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Pulmonary SPECT imaging and the stripe sign
Summary
The stripe sign on planar ventilation/perfusion scans may not reliably exclude pulmonary embolism. SPECT imaging is crucial for accurate interpretation of perfusion defects, especially when the stripe sign is present.
Area of Science:
- Nuclear Medicine
- Radiology
- Pulmonary Medicine
Background:
- Ventilation/perfusion (V/Q) scintigraphy is a key diagnostic tool for pulmonary embolism (PE).
- The 'stripe sign' on planar V/Q scans, indicating normally perfused lung adjacent to a defect, has been historically associated with non-embolic causes.
- Planar imaging's limitations in projection may affect the interpretation of the stripe sign.
Observation:
- A patient with suspected PE showed a perfusion defect with a stripe sign in the right middle lobe on planar V/Q imaging.
- Simultaneously acquired SPECT images did not show normally perfused tissue between the defect and the pleura.
- This discrepancy highlights potential limitations of planar imaging in evaluating the stripe sign.
Findings:
- The stripe sign on planar V/Q scans may be less specific for non-embolic disease than previously thought.
- SPECT imaging provides more accurate spatial resolution, clarifying the relationship between perfusion defects and the pleura.
- Discrepancies between planar and SPECT findings suggest planar imaging might misinterpret pleural contact.
Implications:
- The diagnostic significance of the stripe sign in planar V/Q scintigraphy may require re-evaluation, particularly in the absence of SPECT data.
- SPECT imaging is essential for accurate assessment of perfusion defects and the stripe sign in suspected PE.
- Clinical decisions regarding PE diagnosis should consider the limitations of planar imaging and the value of SPECT in ambiguous cases.