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Should Dual-Energy Computed Tomography Pulmonary Angiography Replace Single-Energy Computed Tomography Pulmonary Angiography in Pregnant and Postpartum Patients?

McDermott, Shaunagh, MD; Otrakji, Alexi, MD; Flores, Efren, J., MD; Kalra, Mannudeep, K., MD; Shepard, Jo-Anne, O., MD; Digumarthy, Subba, R., MD

Journal of Computer Assisted Tomography: January/February 2018 - Volume 42 - Issue 1 - p 25–32
doi: 10.1097/RCT.0000000000000655
Thoracic Imaging
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Objective The study aims to compare single-energy (SE) and dual-energy (DE) computed tomography pulmonary angiography (CTPA) for evaluation of suspected pulmonary embolism in pregnant and postpartum patients.

Materials and Methods Our study included 59 CTPA performed in pregnant/postpartum women (study group) comprised of 38 SE-CTPA and 21 DE-CTPA. The control group of 21 age- and weight-matched nonpregnant/nonpostpartum women underwent DE-CTPA. Two radiologists assessed pulmonary arterial enhancement, image quality, and artifacts. κ Test and analysis of variance were performed.

Results Fourteen of 38 pregnant/postpartum women (37%) had suboptimal SE-CTPA compared with just 10% (2/21) suboptimal DE-CTPA studies (P = 0.02). Mean Hounsfield unit (HU) in the pulmonary trunk was 550 ± 68 HU in the DE-CTPA pregnant/postpartum group and 245 ± 12 HU in the SE-CTPA (P < 0.001). The mean volume computed tomography dose index in the pregnant/postpartum patients for DE-CTPA and SE-CTPA were 9 ± 2 and 19 ± 8 mGy, respectively (P < 0.001).

Conclusions Dual-energy CTPA substantially increased arterial enhancement for evaluation of pulmonary embolism in pregnant and postpartum women compared with SE-CTPA.

From the Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA.

Received for publication February 10, 2017; accepted June 5, 2017.

Correspondence to: Shaunagh McDermott, MD, Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (e-mail: mcdermott.shaunagh@mgh.harvard.edu).

The authors declare no conflict of interest.

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