Imaging for the exclusion of pulmonary embolism in pregnancy

Abstract

Both CTPA and lung scintigraphy seem appropriate for exclusion of pulmonary embolism during pregnancy. However, the quality of the evidence mandates cautious adoption of this conclusion. Important limitations included poor reference standards, necessary assumptions in the analysis regarding inconclusive test results and the inherent inability of included studies to identify false positives. It is unclear which test has the highest accuracy. There is a need for direct comparisons between diagnostic methods, including MR, in prospective randomized diagnostic studies.

Imaging in pregnancy

“…A Cochrane review to determine the diagnostic accuracy of CTPA and V/Q scanning for diagnosis of pulmonary embolism demonstrated no significant difference between the imaging techniques. The median frequency of inconclusive results was 5.9% for CTPA and 4.0% for V/Q scanning …”

Conduct and reporting of citation searching in Cochrane systematic reviews: A cross‐sectional study

“…Of the 18 Cochrane reviews that reported using a citation index to conduct citation searching, 15 (83%) reported the name of the citation index(es) used. Google Scholar was reported in one review 55 ; Scopus was reported in two reviews 24,29 ; and Web of Science was reported in 13 reviews, [26][27][28][29]31,32,[34][35][36][37][38][39][40] including seven reviews [26][27][28][29]32,34,39 that reported searching the Science Citation Index (a subset of the Web of Science) in particular and one review 35 that reported searching the Core Collection (which includes the Social Sciences Citation Index and Arts & Humanities Citation Index) in particular.…”

“…Van Mens et al 40 reported conducting forward citation searching using PubMed (in addition to Web of Science), which probably refers to a Similar Articles search as PubMed does not facilitate citation searching. A Similar Articles search uses an algorithm to detect similar articles to a source study rather than identifying citing or cited articles.…”

“…A Similar Articles search uses an algorithm to detect similar articles to a source study rather than identifying citing or cited articles. 56 In addition to Van Mens et al, 40 we serendipitously identified a small number of reviews that reported using Similar Articles search or equivalent searches in other databases. 29,57 However, because we were not systematically searching for this search method, it may have been reported more widely in the sample.…”

Diagnostic approach to pulmonary embolism in pregnancy: are the winds of change upon us or is it déjà vu all over again?

“…By the early 2000s, protocols for evaluation of clinically suspected PE in pregnancy called for initiation of assessment with a V/Q scan or spiral CT, depending on local availability/expertise, and for follow-up of non-diagnostic V/Q results with either a spiral CT or pulmonary angiography (Nijkeuter et al, 2006), acknowledging the lack of studies assessing the accuracy or outcomes of CT pulmonary angiography (CT-PA) in pregnancy (Bourjeily et al, 2010). This reservation was supplanted to a degree by the recent Cochrane review, which concluded that, on the basis of diagnostic accuracy, both CT-PA and lung scintigraphy are appropriate for exclusion of PE in pregnancy (van Mens et al, 2017).…”