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

Abstract

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