A combined procedure for 99m Tc aerosol ventilation and perfusion imaging

For several years, radioaerosols have been successfully used to provide detailed images of regional ventilation to aid in the differential diagnosis of pulmonary embolism. It has been widely advocated that the ventilation images should follow the perfusion scan and that the amount of aerosol deposited in the patient's lungs should be three times greater than the perfusion dose. We employed an alternative approach which avoided the deposition of an unpredictable amount of aerosol in individual patients. The aerosol study was performed first, and the activity of the microspheres used for the perfusion images was then tailored to the actual amount of aerosol which the patient had retained. This allowed a microsphere/aerosol activity ratio of 10:1 to be readily achieved, thus successfully masking the ventilation pattern by the perfusion activity. The faster biological clearance of 99mTc-DTPA aerosol from the lung fields, as compared to 99mTc-sulphur-colloid aerosol, allowed higher initial activities to be deposited in the lungs, thus enabling a high-resolution collimator to be used. When the perfusion study was delayed by 1 h (one effective half-life for the 99mTc-DTPA aerosol), it was not necessary to increase the perfusion activity required to mask the ventilation image.