CTPA for the diagnosis of acute pulmonary embolism during pregnancy

Schaefer-Prokop, Cornelia; Prokop, Mathias

doi:10.1007/s00330-008-1158-8

Cited by 68 publications

(32 citation statements)

References 27 publications

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“…Our routine iodine delivery rate of 0.9 gI/s, which ensured a mean attenuation of 418 HU in 100 patients and was entirely sufficient in our collective, can be simply doubled by using 370 mgI/mL CM at a rate of 5 mL/s to counteract the increased cardiac output and plasma volume in pregnancy [20][21][22]. Furthermore, if we accept that subsegmental emboli do not have an impact on therapeutic decisions, the anatomical range to be covered can be limited from the level of the aortic arch to the right hemidiaphragm.…”

Section: Discussionmentioning

confidence: 98%

Is body weight the most appropriate criterion to select patients eligible for low-dose pulmonary CT angiography? Analysis of objective and subjective image quality at 80 kVp in 100 patients

et al. 2009

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The objective of this retrospective study was to assess image quality with pulmonary CT angiography (CTA) using 80 kVp and to find anthropomorphic parameters other than body weight (BW) to serve as selection criteria for low-dose CTA. Attenuation in the pulmonary arteries, anteroposterior and lateral diameters, cross-sectional area and soft-tissue thickness of the chest were measured in 100 consecutive patients weighing less than 100 kg with 80 kVp pulmonary CTA. Body surface area (BSA) and contrast-to-noise ratios (CNR) were calculated. Three radiologists analyzed arterial enhancement, noise, and image quality. Image parameters between patients grouped by BW (group 1: 0-50 kg; groups 2-6: 51-100 kg, decadally increasing) were compared. CNR was higher in patients weighing less than 60 kg than in the BW groups 71-99 kg (P between 0.025 and <0.001). Subjective ranking of enhancement (P = 0.165-0.605), noise (P = 0.063), and image quality (P = 0.079) did not differ significantly across all patient groups. CNR correlated moderately strongly with weight (R = -0.585), BSA (R = -0.582), cross-sectional area (R = -0.544), and anteroposterior diameter of the chest (R = -0.457; P < 0.001 all parameters). We conclude that 80 kVp pulmonary CTA permits diagnostic image quality in patients weighing up to 100 kg. Body weight is a suitable criterion to select patients for low-dose pulmonary CTA.

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Section: Discussionmentioning

confidence: 98%

Is body weight the most appropriate criterion to select patients eligible for low-dose pulmonary CT angiography? Analysis of objective and subjective image quality at 80 kVp in 100 patients

et al. 2009

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“…Moreover, the sensitivity of MDCT has recently been shown to be very low, probably due to hemodynamic circumstances during pregnancy. [44][45][46] For the aforementioned reasons, we recommend that perfusion-only scintigraphy be considered during pregnancy. [47][48][49] Another situation in which perfusiononly SPECT is recommended is in emergencies with a strong suspicion of massive PE.…”

Section: Spect Lung Scanning In Pregnancymentioning

confidence: 99%

Methodology for Ventilation/Perfusion SPECT

Bajc

Neilly

Miniati

et al. 2010

Seminars in Nuclear Medicine

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Ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) is the scintigraphic technique of choice for the diagnosis of pulmonary embolism and many other disorders that affect lung function. Data from recent ventilation studies show that the theoretic advantages of Technegas over radiolabeled liquid aerosols are not restricted to the presence of obstructive lung disease. Radiolabeled macroaggregated human albumin is the imaging agent of choice for perfusion scintigraphy. An optimal combination of nuclide activities and acquisition times for ventilation and perfusion, collimators, and imaging matrix yields an adequate V/Q SPECT study in approximately 20 minutes of imaging time. The recommended protocol based on the patient remaining in an unchanged position during the initial ventilation study and the perfusion study allows presentation of matching ventilation and perfusion slices in all projections as well as in rotating volume images based upon maximum intensity projections. Probabilistic interpretation of V/Q SPECT should be replaced by a holistic interpretation strategy on the basis of all relevant information about the patient and all ventilation/perfusion patterns. PE is diagnosed when there is more than one subsegment showing a V/Q mismatch representing an anatomic lung unit. Apart from pulmonary embolism, other pathologies should be identified and reported, for example, obstructive disease, heart failure, and pneumonia. Pitfalls exist both with respect to imaging technique and scan interpretation. Semin Nucl Med 40: [415][416][417][418][419][420][421][422][423][424][425]

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“…2 There is growing evidence that the diagnostic quality of CT scanning diminishes during pregnancy, due to physiologic changes and increased noise from dense breast tissue. 32 The risk of radiation-induced cancer is increased in pregnant women because the radiation dose absorbed by the breasts increases with breast size. 33 Potentially adverse effects of gadopentetate dimeglumine on the fetus have not been determined, and it is not known to what extent it is excreted in human breast milk.…”

Section: Methodsmentioning

confidence: 99%

“…44 Protocols for CTAs, therefore, should be modified in pregnant women. 32 Question 11. What is the most appropriate diagnostic approach to hemodynamically stable nonpregnant young female with suspected acute PE and a normal chest radiograph?…”

Section: Methodsmentioning

confidence: 99%

Controversies in Diagnosis of Pulmonary Embolism

Stein

Sostman

Dalen

et al. 2010

Clin Appl Thromb Hemost

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The approach to the diagnosis of acute pulmonary embolism (PE) is under constant revision with advances in technology, noninvasive approaches, and increasing awareness of the risks of ionizing radiation. Optimal approaches in some categories of patients are controversial. Data are insufficient for evidence-based recommendations. Therefore, this survey of investigators in the field was undertaken. Even among experts there were marked differences of opinion regarding the approach to the diagnosis of acute PE. Although CT pulmonary angiography was usually the imaging test of choice, the respondents were keenly aware of the dangers of ionizing radiation. In view of advances in scintigraphic diagnosis since the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) trial, ventilation/perfusion (V/Q) lung scans or perfusion scans alone and single photon emission computed tomography (SPECT) V/Q lung scans are often recommended. The choice depends on the patient's age, gender, and complexity of the findings on the plain chest radiograph.

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CTPA for the diagnosis of acute pulmonary embolism during pregnancy

Cited by 68 publications

References 27 publications

Is body weight the most appropriate criterion to select patients eligible for low-dose pulmonary CT angiography? Analysis of objective and subjective image quality at 80 kVp in 100 patients

Is body weight the most appropriate criterion to select patients eligible for low-dose pulmonary CT angiography? Analysis of objective and subjective image quality at 80 kVp in 100 patients

Methodology for Ventilation/Perfusion SPECT

Controversies in Diagnosis of Pulmonary Embolism

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