Imaging modalities for confirming pulmonary embolism during pregnancy: results from a multicenter international study.
Eur Radiol
; 32(2): 1238-1246, 2022 Feb.
Article
in En
| MEDLINE
| ID: mdl-34331113
ABSTRACT
OBJECTIVES:
We explored the variations in use of imaging modalities for confirming pulmonary embolism (PE) according to the trimester of pregnancy.METHODS:
We included all pregnant patients with confirmed acute PE from RIETE, a prospective registry of patients with PE (03/2001-02/2020). Imaging modalities included computed tomography pulmonary angiography (CTPA), ventilation-perfusion (V/Q) scan, or presence of signs of acute PE along with imaging-confirmed proximal deep vein thrombosis (pDVT) without pulmonary vascular imaging. We compared the imaging modalities to postpartum patients with PE, and other non-pregnant women with PE.RESULTS:
There were 157 pregnant patients (age 32.7 ± 0.5), 228 postpartum patients (age 33.9 ± 0.5), and 23,937 non-pregnant non-postpartum women (age 69.5 ± 0.1). CTPA was the most common modality for confirming PE, from 55.7% in first trimester to 58.3% in second trimester, and 70.0% in third trimester. From first trimester to third trimester, V/Q scanning was used in 21.3%, 16.7%, and 18.3% of cases, respectively. Confirmed pDVT along with the presence of signs/symptoms of PE was the confirmatory modality for PE in 21.3% of patients in first trimester, 19.4% in second trimester, and 6.7% in third trimester. The proportion of postpartum patients confirmed with CTPA (85.5%) was comparable to that of non-pregnant non-postpartum women (83.2%). From the first trimester of pregnancy to postpartum period, there was a linear increase in the proportion of patients with PE diagnosed with CTPA (p = 0.039).CONCLUSION:
CTPA was the primary modality for confirming PE in all trimesters of pregnancy, although its proportional use was higher in later stages of pregnancy. KEY POINTS ⢠Computed tomography pulmonary angiography (CTPA) was the primary modality of diagnosis in all trimesters of pregnancy among patients with confirmed pulmonary embolism, even in the first trimester. ⢠From the first trimester of pregnancy to postpartum period, there was a linear increase in the proportion of patients with pulmonary embolism who were diagnosed based on CTPA. ⢠In the postpartum period, use of CTPA as the modality to confirm pulmonary embolism was comparable to non-pregnant patients.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pulmonary Embolism
Type of study:
Clinical_trials
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Pregnancy
Language:
En
Journal:
Eur Radiol
Journal subject:
RADIOLOGIA
Year:
2022
Type:
Article
Affiliation country:
United States