Tester Jodie, Rees Megan, Pascoe Diane, Earl Victoria, Einsiedel Paul, Lim Wen Kwang, Irving Louis, Hammerschlag Gary
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Department of Respiratory Medicine and Sleep Disorders, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2023 Apr;67(3):223-231. doi: 10.1111/1754-9485.13420. Epub 2022 May 26.
To compare the radiation dose exposure and diagnostic efficiency of computed tomographic pulmonary angiography (CTPA) and ventilation/perfusion imaging (V/Q) for clinically suspected pulmonary embolism (PE) in pregnant and postpartum women in a tertiary hospital setting.
A retrospective cohort study of 473 pregnant and postpartum women referred for CTPA or V/Q for clinically suspected PE between January 2013 and December 2018 at a tertiary hospital. Maternal effective radiation dose, breast-absorbed radiation dose and fetal-absorbed dose estimates were calculated. Diagnostic yield was evaluated from radiological findings.
Computed tomographic pulmonary angiography (CTPA) was more commonly used for the imaging of suspected PE in pregnant and postpartum populations (51.9% vs. 48.1% and 77.1% vs. 22.9%, respectively). CTPA was associated with higher maternal effective and breast-absorbed doses (maternal effective CTPA 4.7 (±2.9) mSv (millisievert), V/Q 1.7(±0.8) mSv (mean difference 2.93 mSv P < 0.001), and breast-absorbed CTPA 8.0 (±5.2) mGy (milligray), V/Q 0.3 (±0.1) (mean difference 7.67 mGy P < 0.001), respectively). Fetal radiation dose exposure was low. The incidence of positive PE was 5.5%. Indeterminate rates of CTPA and V/Q were 3.0% and 5.5% (P = 0.176), respectively.
Compared to V/Q, CTPA is associated with higher maternal and breast radiation dose; however, modern CT scanners achieve lower radiation doses than historically described. Fetal radiation dose was comparably low. The diagnostic yield of the imaging modalities in pregnant and postpartum women is similar. Revision of guidelines should occur with the advances in CT technology.
在一家三级医院环境中，比较计算机断层扫描肺动脉造影（CTPA）和通气/灌注成像（V/Q）对临床疑似肺栓塞（PE）的孕妇和产后妇女的辐射剂量暴露及诊断效率。
对2013年1月至2018年12月期间在一家三级医院因临床疑似PE而接受CTPA或V/Q检查的473名孕妇和产后妇女进行回顾性队列研究。计算母体有效辐射剂量、乳腺吸收辐射剂量和胎儿吸收剂量估计值。根据影像学检查结果评估诊断率。
计算机断层扫描肺动脉造影（CTPA）在孕妇和产后人群中更常用于疑似PE的成像（分别为51.9%对48.1%和77.1%对22.9%）。CTPA与较高的母体有效剂量和乳腺吸收剂量相关（母体有效剂量CTPA为4.7（±2.9）毫希沃特（mSv），V/Q为1.7（±0.8）mSv（平均差异2.93 mSv，P < 0.001），乳腺吸收剂量CTPA为8.0（±5.2）毫戈瑞（mGy），V/Q为0.3（±0.1）（平均差异7.67 mGy，P < 0.001））。胎儿辐射剂量暴露较低。PE阳性发生率为5.5%。CTPA和V/Q的不确定率分别为3.0%和5.5%（P = 0.176）。
与V/Q相比，CTPA与更高的母体和乳腺辐射剂量相关；然而，现代CT扫描仪的辐射剂量低于以往报道。胎儿辐射剂量相对较低。孕妇和产后妇女中这两种成像方式的诊断率相似。应随着CT技术的进步修订指南。
