Hanan Ibrahim Khalil MD, Presenter: Nothing to Disclose

Ghada Bourjeily MD, Abstract Co-Author: Nothing to Disclose

Elizabeth Lazarus MD, Abstract Co-Author: Nothing to Disclose

Don C. Yoo MD, Abstract Co-Author: Nothing to Disclose

William W. Mayo-Smith MD, Abstract Co-Author: Research support, General Electric Company Research support, Bracco Group

Given the increased cardiac output and plasma volume associated with pregnancy, the purpose of this study was to evaluate the technical adequacy and findings of 224 consecutive multidetector CT pulmonary angiograms (MDCTPA) in pregnant patients.

This study was approved by the hospital IRB and is HIPPA compliant. A retrospective review of the reports of 224 consecutive MDCTPA exams in pregnant patients from one institution over a 3.2 year period from 2003 through February 2007 was performed. CT exams were performed using 4 detector-row CT (MDCT) and 125-150 cc of low osmolar contrast administered at 3-4 cc/sec. Results were recorded as positive, negative or technically limited. Images of the limited MDCTPA exams were reviewed for type and extent of limitation. Limiting factors were categorized into poor opacification due to the physiology of pregnancy or other factors.

Of 224 studies, 174 (77.6 %) were technically adequate. Of all the studies, 166 (74.1%) were negative and 8 (3.5%) were positive for PE. The remaining 50 (22.4%) were technically limited by the degree of pulmonary opacification. Of these, 14% were limited in the subsegmental branches, 78% in the segmental branches and 0.4% was an inadequate study due to the lack of opacification. Of these limited studies, 46 (92%) were thought to be secondary to increased cardiac output during pregnancy and 4 (8%) non-pregnancy related due to motion, streak artifacts and poor intravenous access. An alternative diagnosis was found in 16% of the studies.

MDCT for the diagnosis of PE in pregnant patients had a higher rate of technically limited studies (22%) compared to 2-9% reported in the literature for nonpregnant adults. This may be due to the increased cardiac output during pregnancy and an effort to tailor MDCTPA technique specifically for pregnant women should be made.

MDCT is becoming a first line exam for evaluation of pulmonary embolism in pregnant patients. Careful attention to technique should be made to perform optimal exams in this patient cohort to minimize radiation exposure to both the mother and fetus.

Khalil, H, Bourjeily, G, Lazarus, E, Yoo, D, Mayo-Smith, W, Multidetector CT Pulmonary Angiograms in Pregnant Patients: The “Limited, No Central PE”—How Limited?.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5011686.html