Pulmonary perfusion assessment was performed after an intravenous injection of albumin macroaggregates labelled with radioactive technetium (99mTc-MAA Makro-Albumon®; Medi-Radiopharma Ltd., Érd, Hungary) intravenous. The imaging procedure was commenced immediately after the administration of the radiotracer and the images were acquired by a SPECT/CT hybrid dual-head gamma camera, Infinia VC Hawkeye 4 (GE Healthcare, General Electric Healthcare, Chicago, IL, USA). All SPECT/CT acquisitions were obtained with the patient in the same position. The SPECT/CT images were interpreted by Xeleris 1 and 2 Functional Imaging Workstations (GE Healthcare). The scintigrams were analyzed by two expert nuclear medicine specialists (with 7 and 28 years of experience, respectively).
Based on the SPECT/CT results, the following criteria for the diagnosis of PE were adopted: at least 1 segmental or two sub-segmental perfusion defects (wedge-shaped, base directed towards the pleura) without corresponding abnormalities in the pulmonary parenchyma.