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Original Article

Perception of the role of scintigraphic imaging in the exploration of pulmonary embolism by cardiologists in French-speaking sub-Saharan Africa

Kokou Adambounou, Amegninou Mawuko Yao Adigo, Abalo Mario Bakai, Komlan Amoussou, Ekoue Edem Fabrice Sodogas.

Background: The purpose of this study is to assess the place given to pulmonary scintigraphy in the exploration of pulmonary embolism (PE) by cardiologists in French-speaking sub-Saharan Africa.
Methods: The cross-sectional study, carried out from 1 Feb to 30 May 2017 and included 103 cardiologists working in Frenchspeaking sub-Saharan African countries. Their accessibility, knowledge, and attitudes regarding the use of lung scintigraphy in the exploration of PE were analyzed.
Results: The sample consisted of 103 cardiologists of various nationalities practicing mainly in West Africa (85.4%) and 36.9% of whom had completed a clinical internship in Europe. A nuclear medicine service existed in their country, city, and practice hospital in 56.3%, 48.5%, and 15.5% of cases, respectively. A large majority of cardiologists had never ordered for a pulmonary scintigraphy (79.6%), 15.5% ordered it rarely, and 4.9% often. With equal accessibility, 86.4% would choose Computed tomography (CT) pulmonary angiography as the examination of choice in managing suspected cases of PE, compared to 11.7% for pulmonary scintigraphy. To rule out PE in case of chest pain with normal chest X-ray, only 16.5% would request for a pulmonary scintigraphy, against 80.6% for a CT angiography. However, 61.2% preferred a pulmonary scintigraphy to a CT pulmonary angiography (32%) to diagnose PE in a pregnant woman. More than half (56.3%) said they were unable to recognize a typical scintigraphic image of PE and 28.2% believed that pulmonary scintigraphy was more irradiating than CT pulmonary angiography. Overall, the differences in perception were not statistically significant depending on their country of practice, their professional experience, the completion of a previous internship in Europe.
Conclusion: The place given to pulmonary scintigraphy in the exploration of PE by cardiologists in sub-Saharan Africa is not very satisfactory. It is, therefore, necessary to sensitize clinicians to its diagnostic and prognostic value.

Key words: Pulmonary scintigraphy, pulmonary embolism, medical imaging, French-speaking sub-Saharan Africa.

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