Diagnosing Pulmonary Embolism in Pregnancy Using Computed-Tomographic Angiography or Ventilation-Perfusion
Diagnosing Pulmonary Embolism in Pregnancy Using Computed-Tomographic Angiography or Ventilation-Perfusion
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DOI：
10.1097/aog.0b013e3181aef106
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发表时间：
2009-07-01
影响因子：
7.2
通讯作者：
Bhalla, Sanjeev
中科院分区：
文献类型：
--
作者：
Cahill, Alison G.;Stout, Molly J.;Bhalla, Sanjeev
目的：比较采用计算机断层血管造影诊断妊娠期肺栓塞患者与采用通气灌注成像诊断妊娠期肺栓塞患者的未诊断率。方法：这是一项回顾性队列研究，从2001年到2006年，所有怀孕或产后6周、至少接受过计算机断层血管造影或通气灌注扫描的临床怀疑肺栓塞的妇女进行了连续评估。对病史、临床表现、检查、影像学、妊娠和产妇结局进行抽象化。通过计算机断层血管造影进行初步诊断的妇女与进行通气灌注的妇女进行比较。主要结局被定义为一项非诊断性研究：计算机断层血管造影组未诊断出肺栓塞，或通气灌注组“低或中等概率”。进行单变量、双变量和多变量分析。结果：在304名临床怀疑肺栓塞的女性中，108名（35.1%）女性通过计算机断层血管造影进行初步诊断，196名（64.9%）女性通过通气灌注进行初步诊断。接受计算机断层血管造影的女性非诊断性研究的比例略高（17.0%比13.2%，P= 0.38）。检查胸部x线正常的女性亚组，即使校正了相关的混杂效应(30.0%比5.6%，校正优势比5.4,95%置信区间1.4-20.1，P
OBJECTIVE: To estimate the rate of nondiagnosis for patients who initially undergo computed-tomographic angiography compared with those who undergo ventilation-perfusion imaging to diagnose pulmonary embolism in pregnancy.METHODS: This was a retrospective cohort study of all women consecutively evaluated from 2001-2006 for clinical suspicion of pulmonary embolism who were pregnant or 6 weeks postpartum and underwent at least computed-tomographic angiography or ventilation-perfusion scan. Charts were abstracted for history, clinical presentation, examination, imaging, and pregnancy and maternal outcomes. Women who underwent computed-tomographic angiography for initial diagnosis were compared with women who underwent ventilation-perfusion. Primary outcome was defined as a nondiagnostic study: nondiagnostic for pulmonary embolism in the computed-tomographic angiography group, or "low or intermediate probability" in the ventilation-perfusion group. Univariable, bivariable, and multivariable analyses were performed.RESULTS: Of 304 women with a clinical suspicion of pulmonary embolism, initial diagnosis was sought by computed-tomographic angiography in 108 (35.1%) and by ventilation-perfusion in 196 (64.9%) women. Women who underwent computed-tomographic angiography tended to have a slightly higher rate of nondiagnostic study (17.0% compared with 13.2%, P=.38). Examining the subgroup of women with a normal chest X-ray, computed-tomographic angiography was much more likely to yield a nondiagnostic result than ventilation-perfusion, even after adjusting for relevant confounding effects (30.0% compared with 5.6%, adjusted odds ratio 5.4, 95% confidence interval 1.4-20.1, P