Pulmonary Embolism in Pregnant Patients: Fetal Radiation Dose with Helical CT

Winer-Muram, Helen T.; Boone, John M.; Brown, Haywood L.; Jennings, S. Gregory; Mabie, William C.; Lombardo, Gerard

doi:10.1148/radiol.2242011581

Cited by 299 publications

(139 citation statements)

References 22 publications

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“…Foetal doses were calculated utilizing the methodology presented by Winer-Muram et al, 26 which requires knowledge of the xiphoid-to-foetus distance (Equation (1)). This was not known, as for CTPA examinations, the scan length falls short of the uterus.…”

Section: Ct Dosimetrymentioning

confidence: 99%

Diagnosing venous thromboembolism in pregnancy

Grüning

Mingo

Gosling

et al. 2016

BJR

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Objective: We report the imaging outcomes of all pregnant patients referred for suspected thromboembolism over a 43-month period. Methods: We identified 168 patients who underwent ventilation/perfusion (VQ) single-photon emission CT (SPECT), CT pulmonary angiography (CTPA) or a Doppler ultrasound scan of the lower legs, as well as a control group of 89 non-pregnant age-and sex-matched patients who underwent VQ SPECT during the same period. Imaging outcomes were recorded, and radiation doses were calculated for individual patients. Results: VQ SPECT and CTPA were equally likely to diagnose pulmonary embolism (PE) in about one patient out of every seven patients investigated. One in three CTPA scans was of suboptimal quality. A Doppler ultrasound examination of the legs will find deep venous thrombosis much less often, in about 1 patient out of every 15 patients investigated. The prevalence of PE in pregnant patients (as diagnosed by VQ SPECT) was similar to that in the non-pregnant, age-and sex-matched control group. The effective dose and the absorbed radiation dose to the maternal breast were lower with VQ SPECT. The foetal dose is comparable for both VQ SPECT and CTPA. Conclusion: VQ SPECT and CTPA provide a similar diagnostic yield for diagnosing PE during pregnancy, but VQ SPECT does so with a lower radiation dose to the mother (effective dose and breast dose). Advances in knowledge: Ours is the first report of the diagnostic performance of VQ SPECT, rather than planar VQ scans, in pregnancy in a routine clinical setting.

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Section: Ct Dosimetrymentioning

confidence: 99%

Diagnosing venous thromboembolism in pregnancy

Grüning

Mingo

Gosling

et al. 2016

BJR

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“…CT angiography has now become an established technique for minimally invasive vascular imaging (20). The 4-or 16-slice CTPA already provides a high level of image quality resulting in a diagnostic performance that equals or surpasses that of conventional pulmonary angiography (21), with sensitivity and specificity varying between 83%-100% and 89%-96%, respectively (22)(23)(24). Also, the sensitivity of CT for identifying PE in small pulmonary arteries (92%) is superior to that of invasive pulmonary angiography (56%) (22,25).…”

mentioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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A cute pulmonary embolism (PE) is the third most common cardiovascular condition, after coronary artery disease and stroke (1). Due to lack of specific sets of symptoms that accurately predict or exclude the diagnosis of acute PE, the diagnosis strongly relies on noninvasive imaging techniques. Diagnostic strategies for evaluating PE have undergone important changes over the past decades (2). Due to rapid technical advances in speed and spatial resolution, the utility of computed tomography (CT) angiography has been recognized in vascular imaging. Particularly, after the development of multidetector row CT in 1998 (3), CT pulmonary angiography (CTPA) has become the imaging method of choice in the diagnosis of acute PE (4). CTPA has advantages over conventional invasive X-ray pulmonary angiography and nuclear ventilation-perfusion (V/Q) imaging. CT is a widely available, fast and noninvasive technique, has the capability to directly visualize emboli, and may provide alternative diagnoses (4).Despite adequate diagnosis and anticoagulant therapy, death rate after a diagnosis of acute PE is still 8%-15% (5, 6). The prognosis of acute PE mainly depends on residual pulmonary circulation and the severity of right ventricular (RV) dysfunction (7). Recent studies have shown that CT permits the assessment of acute right-sided heart failure. Furthermore, CT can predict adverse clinical outcome by using the RV/left ventricular (LV) diameter ratio (8, 9) or RV ejection fraction in patients with PE (10).The aim of this review is to discuss the developments of CT in PE diagnosis, and to analyze the added value of CT in estimating PE severity and prognosis. Furthermore, CT findings of chronic thromboembolic pulmonary arterial hypertension (CTEPH) as a complication of acute PE will be discussed. CT developments in PE diagnosisHistorically, pulmonary angiography and nuclear planar V/Q-imaging were the main imaging methods used for diagnosing PE. Both methods have recognized limitations. Pulmonary angiography has previously been regarded as reference standard, but the method CHEST IMAGING REVIEW ABSTRACT Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome. Con...

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“…When compared for fetal radiation exposure V/Q scan has 3 times (130 Versus 370 uGy) more exposure than CTPA. [17] All types of radiation carries risk to the fetus, but this risk should be weighed against the benefits of diagnosis and treatment of maternal PE. When considering the radiation risk to the fetus, we shouldn't forget the radiation exposure to the maternal breast.…”

Section: Clinical Features and Diagnosismentioning

confidence: 99%

Peripartum pulmonary embolism: Anesthetic and surgical considerations

Shaikh¹,

Ummunnisa²,

Aboobacker³

et al. 2013

OJOG

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Pregnancy and peripartum period leads to Virchow's triad (hypercoagulability, venous stasis and vascular injury) thereby increasing the risk of thromboembolism by many folds in these patients. Accurate diagnosis of peripartum pulmonary embolism is pertinent for reducing morbidity and mortality. Accurate diagnosis is also vital for avoiding the adverse effects of unwanted anticoagulation in pregnant mother and fetus in a patient wrongly diagnosed with this condition. Computerized tomographic pulmonary angiography has a high specificity and sensitivity in comparison to ventilation/perfusion scan for diagnosis of peripartum pulmonary embolism (PPE). It has a lower fetal radiation exposure and aids in arriving at an alternative diagnosis, if PPE is absent. Low molecular weight heparin is the medication of choice in the treatment of peripartum pulmonary embolism. Thrombolysis is considered in patients with massive PPE and hemodynamic instability, refractory hypoxia or right ventricular dysfunction. Regional anesthesia/analgesia can be given safely in these patients. We report two cases of PPE and review the anesthetic and surgical consideration.

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Pulmonary Embolism in Pregnant Patients: Fetal Radiation Dose with Helical CT

Abstract: The average fetal radiation dose with helical CT is less than that with ventilation-perfusion lung scanning during all trimesters.

Cited by 299 publications

References 22 publications

Diagnosing venous thromboembolism in pregnancy

Diagnosing venous thromboembolism in pregnancy

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Peripartum pulmonary embolism: Anesthetic and surgical considerations

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