Comparison of Tc-99m DTPA aerosol with radioactive gas ventilation imaging in patients (pts) with suspected pulmonary embolism (PE)

The utility of Tc-99m labeled DTPA aerosol (A) as a ventilation agent was compared to that of Xe-133 (Xe) or Kr-81m (Kr) gases in a series of 100 pts (age range 20-83, 53% women) undergoing ventilation-perfusion (V-P) imaging for suspected PE. The majority of pts had A and Xe studies in conjunction with P scans; 26 had A and Kr studies. All A studies were comprised of multiple 100K ct views performed prior to P scanning. Conventional Xe or Kr studies were then performed in conjunction with a multiview P scan. The studies were later reviewed by four independent readers who evaluated 100 V-P studies (100 A-P pairs, 100 gas-P pairs) and the accompanying chest radiographs and determined the probability of PE as none, low, high, or nondiagnostic (NDX). The A scans showed central hot spots in 27% of pts, but poor peripheral penetration in only 5%. Prominent lower lobe deposition was seen in 19 of the 66 pts who inhaled A upright, but in none who inhaled in the supine position. The A-P and gas-P scans were either both diagnostic or both NDX 82% of the time. There were 77% agreement between probability categories for A-P and Kr-P studies, and 74% agreement with Xe-P. These results were better than the inter-observer agreement for gas-P studies alone. Angiography revealed that 3 A-P studies were true negatives, 3 were true positives (pos), and one was a false pos (also pos by gas-P). The results suggest that commercially available DTPA aerosols provide comparable results to gas-P studies in pts with suspected PE