CT venography for the diagnosis of postpartum venous thromboembolism: a prospective multi-center cohort study.

Autor: Revel MP; Université Paris Cité, Paris, France. marie-pierre.revel@aphp.fr.; APHP, Hôpital Cochin, Service de Radiologie, Paris, France. marie-pierre.revel@aphp.fr., Chassagnon G; Université Paris Cité, Paris, France.; APHP, Hôpital Cochin, Service de Radiologie, Paris, France., Sanchez O; Université Paris Cité, Paris, France.; APHP, Hôpital Européen Georges Pompidou, Service de pneumologie et de soins intensifs, Paris, France., Ferretti G; Université Grenoble Alpes, Grenoble, France.; CHU Grenoble Alpes, Service de Radiologie, Grenoble, France., Millet I; IDESP, Université de Montpellier, Montpellier, France.; CHU Lapeyronie, Service de Radiologie, Montpellier, France., Rocher L; Université Paris-Saclay, Orsay, France.; APHP, Hôpital Antoine Béclère, Service de Radiologie, Clamart, France., Maitre S; APHP, Hôpital Antoine Béclère, Service de Radiologie, Clamart, France., Lederlin M; Université de Rennes 1, Rennes, France.; Hôpital Pontchaillou, Service de Radiologie, Rennes, France., Ducou-le-Pointe H; Sorbonne Université, Paris, France.; APHP, Hôpital Armand Trousseau, Service de Radiologie, Paris, France., Rousset P; Université Claude Bernard Lyon 1, Villeurbanne, France.; Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Radiologie, Pierre Bénite, France., Bennani S; APHP, Hôpital Cochin, Service de Radiologie, Paris, France., Zins M; Hôpital Saint Joseph, Service de Radiologie, Paris, France., Bruneau B; Hôpital Pontchaillou, Service de Radiologie, Rennes, France., Tissot V; Centre Hospitalier Universitaire de Brest, Service de Radiologie, Brest, France., Alison M; Université Paris Cité, Paris, France.; APHP, Hôpital Robert Debré, Service de Radiologie, Paris, France., Canniff E; Université Paris Cité, Paris, France.; APHP, Hôpital Cochin, Service de Radiologie, Paris, France., Siauve N; Université Paris Cité, Paris, France.; APHP, Hôpital Louis Mourier, Service de Radiologie, Colombes, France., Vandeventer S; Université Paris Cité, Paris, France.; APHP, Hôpital Necker, Service de Radiologie, Paris, France., Le Blanche AF; Université Paris-Saclay, Orsay, France.; Centre hospitalier Nord-Ouest Val d'Oise, Site de Pontoise, Service de Radiologie, Pontoise, France., Planquette B; Université Paris Cité, Paris, France.; APHP, Hôpital Européen Georges Pompidou, Service de pneumologie et de soins intensifs, Paris, France., Tsatsaris V; Université Paris Cité, Paris, France.; APHP, Hôpital Cochin, Maternité Port-Royal, FHU PREMA, Paris, France., Coste J; Université Paris Cité, Paris, France.; APHP, Hôpital Cochin, Service d'Epidémiologie et de Biostatistiques, Paris, France.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2024 Nov; Vol. 34 (11), pp. 7419-7428. Date of Electronic Publication: 2024 May 23.
DOI: 10.1007/s00330-024-10791-8
Abstrakt: Objectives: To assess the role of CT venography (CTV) in the diagnosis of venous thromboembolism (VTE) during the postpartum period.
Materials and Methods: This multicenter prospective cohort study was conducted between April 2016 and April 2020 in 14 university hospitals. All women referred for CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE) within the first 6 weeks postpartum were eligible. All CTPAs were performed on multidetector CT machines with the usual parameters and followed by CTV of the abdomen, pelvis, and proximal lower limbs. On-site reports were compared to expert consensus reading, and the added value of CTV was assessed for both.
Results: The final study population consisted of 123 women. On-site CTPA reports mentioned PE in seven women (7/123, 5.7%), all confirmed following expert consensus reading, three involving proximal pulmonary arteries and four limited to distal arteries. Positive CTV was reported on-site in nine women, five of whom had negative and two indeterminate CTPAs, bringing the VTE detection rate to 11.4% (14/123) (95%CI: 6.4-18.4, p = 0.03). Expert consensus reading confirmed all positive on-site CTV results, but detected a periuterine vein thrombosis in an additional woman who had a negative CTPA, increasing the VTE detection rate to 12.2% (15/123) (95%CI: 7.0-19.3, p = 0.008). Follow-up at 3 months revealed no adverse events in this woman, who was left untreated. Median Dose-Length-Product was 117 mGy.cm for CTPA and 675 mGy.cm for CTPA + CTV.
Conclusion: Performing CTV in women suspected of postpartum PE doubles the detection of venous thromboembolism, at the cost of increased radiation exposure.
Clinical Relevance Statement: CTV can help in the decision-making process concerning curative anticoagulation in women with suspected postpartum PE, particularly those whose CTPA results are indeterminate or whose PE is limited to the subsegmental level.
Key Points: Postpartum women are at risk of pulmonary embolism, and CT pulmonary angiography can give equivocal results. CT venography (CTV) positivity increased the venous thromboembolism detection rate from 5.7 to 11.4%. CTV may help clinical decision-making, especially in women with indeterminate CTPA results or subsegmental emboli.
(© 2024. The Author(s), under exclusive licence to European Society of Radiology.)
Databáze: MEDLINE
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