In patients with novel coronavirus disease 2019 (COVID-19) referred for lung scintigraphy because of suspected pulmonary embolism (PE), there has been an ongoing debate within the nuclear medicine community as to whether and when the ventilation imaging should be performed. Indeed, whereas PE diagnosis typically relies on the recognition of ventilation–perfusion (V/P) mismatched defects, the ventilation procedure potentially increases the risk of contamination to health-care workers. The primary aim of this study was to assess the role of ventilation imaging when lung scintigraphy is performed because of suspected PE in COVID-19 patients. The secondary aim was to describe practices and imaging findings in this specific population. Methods: A national registry was created in collaboration with the French Society of Nuclear Medicine to collect lung scans performed on COVID-19 patients for suspected PE. The practices of departments were assessed regarding imaging protocols and aerosol precautions. A retrospective review of V/P SPECT/CT scans was then conducted. Two physicians masked to clinical information reviewed each case by sequentially viewing perfusion SPECT, perfusion SPECT/CT, and V/P SPECT/CT images. The scans were classified into 1 of the 4 following categories: patients for whom PE could reasonably be excluded on the basis of perfusion SPECT only, perfusion SPECT/CT, or V/P SPECT/CT and patients with mismatched defects suggestive of PE according to the European Association of Nuclear Medicine criteria. Results: Data from 12 French nuclear medicine departments were collected. Lung scans were performed between March 2020 and April 2021. Personal protective equipment and dedicated cleaning procedures were used in all departments. Of the 145 V/Q SPECT/CT scans included in the central review, PE could be excluded using only perfusion SPECT, perfusion SPECT/CT, or V/P SPECT/CT in 27 (19%), 55 (38%), and 45 (31%) patients, respectively. V/P SPECT/CT was positive for PE in 18 (12%) patients, including 12 (67%) with a low burden of PE (≤10%). Conclusion: In this population of COVID-19 patients assessed with lung scintigraphy, PE could confidently be excluded without the ventilation imaging in only 57% of patients. Ventilation imaging was required to confidently rule out PE in 31% of patients. Overall, the prevalence of PE was low (12%).

对于因疑似肺栓塞 (PE) 而转诊进行肺闪烁扫描的 2019 年新型冠状病毒病 (COVID-19) 患者，核医学界一直在争论是否以及何时应进行通气成像。事实上，虽然 PE 诊断通常依赖于对通气 - 灌注 (V/P) 不匹配缺陷的识别，但通气过程可能会增加卫生保健工作者受到污染的风险。本研究的主要目的是评估因 COVID-19 患者疑似肺栓塞而进行肺闪烁显像时通气成像的作用。次要目的是描述这一特定人群的实践和影像学发现。方法：与法国核医学学会合作创建了一个国家登记处，以收集对疑似 PE 的 COVID-19 患者进行的肺部扫描。评估了各部门在成像方案和气溶胶预防措施方面的做法。然后对 V/P SPECT/CT 扫描进行了回顾性审查。两名不了解临床信息的医生通过依次查看灌注 SPECT、灌注 SPECT/CT 和 V/P SPECT/CT 图像来审查每个病例。扫描分为以下 4 类中的 1 类：仅基于灌注 SPECT、灌注 SPECT/CT 或 V/P SPECT/CT 可以合理排除 PE 的患者，以及根据根据欧洲核医学协会标准。结果：收集了来自法国 12 个核医学部门的数据。2020 年 3 月至 2021 年 4 月期间进行了肺部扫描。所有部门都使用了个人防护设备和专用清洁程序。在中央审查中包括的 145 例 V/Q SPECT/CT 扫描中，27 例（19%）、55 例（38%）仅使用灌注 SPECT、灌注 SPECT/CT 或 V/P SPECT/CT 可以排除 PE，和 45 (31%) 名患者，分别。18 名 (12%) 患者的 V/P SPECT/CT 对 PE 呈阳性，其中 12 名 (67%) 的 PE 负担较低 (≤10%)。结论：在这一用肺闪烁显像评估的 COVID-19 患者群体中，只有 57% 的患者在没有通气成像的情况下可以自信地排除 PE。31% 的患者需要进行通气成像才能自信地排除 PE。总体而言，PE 的患病率较低（12%）。