Diagnostic algorithm for pulmonary embolism in pregnant women (based on practice guidelines of the American Thoracic Society and the Society of Thoracic Radiology)
Abstract
References
1. Centers for Disease Control and Prevention. Pregnancyrelated mortality surveillance–United States, 1991–1999. Morbid. Mortal. Wkly Rep. 2003; 52: 1–8.
2. Marik P.E., Plante L.A. Venous thromboembolic disease and pregnancy. N. Engl. J. Med. 2008; 359: 2025–2033.
3. Royal College of Obstetricians and Gynaecologists. Greentop Guideline № 28: Thromboembolic disease in pregnancy and the puerperium: Acute management. 2007 [accessed Oct. 4, 2011]. Available from: www.rcog.org.uk / guidelines
4. Stein P.D., Woodard P.K., Weg J.G. et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators. Radiology 2007; 242: 15–21.
5. Schuster M.E., Fishman J.E., Copeland J.F. et al. Pulmonary embolism in pregnant patients: a survey of practices and policies for CT pulmonary angiography. Am. J. Roentgenol. 2003; 181: 1495–1498.
6. Bourjeily G., Paidas M., Khalil H. et al. Pulmonary embolism in pregnancy. Lancet 2010; 375: 500–512.
7. Schunemann H.J., Jaeschke R., Cook D.J. et al. An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am. J. Respir. Crit. Care Med. 2006; 174: 605–614.
8. Chan W.S., Ray J.G., Murray S. et al. Suspected pulmonary embolism in pregnancy: clinical presentation, results of lung scanning, and subsequent maternal and pediatric outcomes. Arch. Intern. Med. 2002; 162: 1170–1175.
9. Cahill A.G., Stout M.J., Macones G.A., Bhalla S. Diagnosing pulmonary embolism in pregnancy using computed-tomographic angiography or ventilation-perfusion. Obstetr. And Gynecol. 2009; 114: 124–129.
10. Gherman R.B., Goodwin T.M., Leung B. et al. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstetr. And Gynecol. 1999; 94: 730–734.
11. Powrie R.O., Larson L., Rosene*Montella K. et al. Alveolararterial oxygen gradient in acute pulmonary embolism in pregnancy. Am. J. Obstetr. Gynecol. 1998; 178: 394–396.
12. Heit J.A., Kobbervig C.E., James A.H. et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann. Intern. Med. 2005; 143: 697–706.
13. Damodaram M., Kaladindi M., Luckit J., Yoong W. D-dimers as a screening test for venous thromboembolism in pregnancy: is it of any use? J. Obstetr. Gynaecol.2009; 29: 101–103.
14. Levy M.S., Spencer F., Ginsberg J.S., Anderson J.A. Reading between the (Guidelines). Management of submassive pulmonary embolism in the first trimester of pregnancy. Thromb. Res. 2008; 121: 705–707.
15. To M.S., Hunt B.J., Nelson*Piercy C. A negative D-dimer does not exclude venous thromboembolism (VTE) in pregnancy. J. Obstetr. Gynaecol. 2008; 28: 222–223.
16. Chan W.S., Lee A., Spencer F.A. et al. D-dimer testing in pregnant patients: towards determining the next ’level’ in the diagnosis of deep vein thrombosis. J. Thromb. Haemost. 2010; 8: 1004–1011.
17. Kovac M., Mikovic Z., Rakicevic L. et al. The use of D-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy. Eur. J. Obstetr. Gynecol. Reprod. Biol. 2010; 148: 27–30.
18. Chan W.S., Chunilal S., Lee A. et al. A red blood cell agglutination D-dimer test to exclude deep venous thrombosis in pregnancy. Ann. Intern. Med. 2007; 147: 165–170.
19. Ahmad A., Jamjute P., Ghosh T., Klazinga D. D-dimer negative deep vein thrombosis in puerperium. Eur. Clin. Obstetr. Gynaecol. 2008; 3: 131–134.
20. International Commission of Radiological Protection. Pregnancy and medical radiation: Publication 84. Ann. ICRP 2000; 30: 1–44.
21. McCollough C.H., Schueler B.A., Atwell T.D. et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics 2007; 27: 909–917; discuss. 917–908.
22. Linet M.S., Kim K.P., Rajaraman P. Children’s exposure to diagnostic Medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr. Radiol. 2009; 39: S4–S26.
23. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation NRC. Health risks from exposure to low levels of ionizing radiation: BEIR VII – Phase 2. Washington: National Academy Press; 2006.
24. Bourjeily G., Chalhoub M., Phornphutkul C. et al. Neonatal thyroid function: effect of a single exposure to iodinated contrast medium in utero. Radiology 2010; 256: 744–750.
25. Food and Drug Administration. Content and format of labeling for human prescription drug and biological products; requirements for pregnancy and lactation labeling. Fed. Registr. 2008; 29: 30831–30868.
26. Lin S.P., Brown J.J. MR contrast agents: physical and pharmacologic basics. J. Magn. Reson. Imag. 2007; 25: 884–899.
27. Webb J.A., Thomsen H.S., Morcos S.K. The use of iodinated and gadolinium contrast Med.ia during pregnancy and lactation. Eur. Radiol. 2005; 15: 1234–1240.
28. Worsley D.F., Alavi A., Aronchick J.M. et al. Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology 1993; 189: 133–136.
29. Greenspan R.H., Ravin C.E., Polansky S.M., McLoud T.C. Accuracy of the chest radiograph in diagnosis of pulmonary embolism. Invest. Radiol. 1982; 17: 539–543.
30. Gottschalk A., Stein P.D., Goodman L.R., Sostman H.D. Overview of prospective investigation of pulmonary embolism diagnosis II. Semin. Nucl. Med. 2002; 32: 173–182.
31. Daftary A., Gregory M., Seibyl J.P., Saluja S. Chest radiograph as a triage tool in the imaging-based diagnosis of pulmonary embolism. Am. J. Roentgenol. 2005; 185: 132–134.
32. Forbes K.P., Reid J.H., Murchison J.T. Do preliminary chest X-ray findings define the optimum role of pulmonary scintigraphy in suspected pulmonary embolism? Clin. Radiol. 2001; 56: 397–400.
33. Scarsbrook A.F., Bradley K.M., Gleeson F.V. Perfusion scintigraphy: diagnostic utility in pregnant women with suspected pulmonary embolic disease. Eur. Radiol. 2007; 17: 2554–2560.
34. Ridge C.A., McDermott S., Freyne B.J. et al. Pulmonary embolism in pregnancy: comparison of pulmonary CT angiography and lung scintigraphy. Am. J. Roentgenol. 2009; 193: 1223–1227.
35. Righini M., Le Gal G., Aujesky D. et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised noninferiority trial. Lancet 2008; 371: 1343–1352.
36. van Rossum A.B., van Houwelingen H.C., Kieft G.J., Patty* nama P.M. Prevalence of deep vein thrombosis in suspected and proven pulmonary embolism: a meta-analysis. Br. J. Radiol. 1998; 71: 1260–1265.
37. Chan W.S., Lee A., Spencer F.A. et al. Predicting deep venous thrombosis in pregnancy: out in “LEFt” field? Ann. Intern. Med. 2009; 151: 85–92.
38. Parker J.A., Coleman R.E., Siegel B.A. et al. Procedure guideline for lung scintigraphy: 1.0. Society of Nuclear Medicine. J. Nucl. Med. 1996; 37: 1906–1910.
39. Shahir K., Goodman L.R., Tali A. et al. Pulmonary embolism in pregnancy: CT pulmonary angiography versus perfusion scanning. Am. J. Roentgenol. 2010; 195: W214– W220.
40. Revel M.P., Cohen S., Sanchez O. et al. Pulmonary embolism during pregnancy: diagnosis with lung scintigraphy or CT angiography? Radiology 2011; 258: 590–598.
41. King U., Im J.M., Freeman S.J. et al. Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy. Eur. Radiol. 2008; 18: 2709–2715.
42. Litmanovich D., Boiselle P.M., Bankier A.A. et al. Dose reduction in computed tomographic angiography of pregnant patients with suspected acute pulmonary embolism. J. Comput. Assist. Tomogr. 2009; 33: 961–966.
43. Kluge A., Luboldt W., Bachmann G. Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT. AJR Am. J. Roentgenol. 2006; 187: W7–14.
44. Chen M.M., Coakley F.V., Kaimal A., Laros R.K.Jr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstetr. and Gynecol. 2008; 112: 333–340.
45. Meaney J.F., Weg J.G., Chenevert T.L. et al. Diagnosis of pulmonary embolism with magnetic resonance angiography. N. Engl. J. Med. 1997; 336: 1422–1427.
46. Gupta A., Frazer C.K., Ferguson J.M. et al. Acute pulmonary embolism: diagnosis with MR angiography. Radiology 1999; 210: 353–359.
47. Oudkerk M., van Beek E.J., Wielopolski P. et al. Comparison of contrastenhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: a prospective study. Lancet 2002; 359: 1643–1647.
48. Ohno Y., Higashino T., Takenaka D. et al. MR angiography with sensitivity encoding (SENSE) for suspected pulmonary embolism: comparison with MDCT and ventilation-perfusion scintigraphy. Am. J. Roentgenol. 2004; 183: 91–98.
49. Pleszewski B., Chartrand*Lefebvre C., Qanadli S.D. et al. Gadolinium-enhanced pulmonary magnetic resonance angiography in the diagnosis of acute pulmonary embolism: a prospective study on 48 patients. Clin. Imag. 2006; 30: 166–172.
50. Stein P.D., Chenevert T.L., Fowler S.E. et al. Gadoliniumenhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann. Intern. Med. 2010; 152: 434–443.
51. van Rooij W.J., den Heeten G.J., Sluzewski M. Pulmonary embolism: diagnosis in 211 patients with use of selective pulmonary digital subtraction angiography with a flowdirected catheter. Radiology 1995; 195: 793–797.
52. Forauer A.R., McLean G.K., Wallace L.P. Clinical follow-up of patients after a negative digital subtraction pulmonary arteriogram in the evaluation of pulmonary embolism. J. Vasc. Interv. Radiol. 1998; 9: 903–908.
53. Henry J.W., Relyea B., Stein P.D. Continuing risk of thromboemboli among patients with normal pulmonary angiograms. Chest 1995; 107: 1375–1378.
54. Wittram C., Waltman A.C., Shepard J.A. et al. Discordance between CT and angiography in the PIOPED II study. Radiology 2007; 244: 883–889.
55. Hurwitz L.M., Yoshizumi T., Reiman R.E. et al. Radiation dose to the fetus from body MDCT during early gestation. Am. J. Roentgenol. 2006; 186: 871–876.
56. Winer*Muram H.T., Boone J.M., Brown H.L. et al. Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 2002; 224: 487–492.
57. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation NRC. Health risks from exposure to low levels of ionizing radiation: BEIR VII – Phase 2. National Academy of Sciences; 2006.
58. Parker M.S., Hui F.K., Camacho M.A. et al. Female breast radiation exposure during CT pulmonary angiography. Am. J. Roentgenol. 2005; 185: 1228–1233.
59. Cook J.V., Kyriou J. Radiation from CT and perfusion scanning in pregnancy. Br. Med. J. 2005; 331: 350.
60. Hurwitz L.M., Yoshizumi T.T., Reiman R.E. et al. Radiation dose to the female breast from 16-MDCT body protocols. Am. J. Roentgenol. 2006; 186: 1718–1722.
61. International Commission on Radiological Protection. Radiation dose to patients from radiopharmaceuticals: Publication 53. Ann. ICRP 1987; 18: 1–377.
62. International Commission on Radiological Protection. Radiation dose to patients from radiopharmaceuticals: Publication 80 (addendum 2 to ICRP publication 53). Ann. ICRP 1998; 28: 1–126.
63. Hurwitz L.M., Reiman R.E., Yoshizumi T.T. et al. Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: implications for cancer induction. Radiology 2007; 245: 742–750.
64. Brenner D.J., Doll R., Goodhead D.T. et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc. Natl Acad. Sci. USA 2003; 100: 13761–13766.
65. McCullough L.B., Chervenak F.A. Ethics in obstetrics and gynecology. New York: Oxford University Press; 1994.
66. Schaefer*Prokop C., Prokop M. CTPA for the diagnosis of acute pulmonary embolism during pregnancy. Eur. Radiol. 2008; 18: 2705–2708.
67. Kearon C., Kahn S.R., Agnelli G. et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 454S–545S.
68. Kline J.A., Hernandez*Nino J., Jones A.E. et al. Prospective study of the clinical features and outcomes of emergency department patients with delayed diagnosis of pulmonary embolism. Acad. Emerg. Med. 2007; 14: 592–598.
69. Smith S.B., Geske J.B., Maguire J.M. et al. Early anticoagulation is associated with reduced mortality for acute pulmonary embolism. Chest 2010; 137: 1382–1390.
70. Sostman H.D., Coleman R.E., DeLong D.M. et al. Evaluation of revised criteria for ventilation-perfusion scintigraphy in patients with suspected pulmonary embolism. Radiology 1994; 193: 103–107.
71. Sostman H.D., Miniati M., Gottschalk A. et al. Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J. Nucl. Med. 2008; 49: 1741–1748.
Review
For citations:
Diagnostic algorithm for pulmonary embolism in pregnant women (based on practice guidelines of the American Thoracic Society and the Society of Thoracic Radiology). PULMONOLOGIYA. 2012;(2):13-24. (In Russ.)