Performance of Low-Dose Perfusion Scintigraphy and CT Pulmonary Angiography for Pulmonary Embolism in Pregnancy

Jean Ju Sheen, Linda B. Haramati, Anna Natenzon, Hong Ma, Pamela Tropper, Anna S. Bader, Leonard M. Freeman, Peter S. Bernstein, Renee M. Moadel

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background The symptoms of normal pregnancy overlap those of pulmonary embolism (PE). Limited literature suggests that low-dose perfusion scanning (LDQ), which yields lower maternal–fetal radiation exposure than CT pulmonary angiography (CTPA), performs well in excluding PE in pregnant patients. Methods We performed a retrospective cohort study of sequential pregnant women who underwent imaging for PE with LDQ or CTPA between 2008 and 2013 at Montefiore Medical Center. Our practice recommends LDQ for patients with negative results on chest radiographs. Patients were categorized according to initial imaging modality, and a subgroup analysis was performed in patients with asthma. The primary outcome was the negative predictive value (NPV) of imaging determined by VTE diagnosis within 90 days. Results Of 322 pregnant women (mean age, 27.3 ± 6.3 years), initial imaging was positive for PE in 2.7% (6 of 225) of LDQs and 4.1% (4 of 97) of CTPAs, negative in 88.0% (198 of 225) of LDQs and 86.6% (84 of 97) of CTPAs, and indeterminate/nondiagnostic in 9.3% (21 of 225) of LDQs and 9.3% (9 of 97) of CTPAs (P =.79). Ten patients (3.1%) were treated for PE. The NPV was 100% for LDQ and 97.5% for CTPA. Subgroup analysis of patients with asthma (23.9% of this population) revealed a high likelihood of a negative study in the LDQ and CTPA groups (74.1% and 87.0%, respectively) and 100% NPV for both modalities. Conclusions PE is an uncommon diagnosis in pregnancy. LDQ and CTPA perform well, with less maternal–fetal radiation exposure with LDQ. Therefore, when available, LDQ is a reasonable first-choice modality for suspected PE in pregnant women with a negative result on chest radiograph.

Original languageEnglish (US)
Pages (from-to)152-160
Number of pages9
JournalChest
Volume153
Issue number1
DOIs
StatePublished - Jan 1 2018

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Perfusion Imaging
Pulmonary Embolism
Pregnancy
Lung
Pregnant Women
Thorax
Asthma
Computed Tomography Angiography
Cohort Studies
Retrospective Studies
Perfusion
Population
4-((1,4,8,11-tetraazacyclotetradec-1-yl)methyl)benzoic acid

Keywords

  • asthma
  • CT pulmonary angiography
  • low-dose perfusion scintigraphy
  • maternal–fetal radiation exposure
  • pregnancy
  • pulmonary embolism

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Performance of Low-Dose Perfusion Scintigraphy and CT Pulmonary Angiography for Pulmonary Embolism in Pregnancy. / Sheen, Jean Ju; Haramati, Linda B.; Natenzon, Anna; Ma, Hong; Tropper, Pamela; Bader, Anna S.; Freeman, Leonard M.; Bernstein, Peter S.; Moadel, Renee M.

In: Chest, Vol. 153, No. 1, 01.01.2018, p. 152-160.

Research output: Contribution to journalArticle

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abstract = "Background The symptoms of normal pregnancy overlap those of pulmonary embolism (PE). Limited literature suggests that low-dose perfusion scanning (LDQ), which yields lower maternal–fetal radiation exposure than CT pulmonary angiography (CTPA), performs well in excluding PE in pregnant patients. Methods We performed a retrospective cohort study of sequential pregnant women who underwent imaging for PE with LDQ or CTPA between 2008 and 2013 at Montefiore Medical Center. Our practice recommends LDQ for patients with negative results on chest radiographs. Patients were categorized according to initial imaging modality, and a subgroup analysis was performed in patients with asthma. The primary outcome was the negative predictive value (NPV) of imaging determined by VTE diagnosis within 90 days. Results Of 322 pregnant women (mean age, 27.3 ± 6.3 years), initial imaging was positive for PE in 2.7{\%} (6 of 225) of LDQs and 4.1{\%} (4 of 97) of CTPAs, negative in 88.0{\%} (198 of 225) of LDQs and 86.6{\%} (84 of 97) of CTPAs, and indeterminate/nondiagnostic in 9.3{\%} (21 of 225) of LDQs and 9.3{\%} (9 of 97) of CTPAs (P =.79). Ten patients (3.1{\%}) were treated for PE. The NPV was 100{\%} for LDQ and 97.5{\%} for CTPA. Subgroup analysis of patients with asthma (23.9{\%} of this population) revealed a high likelihood of a negative study in the LDQ and CTPA groups (74.1{\%} and 87.0{\%}, respectively) and 100{\%} NPV for both modalities. Conclusions PE is an uncommon diagnosis in pregnancy. LDQ and CTPA perform well, with less maternal–fetal radiation exposure with LDQ. Therefore, when available, LDQ is a reasonable first-choice modality for suspected PE in pregnant women with a negative result on chest radiograph.",
keywords = "asthma, CT pulmonary angiography, low-dose perfusion scintigraphy, maternal–fetal radiation exposure, pregnancy, pulmonary embolism",
author = "Sheen, {Jean Ju} and Haramati, {Linda B.} and Anna Natenzon and Hong Ma and Pamela Tropper and Bader, {Anna S.} and Freeman, {Leonard M.} and Bernstein, {Peter S.} and Moadel, {Renee M.}",
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AU - Sheen, Jean Ju

AU - Haramati, Linda B.

AU - Natenzon, Anna

AU - Ma, Hong

AU - Tropper, Pamela

AU - Bader, Anna S.

AU - Freeman, Leonard M.

AU - Bernstein, Peter S.

AU - Moadel, Renee M.

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N2 - Background The symptoms of normal pregnancy overlap those of pulmonary embolism (PE). Limited literature suggests that low-dose perfusion scanning (LDQ), which yields lower maternal–fetal radiation exposure than CT pulmonary angiography (CTPA), performs well in excluding PE in pregnant patients. Methods We performed a retrospective cohort study of sequential pregnant women who underwent imaging for PE with LDQ or CTPA between 2008 and 2013 at Montefiore Medical Center. Our practice recommends LDQ for patients with negative results on chest radiographs. Patients were categorized according to initial imaging modality, and a subgroup analysis was performed in patients with asthma. The primary outcome was the negative predictive value (NPV) of imaging determined by VTE diagnosis within 90 days. Results Of 322 pregnant women (mean age, 27.3 ± 6.3 years), initial imaging was positive for PE in 2.7% (6 of 225) of LDQs and 4.1% (4 of 97) of CTPAs, negative in 88.0% (198 of 225) of LDQs and 86.6% (84 of 97) of CTPAs, and indeterminate/nondiagnostic in 9.3% (21 of 225) of LDQs and 9.3% (9 of 97) of CTPAs (P =.79). Ten patients (3.1%) were treated for PE. The NPV was 100% for LDQ and 97.5% for CTPA. Subgroup analysis of patients with asthma (23.9% of this population) revealed a high likelihood of a negative study in the LDQ and CTPA groups (74.1% and 87.0%, respectively) and 100% NPV for both modalities. Conclusions PE is an uncommon diagnosis in pregnancy. LDQ and CTPA perform well, with less maternal–fetal radiation exposure with LDQ. Therefore, when available, LDQ is a reasonable first-choice modality for suspected PE in pregnant women with a negative result on chest radiograph.

AB - Background The symptoms of normal pregnancy overlap those of pulmonary embolism (PE). Limited literature suggests that low-dose perfusion scanning (LDQ), which yields lower maternal–fetal radiation exposure than CT pulmonary angiography (CTPA), performs well in excluding PE in pregnant patients. Methods We performed a retrospective cohort study of sequential pregnant women who underwent imaging for PE with LDQ or CTPA between 2008 and 2013 at Montefiore Medical Center. Our practice recommends LDQ for patients with negative results on chest radiographs. Patients were categorized according to initial imaging modality, and a subgroup analysis was performed in patients with asthma. The primary outcome was the negative predictive value (NPV) of imaging determined by VTE diagnosis within 90 days. Results Of 322 pregnant women (mean age, 27.3 ± 6.3 years), initial imaging was positive for PE in 2.7% (6 of 225) of LDQs and 4.1% (4 of 97) of CTPAs, negative in 88.0% (198 of 225) of LDQs and 86.6% (84 of 97) of CTPAs, and indeterminate/nondiagnostic in 9.3% (21 of 225) of LDQs and 9.3% (9 of 97) of CTPAs (P =.79). Ten patients (3.1%) were treated for PE. The NPV was 100% for LDQ and 97.5% for CTPA. Subgroup analysis of patients with asthma (23.9% of this population) revealed a high likelihood of a negative study in the LDQ and CTPA groups (74.1% and 87.0%, respectively) and 100% NPV for both modalities. Conclusions PE is an uncommon diagnosis in pregnancy. LDQ and CTPA perform well, with less maternal–fetal radiation exposure with LDQ. Therefore, when available, LDQ is a reasonable first-choice modality for suspected PE in pregnant women with a negative result on chest radiograph.

KW - asthma

KW - CT pulmonary angiography

KW - low-dose perfusion scintigraphy

KW - maternal–fetal radiation exposure

KW - pregnancy

KW - pulmonary embolism

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