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Perfusion abnormalities in pulmonary embolism studied with perfusion MRI and ventilation-perfusion scintigraphy: an
Tore Amundsen1, Geir Torheim, Kjell A Kvistad
1Department of Medicine, University Hospital of Trondheim, Norwegian University of Science and Technology, Trondheim, Norway. Tore.Amundsen@medisin.ntnu.no
Purpose:
To compare perfusion magnetic resonance imaging (MRI) and ventilation-perfusion scintigraphy (V-P scan) in the study of perfusion abnormalities in pulmonary embolism (PE) and to compare the PE results to the findings previously reported for pneumonia and chronic obstructive pulmonary disease (COPD), in terms of perfusion abnormalities.
Materials And Methods:
Dynamic contrast-enhanced MR images and V-P scans of 20 patients with PE, 11 patients with acute pneumonia, and 13 patients with exacerbation of COPD were studied. Five categories of perfusion abnormalities within each imaging modality were defined. Intra- and inter-modality agreement (kappa values) in the evaluation of perfusion abnormalities were calculated, based on the two observers of each imaging modality (all blinded to each other and true diagnosis). Finally, three categories of perfusion MRI diagnosis (PE, pneumonia, and COPD) were also defined and the inter-observer agreement (kappa value) was calculated.
Results:
For PE, the intra-modality agreement (kappa value) in the evaluation of perfusion abnormalities was 0.77 for MRI and 0.65 for V-P scan. The inter-modality agreement varied from 0.52 to 0.57, respectively, and was observer-dependent. For the pooled group of PE, pneumonia, and COPD, the intra-modality agreement of perfusion abnormalities was 0.76 for MRI and 0.65 for V-P scan, and the inter-modality agreement varied from 0.51 to 0.56. The kappa value for inter-observer agreement for MRI diagnosis was 0.92.
Conclusion:
Evaluation of perfusion abnormalities in PE, pneumonia, and COPD using perfusion MRI and V-P scan showed a high intra-modality agreement that was higher than the inter-modality agreement. Further studies are now needed in patients presenting with possible PE to evaluate the sensitivity and specificity of the method.
Insights
Perfusion MRI showed higher agreement than V-P scans for detecting perfusion abnormalities in pulmonary embolism (PE), pneumonia, and COPD. Further research is needed to confirm MRI
Area of Science:
- Radiology and Imaging Science
- Pulmonary Medicine
- Diagnostic Imaging
Background:
- Pulmonary embolism (PE), pneumonia, and chronic obstructive pulmonary disease (COPD) present with similar perfusion abnormalities.
- Accurate diagnosis of these conditions is crucial for effective patient management and treatment.
- Ventilation-perfusion scintigraphy (V-P scan) is a traditional imaging modality for assessing pulmonary perfusion.
Purpose of the Study:
- To compare the diagnostic performance of perfusion magnetic resonance imaging (MRI) against V-P scans in identifying perfusion abnormalities.
- To evaluate the agreement of perfusion MRI and V-P scans in patients with PE, pneumonia, and COPD.
- To assess the inter-observer agreement for perfusion MRI diagnoses.
Main Methods:
- Dynamic contrast-enhanced MRI and V-P scans were performed on patients diagnosed with PE, pneumonia, or COPD exacerbation.
- Perfusion abnormalities were categorized, and intra- and inter-modality agreement (kappa values) were calculated.
- Observers were blinded to each other's findings and the true clinical diagnosis.
Main Results:
- Perfusion MRI demonstrated higher intra-modality agreement (kappa=0.77 for PE) compared to V-P scans (kappa=0.65 for PE).
- Inter-modality agreement between MRI and V-P scans ranged from 0.52 to 0.57, indicating observer dependency.
- High inter-observer agreement (kappa=0.92) was observed for perfusion MRI diagnoses.
Conclusions:
- Perfusion MRI offers a reliable method for evaluating perfusion abnormalities in PE, pneumonia, and COPD, with strong intra-modality agreement.
- The intra-modality agreement for perfusion MRI surpasses that of V-P scans.
- Further studies are warranted to determine the sensitivity and specificity of perfusion MRI for diagnosing PE.