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Meta-Analysis
. 2019 Jan;104(1):176-188.
doi: 10.3324/haematol.2018.196121. Epub 2018 Aug 16.

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  4   5 , Pierre-Yves Le Roux  6 , Yvonne Ende-Verhaar  4 , Pierre-Yves Salaun  6 , Christophe Leroyer  2   3 , Francis Couturaud  2   3 , Lucia J M Kroft  7 , Menno V Huisman  4 , Frederikus A Klok  4
Affiliations
Meta-Analysis

Computed tomography pulmonary angiography versus ventilation-perfusion lung scanning for diagnosing pulmonary embolism during pregnancy: a systematic review and meta-analysis

Cécile Tromeur et al. Haematologica. 2019 Jan.

Abstract

Differences between computed tomography pulmonary angiography 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 included 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 strategies with overlapping confidence intervals. The pooled rates of non-diagnostic 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 methods given the lack of high quality data. Both imaging tests seem equally safe to rule out pulmonary embolism in pregnancy. We found no significant differences in efficiency and radiation exposures between computed tomography pulmonary angiography and ventilation-perfusion lung scanning although direct comparisons were not possible.

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Figures

Figure 1.
Figure 1.
Flow chart of the systematic review. MA: meeting abstract; OA: original article; CUS: compression ultrasonography.
Figure 2.
Figure 2.
Meta-analysis of false negative tests after a first negative ventilation-perfusion lung scan and computed tomography pulmonary angiography in pregnant patients with suspected acute pulmonary embolism. A false negative test is defined by a first negative computed tomography pulmonary angiography (CTPA) or ventilation-perfusion (V-Q) lung scan in a woman who had a pulmonary embolism (PE) diagnosed during the 3 months of follow-up. Three patients had a PE during the follow up., The type of imaging test performed to diagnose the PE was not provided.
Figure 3.
Figure 3.
Meta-analysis of non-diagnostic results of ventilation-perfusion lung scanning and computed tomography pulmonary angiography in pregnant patients with suspected acute pulmonary embolism. The number and type of additional imaging tests are provided in Table 3. V-Q: ventilation-perfusion; CTPA: computed tomography pulmonary angiography.
See this image and copyright information in PMC

Comment in

  • Breast dose matters.
    Moadel RM, Sheen JJ, Freeman LM, Broyde-Haramati L. Moadel RM, et al. Haematologica. 2021 Jun 1;106(6):1778. doi: 10.3324/haematol.2019.219584. Haematologica. 2021. PMID: 34060297 Free PMC article. No abstract available.

References

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