Department of Obstetrics and Gynecology & Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
Chest. 2018 Jan;153(1):152-160. doi: 10.1016/j.chest.2017.08.005. Epub 2017 Aug 18.
The symptoms of normal pregnancy overlap those of pulmonary embolism (PE). Limited literature suggests that low-dose perfusion scanning (LDQ), which yields lower maternal-fetal radiation exposure than CT pulmonary angiography (CTPA), performs well in excluding PE in pregnant patients.
We performed a retrospective cohort study of sequential pregnant women who underwent imaging for PE with LDQ or CTPA between 2008 and 2013 at Montefiore Medical Center. Our practice recommends LDQ for patients with negative results on chest radiographs. Patients were categorized according to initial imaging modality, and a subgroup analysis was performed in patients with asthma. The primary outcome was the negative predictive value (NPV) of imaging determined by VTE diagnosis within 90 days.
Of 322 pregnant women (mean age, 27.3 ± 6.3 years), initial imaging was positive for PE in 2.7% (6 of 225) of LDQs and 4.1% (4 of 97) of CTPAs, negative in 88.0% (198 of 225) of LDQs and 86.6% (84 of 97) of CTPAs, and indeterminate/nondiagnostic in 9.3% (21 of 225) of LDQs and 9.3% (9 of 97) of CTPAs (P = .79). Ten patients (3.1%) were treated for PE. The NPV was 100% for LDQ and 97.5% for CTPA. Subgroup analysis of patients with asthma (23.9% of this population) revealed a high likelihood of a negative study in the LDQ and CTPA groups (74.1% and 87.0%, respectively) and 100% NPV for both modalities.
PE is an uncommon diagnosis in pregnancy. LDQ and CTPA perform well, with less maternal-fetal radiation exposure with LDQ. Therefore, when available, LDQ is a reasonable first-choice modality for suspected PE in pregnant women with a negative result on chest radiograph.
正常妊娠的症状与肺栓塞（PE）重叠。有限的文献表明，与 CT 肺动脉造影（CTPA）相比，低剂量灌注扫描（LDQ）在排除妊娠患者的 PE 方面表现良好，且前者可使母婴辐射暴露量更低。
我们对 2008 年至 2013 年间在 Montefiore 医疗中心接受 LDQ 或 CTPA 成像检查以排除 PE 的连续妊娠患者进行了回顾性队列研究。我们的常规做法是对胸片检查结果为阴性的患者推荐 LDQ。根据初始成像方式对患者进行分类，并对哮喘患者进行亚组分析。主要结局是通过 90 天内 VTE 诊断确定的影像学检查的阴性预测值（NPV）。
在 322 名孕妇（平均年龄 27.3 ± 6.3 岁）中，LDQ 检查结果为阳性的患者占 2.7%（225 例中的 6 例），CTPA 检查结果为阳性的患者占 4.1%（97 例中的 4 例），LDQ 检查结果为阴性的患者占 88.0%（225 例中的 198 例），CTPA 检查结果为阴性的患者占 86.6%（97 例中的 84 例），LDQ 检查结果为不确定/无法诊断的患者占 9.3%（225 例中的 21 例），CTPA 检查结果为不确定/无法诊断的患者占 9.3%（97 例中的 9 例）（P=.79）。10 名患者（3.1%）因 PE 接受了治疗。LDQ 的 NPV 为 100%，CTPA 的 NPV 为 97.5%。对哮喘患者（该人群中的 23.9%）的亚组分析显示，LDQ 和 CTPA 组的阴性研究可能性较大（分别为 74.1%和 87.0%），两种方法的 NPV 均为 100%。
PE 在妊娠中是一种罕见的诊断。LDQ 和 CTPA 表现良好，且 LDQ 对母婴的辐射暴露量更低。因此，当 LDQ 可用时，对于胸片检查结果为阴性的疑似妊娠患者，LDQ 是一种合理的首选 PE 检查方法。
