Evaluation of Imaging Quality of Pulmonary 64-MDCT Angiography in Pregnancy and Puerperium

Browne, Ann Michelle; Cronin, Carmel G.; NiMhuircheartaigh, Jennifer; Donagh, Carol; Lohan, Derek G.; Murphy, Joseph

doi:10.2214/ajr.12.9917

Cited by 18 publications

(25 citation statements)

References 34 publications

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“…that the "normal range" outside of pregnancy cannot be applied to pregnant women (Browne et al, 2014;Hedengran et al, 2016). Hedengran et al (2016) also showed that the Ddimer values in individual healthy pregnant women fluctuated by more than 50% and concluded that they may not be of value in the diagnosis of VTE during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspected venous thromboembolism during pregnancy and puerperium

et al. 2018

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SummaryThis study aimed to estimate the diagnostic utility of biomarkers for suspected venous thromboembolism (VTE) in pregnancy and the puerperium. Research nurses/midwives collected blood samples from 310 pregnant/postpartum women with suspected pulmonary emboli (PE) and 18 with diagnosed deep vein thrombosis (DVT). VTE was diagnosed using imaging, treatment and adverse outcome data. Primary analysis was limited to women with conclusive imaging (36 with VTE, 247 without). The area under the curve (AUC) for each biomarker was: activated partial thromboplastin time 0·669 (95% confidence interval 0·570–0·768), B‐type natriuretic peptide 0·549 (0·453–0·645), C‐reactive protein 0·542 (0·445–0·639), Clauss fibrinogen 0·589 (0·476–0·701), D‐Dimer (by enzyme‐linked immunosorbent assay) 0·668 (0·561–0·776), near‐patient D‐Dimer 0·651 (0·545–0·758), mid‐regional pro‐atrial natriuretic peptide 0·524 (0·418–0·630), prothrombin fragment 1 + 2 0·562 (0·462–0·661), plasmin‐antiplasmin complexes 0·639 (0·536–0·742), prothombin time 0·613 (0·508–0·718), thrombin generation lag time 0·702 (0·598–0·806), thrombin generation endogenous potential 0·559 (0·437–0·681), thrombin generation peak 0·596 (0·478–0·715), thrombin generation time to peak 0·655 (0·541–0·769), soluble tissue factor 0·531 (0·424–0·638) and serum troponin 0·597 (0·499–0·695). No diagnostically useful threshold for diagnosing or ruling out VTE was identified. In pregnancy and the puerperium, conventional and candidate biomarkers have no utility either for their negative or positive predictive value in the diagnosis of VTE.

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Section: Discussionmentioning

confidence: 99%

The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspected venous thromboembolism during pregnancy and puerperium

et al. 2018

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“…The authors of that study hypothesized that the use of multidetector CT, higher contrast concentration, faster injection rates, and higher trigger levels may contribute to the decreased amount of nondiagnostic studies [15].…”

Section: Discussionmentioning

confidence: 99%

CT pulmonary angiography in pregnant and postpartum women: low yield, high dose

et al. 2015

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“…67 Interestingly, some results suggest that various effects from pregnancy may impact contrast distribution in CTA with a substantially higher rate of technically suboptimal and nondiagnostic scans compared with nonpregnant patients, that is, up to one-third of scans. 78,79 However, others have found no statistical differences, 80 and a recent meta-analysis found comparable pooled rates of nondiagnostic scans between CTA and V/Q scintigraphy, that is, 12.5 versus 11.5%. 81 It is worth noting that these results on V/Q scans are from planar studies, and the studies on Q SPECT and Q SPECT/CT included in our meta-analysis substantiate the potential of perfusion-only scans in selected groups, for example, pregnant patients.…”

Section: Pulmonary Embolism Imaging In Pregnancymentioning

confidence: 99%

State-of-the-Art Imaging in Pulmonary Embolism: Ventilation/Perfusion Single-Photon Emission Computed Tomography versus Computed Tomography Angiography — Controversies, Results, and Recommendations from a Systematic Review

Hess

Frary

Gerke

et al. 2016

Semin Thromb Hemost

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Pulmonary embolism (PE) is a common, ubiquitous, and potentially lethal disease. As symptoms and clinical findings are notoriously nonspecific, diagnostic imaging is essential to avoid undertreatment as well as overtreatment. Controversies remain regarding first-line imaging in suspected PE. The two main contemporary contenders are ventilation/perfusion scintigraphy with single-photon emission computed tomography (V/Q SPECT) with or without additional low-dose CT (SPECT/CT) and CT angiography (CTA). We present our results from a systematic review and meta-analysis of the diagnostic performances of these modalities: V/Q SPECT, V/Q SPECT/CT, and CTA are all viable options, but we consider V/Q SPECT/CT to be superior in most clinical settings with better overall diagnostic performance, that is, pooled sensitivities (97.6 vs. 82.0%), specificities (95.9 vs. 94.9%), positive predictive values (93.0 vs. 93.8%), negative predictive values (98.6 vs. 84.7%), and accuracies (96.5 vs. 88.6%). We further address some of the ongoing controversies regarding the various modalities, that is, radiation exposure, the issues of subsegmental PE, nondiagnostic studies, and various challenges in specific patient populations.

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Evaluation of Imaging Quality of Pulmonary 64-MDCT Angiography in Pregnancy and Puerperium

Cited by 18 publications

References 34 publications

The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspected venous thromboembolism during pregnancy and puerperium

The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspected venous thromboembolism during pregnancy and puerperium

CT pulmonary angiography in pregnant and postpartum women: low yield, high dose

State-of-the-Art Imaging in Pulmonary Embolism: Ventilation/Perfusion Single-Photon Emission Computed Tomography versus Computed Tomography Angiography — Controversies, Results, and Recommendations from a Systematic Review

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