Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2020 Aug;64(4):505-515. doi: 10.1111/1754-9485.13027. Epub 2020 Apr 20.
Pulmonary embolism (PE) is a leading cause of maternal mortality with women at increased risk of PE during pregnancy and the early postpartum period. Clinical assessment of suspected PE during pregnancy is challenging as signs and symptoms associated with PE overlap with physiological changes of pregnancy. Clinical tests and rules commonly used to assess pre-test probability of PE were historically not well validated in the pregnant population. The challenges of clinical assessment in the pregnant and postpartum population result in a lowered threshold for diagnostic imaging. Computed tomographic pulmonary angiography (CTPA) and nuclear medicine lung scintigraphy or ventilation/perfusion (V/Q) scans are the main types of diagnostic imaging for suspected PE. Both methods are associated with small levels of ionising radiation exposure to mother and foetus. Accuracy of the diagnostic imaging tests is paramount. Haemodynamic changes of pregnancy, including increased heart rate, increased blood volume and altered flow velocity in the pulmonary arteries, may influence the quality of imaging. This comprehensive review examines the literature and evidence for the investigation and diagnostic imaging of suspected pulmonary embolism during pregnancy with CTPA and V/Q. Clinical decision-making tools, biomarkers and diagnostic imaging during pregnancy and postpartum will be considered with a focus on diagnostic accuracy and yield, radiation dose exposure (maternal-foetal) and protocol modifications. Current practice guideline recommendations and recent literature on diagnostic pathways are also presented.
肺栓塞（PE）是孕产妇死亡的主要原因之一，孕妇和产后早期发生 PE 的风险增加。在怀孕期间，由于与 PE 相关的体征和症状与妊娠的生理变化重叠，因此对疑似 PE 的临床评估具有挑战性。临床上用于评估 PE 术前可能性的常用测试和规则在过去并未在孕妇人群中得到很好的验证。在孕妇和产后人群中，临床评估的挑战导致诊断成像的门槛降低。计算机断层扫描肺动脉造影（CTPA）和核医学肺闪烁扫描或通气/灌注（V/Q）扫描是疑似 PE 的主要诊断成像类型。这两种方法都与母亲和胎儿受到小剂量电离辐射有关。诊断成像测试的准确性至关重要。妊娠时的血流动力学变化，包括心率增加、血容量增加和肺动脉血流速度改变，可能会影响成像质量。本综述全面检查了 CTPA 和 V/Q 在疑似妊娠期间肺栓塞的检查和诊断成像方面的文献和证据。将考虑妊娠和产后的临床决策工具、生物标志物和诊断成像，重点关注诊断准确性和收益、辐射剂量（母婴）和方案修改。还介绍了当前的实践指南建议和最近关于诊断途径的文献。
