Computed tomography pulmonary angiography versus ventilation-perfusion lung scanning for diagnosing pulmonary embolism during pregnancy: a systematic review and meta-analysis
Cécile Tromeur,
Liselotte M. van der Pol,
Pierre-Yves Le Roux,
Yvonne Ende-Verhaar,
Pierre-Yves Salaun,
Christophe Leroyer,
Francis Couturaud,
Lucia J.M. Kroft,
Menno V. Huisman,
Frederikus A. Klok
Affiliations
Cécile Tromeur
Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands;Groupe 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;Centre d’Investigation Clinique INSERM 1412, University of Brest, France
Liselotte M. van der Pol
Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands;Department of Internal Medicine, Haga Teaching Hospital, the Hague, the Netherlands
Pierre-Yves Le Roux
Département de Médecine Nucléaire, CHRU Brest, France
Yvonne Ende-Verhaar
Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands
Pierre-Yves Salaun
Département de Médecine Nucléaire, CHRU Brest, France
Christophe Leroyer
Groupe 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;Centre d’Investigation Clinique INSERM 1412, University of Brest, France
Francis Couturaud
Groupe 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;Centre d’Investigation Clinique INSERM 1412, University of Brest, France
Lucia J.M. Kroft
Department of Radiology, Leiden University Medical Center, the Netherlands
Menno V. Huisman
Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands
Frederikus A. Klok
Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands
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.
