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Ferrata Storti Foundation
Haematologica 2019 Volume 104(1):176-188
Coagulation & its Disorders
Computed tomography pulmonary angiography versus ventilation-perfusion lung scanning
for diagnosing pulmonary embolism during pregnancy: a systematic review and meta-analysis
Cécile Tromeur,1,2,3 Liselotte M. van der Pol,1,4 Pierre-Yves Le Roux,5 Yvonne Ende-Verhaar,1 Pierre-Yves Salaun,5 Christophe Leroyer,2,3 Francis Couturaud,2,3 Lucia J.M. Kroft,6 Menno V. Huisman1 and Frederikus A. Klok1
1Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands; 2Groupe d’Etude de la Thrombose de Bretagne Occidentale, University of Brest, Equipe d’Accueil 3878, Department of Internal Medicine and Chest Diseases, CHRU Brest, France; 3Centre d’Investigation Clinique INSERM 1412, University of Brest, France; 4Department of Internal Medicine, Haga Teaching Hospital, the Hague, the Netherlands; 5Département de Médecine Nucléaire, CHRU Brest, France and 6Department of Radiology, Leiden University Medical Center, the Netherlands
ABSTRACT
Differences between computed tomography pulmonary angiogra- phy and ventilation-perfusion lung scanning in pregnant patients with suspected acute pulmonary embolism are not well-known, leading to ongoing debate on which test to choose. We searched in PubMed, EMBASE, Web of Science and the Cochrane Library databases and identified all relevant articles and abstracts published up to October 1, 2017. We assessed diagnostic efficiency, frequency of non-diagnostic results and maternal and fetal exposure to radiation exposure. We includ- ed 13 studies for the diagnostic efficiency analysis, 30 for the analysis of non-diagnostic results and 22 for the radiation exposure analysis. The pooled rate of false negative test results was 0% for both imaging strate- gies with overlapping confidence intervals. The pooled rates of non-diag- nostic results with computed tomography pulmonary angiography and ventilation-perfusion lung scans were 12% (95% confidence interval: 8- 17) and 14% (95% confidence interval: 10-18), respectively. Reported maternal and fetal radiation exposure doses were well below the safety threshold, but could not be compared between the two diagnostic meth- ods given the lack of high quality data. Both imaging tests seem equally safe to rule out pulmonary embolism in pregnancy. We found no signif- icant differences in efficiency and radiation exposures between comput- ed tomography pulmonary angiography and ventilation-perfusion lung scanning although direct comparisons were not possible.
Introduction
Pulmonary embolism (PE) is a major complication of pregnancy and responsible for 2% to 14% of all maternal deaths worldwide.1,2 Although accurate diagnostic tests for PE are essential for this specific population, high quality diagnostic stud- ies are unavailable.3 Clinical decision rules, which are the cornerstone of PE diag- nostic management in the non-pregnant population, were not developed for, nor validated in pregnant patients.4 Furthermore, considering the physiological increase of D-dimer levels throughout pregnancy, the optimal D-dimer threshold to rule out PE is unknown.5 The application of D-dimer tests and clinical decision rules as the initial step of the diagnostic algorithm for suspected PE cannot, there- fore, be recommended in pregnant patients.3
Moreover, the optimal choice of imaging test to rule out or confirm acute PE in
Correspondence:
tromeurcecile@gmail.com
Received: April 23, 2017. Accepted: August 14, 2018. Pre-published: August 16, 2018.
doi:10.3324/haematol.2018.196121
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/1/176
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