在社区实践中怀疑产前肺栓塞的高级成像:偏好,不确定性和临床医生的反应
David R Vinson1,2,3, Madeline J Somers2, Cydney E Middleton4,5
1The Permanente Medical Group, Pleasanton, California, USA.
概括
在怀孕期间诊断肺栓塞 (PE) 时,计算机断层扫描肺血管造影 (CTPA) 是首选的,而不是肺部扫描,尽管不确定结果的比率更高. 不确定的CTPA扫描通常不会导致进一步的成像.
科学领域:
- 放射学 放射学是一门学科.
- 产科 产科 产科 产科 产科
- 肺部医学 肺部医学
背景情况:
- 怀孕期间疑似肺栓塞 (PE) 的最佳先进成像模式,计算机断层扫描肺血管造影 (CTPA) 与肺部扫描相比,仍在争论中.
- 目前的实践模式,不确定的成像率和临床医生对社区医院内孕妇PE评估的反应尚不清楚.
研究的目的:
- 为了比较CTPA和肺部扫描在怀孕患者怀疑PE的使用情况.
- 评估每个模式的不确定成像结果的流行率和随后的临床管理.
- 评估医生在急诊室 (ED) 和分娩单位 (LDU) 进行先进成像的偏好.
主要方法:
- 在2021年10月至2023年3月期间,对接受先进PE成像检查的孕妇进行了回顾性队列研究.
- 医生偏好被分析为整体和可接受光学扫描的病例 (可用,没有胸部X射线扫描的禁忌).
- 结果包括48小时后不确定性成像率和90天静脉血栓栓塞 (VTE) 发生率.
主要成果:
- 在315名孕妇患者中,CTPA在PE评估中被压倒性地偏爱 (91.4%),而不是光阴扫描 (8.6%).
- 不确定的结果在CTPA (24.7%) 显着更常见,而不是光束成像 (0%),随着有限的后续成像.
- 肺栓塞仅在1.6%的病例中被诊断出,所有病例都是通过CTPA;在非阳性CTPA患者中,90天内没有发生VTE事件.
结论:
- 在社区医院,CTPA是怀孕期间怀疑PE的首选成像模式,无论该模式的可用性或适用性如何.
- 与光阴扫描相比,CTPA的不确定性发现率更高,通常不需要进一步的诊断评估.
- 尽管CTPA的使用率很高,但PE的患病率很低,不确定的结果与随后的VTE事件没有相关性.
更多相关视频
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
7.2K
05:50International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
14.6K
相关概念视频
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
328
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
328
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
405
Radiological investigations are paramount in the diagnosis and management of various pulmonary diseases. Two essential investigations are the Pulmonary Angiogram and the Positron Emission Tomography (PET) Scan.
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
405
01:29Pulmonary Embolism I: Introduction
516
Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
516
01:27Pulmonary Embolism III: Nursing Management
363
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
363
01:30Radiological Investigation II: MRI and Ventilation Perfusion Scan
532
Description
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
532
01:20Imaging Studies for Cardiovascular System III: X-Ray
466
The most common cardiovascular diagnostic test is an X-ray. It produces images of the heart, blood vessels, and adjacent structures.
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
466