Harris Benjamin S, Bishop Katherine C, Kuller Jeffrey A
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University Medical Center, Durham, North Carolina.
Clin Obstet Gynecol. 2018 Jun;61(2):219-227. doi: 10.1097/GRF.0000000000000366.
Pulmonary embolism in pregnancy is a leading cause of maternal mortality. The clinical presentation is often nonspecific, making imaging essential for accurate diagnosis. After reviewing the literature on the radiologic diagnosis of pulmonary embolism in pregnancy, we concluded that both computed tomography pulmonary angiography and lung perfusion scintigraphy are sensitive with high positive predictive values in the presence of high clinical suspicion, but lung perfusion scintigraphy is recommended given lower maternal breast exposure to ionizing radiation and lower fetal contrast exposure. However, if a chest x-ray is abnormal, computed tomography pulmonary angiography is preferred due to high nondiagnostic rates of lung perfusion scintigraphy.
妊娠期肺栓塞是孕产妇死亡的主要原因。其临床表现通常不具有特异性,因此影像学检查对于准确诊断至关重要。在回顾了关于妊娠期肺栓塞放射学诊断的文献后,我们得出结论:在临床高度怀疑的情况下,计算机断层扫描肺动脉造影(CTPA)和肺灌注闪烁扫描(LPS)均具有敏感性且阳性预测值高,但鉴于母体乳房接受的电离辐射剂量较低以及胎儿接受的造影剂剂量较低,推荐使用肺灌注闪烁扫描。然而,如果胸部X光检查异常,由于肺灌注闪烁扫描的非诊断率较高,则首选计算机断层扫描肺动脉造影。