Date of Award

2025

Document Type

Capstone

Degree Name

Master of Science (MS)

Committee Chair

Trey Boyd

Abstract

Introduction: Pregnant women who are diagnosed with a pulmonary embolism (PE) face a high rate of mortality due to its significant compilations. Timely and accurate diagnosis of PE is essential for appropriate management. Diagnostic imaging modalities, such as computed tomography pulmonary angiography (CTPA) and ventilation-perfusion (V/Q) scan, are required to confirm the PE. This study aims to determine the most optimal early diagnostic imaging for PE in pregnancy.

Methods: This study searched the PubMed database for research comparing diagnostic imaging modalities used in PE for pregnant women from 2018 to 2024. Keywords searched included “pulmonary embolism,” “pregnancy,” “computed tomography pulmonary angiography,” and “ventilation-perfusion scan.” Final results were filtered by comparing V/Q to CTPA scans among RCTs, systematic reviews, and meta-analyses. Studies included were found via applied filters and reference lists of searched items.

Results: In total, 480 patient data points, including pregnant patients, were analyzed across three studies. One study found that the prevalence of imaging was higher for CTPA scans and lower for non-diagnostic results compared to perfusion scans, with linear regression showing significantly more non-diagnostic outcomes for perfusion scans. Researchers in the subsequent study concluded that CTPA was also identified as the most common imaging modality across all pregnancy trimesters, peaking in the third trimester, with an increasing diagnosis rate for PE from the first trimester to postpartum. The final study indicated that helical CTPA had the highest lung dose, while V/Q scans had the highest overall lung radiation exposure. Notably, fetal radiation doses were lower with CTPA than V/Q scans, particularly in early pregnancy, and the risk of childhood cancer from fetal exposure was greater for V/Q scans.

Discussion:CTPA was the most common initial and superior diagnostic imaging modality for confirming PE in pregnant women across all trimesters over V/Q scans. Due to limited data on maternofetal outcomes with ionizing radiation exposure, further assessments on alternate imaging modalities and clinically proven diagnostic algorithms should be conducted.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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