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Published in: European Radiology 2/2022

01-02-2022 | Angiography | Computed Tomography

Imaging modalities for confirming pulmonary embolism during pregnancy: results from a multicenter international study

Authors: Ghazaleh Mehdipoor, David Jimenez, Laurent Bertoletti, Jorge Del Toro, Carmen Fernández-Capitán, Alessandra Bura-Riviere, Cristina Amado, Beatriz Valero, Ángeles Blanco-Molina, Remedios Otero, Egidio Imbalzano, Ramin Khorasani, Martin R. Prince, Behnood Bikdeli, Manuel Monreal, the RIETE Investigators

Published in: European Radiology | Issue 2/2022

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Abstract

Objectives

We explored the variations in use of imaging modalities for confirming pulmonary embolism (PE) according to the trimester of pregnancy.

Methods

We included all pregnant patients with confirmed acute PE from RIETE, a prospective registry of patients with PE (03/2001–02/2020). Imaging modalities included computed tomography pulmonary angiography (CTPA), ventilation-perfusion (V/Q) scan, or presence of signs of acute PE along with imaging-confirmed proximal deep vein thrombosis (pDVT) without pulmonary vascular imaging. We compared the imaging modalities to postpartum patients with PE, and other non-pregnant women with PE.

Results

There were 157 pregnant patients (age: 32.7 ± 0.5), 228 postpartum patients (age: 33.9 ± 0.5), and 23,937 non-pregnant non-postpartum women (age: 69.5 ± 0.1). CTPA was the most common modality for confirming PE, from 55.7% in first trimester to 58.3% in second trimester, and 70.0% in third trimester. From first trimester to third trimester, V/Q scanning was used in 21.3%, 16.7%, and 18.3% of cases, respectively. Confirmed pDVT along with the presence of signs/symptoms of PE was the confirmatory modality for PE in 21.3% of patients in first trimester, 19.4% in second trimester, and 6.7% in third trimester. The proportion of postpartum patients confirmed with CTPA (85.5%) was comparable to that of non-pregnant non-postpartum women (83.2%). From the first trimester of pregnancy to postpartum period, there was a linear increase in the proportion of patients with PE diagnosed with CTPA (p = 0.039).

Conclusion

CTPA was the primary modality for confirming PE in all trimesters of pregnancy, although its proportional use was higher in later stages of pregnancy.

Key Points

Computed tomography pulmonary angiography (CTPA) was the primary modality of diagnosis in all trimesters of pregnancy among patients with confirmed pulmonary embolism, even in the first trimester.
From the first trimester of pregnancy to postpartum period, there was a linear increase in the proportion of patients with pulmonary embolism who were diagnosed based on CTPA.
In the postpartum period, use of CTPA as the modality to confirm pulmonary embolism was comparable to non-pregnant patients.
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Metadata
Title
Imaging modalities for confirming pulmonary embolism during pregnancy: results from a multicenter international study
Authors
Ghazaleh Mehdipoor
David Jimenez
Laurent Bertoletti
Jorge Del Toro
Carmen Fernández-Capitán
Alessandra Bura-Riviere
Cristina Amado
Beatriz Valero
Ángeles Blanco-Molina
Remedios Otero
Egidio Imbalzano
Ramin Khorasani
Martin R. Prince
Behnood Bikdeli
Manuel Monreal
the RIETE Investigators
Publication date
01-02-2022
Publisher
Springer Berlin Heidelberg
Keyword
Angiography
Published in
European Radiology / Issue 2/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-021-08161-9

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