery

• Published in: Clinical nuclear medicine 1991-01, Vol.16 (1), p.13-19
• Main Authors: KEENAN, ANDREW M, PALEVSKY, HAROLD I, STEINBERG, MARVIN E, HARTMAN, KAREN M, ALAVI, ABASS, LOTKE, PAUL A
• Format: Article
• Language: English
• Subjects: 550601 - Medicine- Unsealed Radionuclides in Diagnostics; Aged; ALBUMINS; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; BODY; BONE JOINTS; COUNTING TECHNIQUES; DIAGNOSIS; DIAGNOSTIC TECHNIQUES; DISEASES; Evaluation Studies as Topic; Female; Hip Prosthesis; HOURS LIVING RADIOISOTOPES; Humans; INTERMEDIATE MASS NUCLEI; ISOMERIC NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; Knee Prosthesis; Lung - diagnostic imaging; LUNGS; Male; MEDICAL SUPPLIES; NUCLEI; ODD-EVEN NUCLEI; ORGANIC COMPOUNDS; ORGANS; PATIENTS; PERFUSED ORGANS; Postoperative Care; Postoperative Complications - diagnostic imaging; Preoperative Care; PROSTHESES; PROTEINS; Pulmonary Embolism - diagnostic imaging; RADIOISOTOPE SCANNING; RADIOISOTOPES; RADIOLOGY AND NUCLEAR MEDICINE; Radionuclide Imaging; RESPIRATORY SYSTEM; RESPIRATORY SYSTEM DISEASES; SCINTISCANNING; SKELETON; TECHNETIUM 99; TECHNETIUM ISOTOPES; Technetium Tc 99m Aggregated Albumin; Xenon Radioisotopes; YEARS LIVING RADIOISOTOPES
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/00003072-199101000-00004

One hundred two patients undergoing elective knee or hip arthroplasty were studied with radionuclide ventilation scans (V) and perfusion scans (Q) preoperatively (preop) and postoperatively (postop) to assess their relative value in the diagnosis of asymptomatic pulmonary embolism (PE) after orthopedic surgery. Postop Q were read in combination with preop V and Q and postop V using prospective investigation of pulmonary embolism diagnosis (PIOPED) criteria. Of 25 postop Q interpreted as either high or intermediate probability for PE, preop Q were judged useful in 96%; the postop V were useful in 78%; and the preop V were not helpful in any of the cases. Of 63 postop Q interpreted as low probability, preop Q were useful in 74%; the postop V were useful in only 33%; and the preop V were useful in only one case. When postop Q were read as normal (14 cases), none of the three auxiliary studies were found to be useful. Overall, postop V were more helpful than preop Q in only 2%, and preop V contributed significantly in only 1%. This experience suggests that preop Q alone is the most useful adjunct to the postop Q in the postoperative evaluation for PE. The authors conclude that to screen for asymptomatic PE after elective orthopedic surgery, preop Q should be performed in all cases, preop V are not necessary, and postop V need be performed only if a baseline preop Q is not available.