CT and MR in pulmonary embolism: A changing role for nuclear medicine in diagnostic strategy

The goal of this article is to summarize current data on computed tomography (CT) and magnetic resonance (MR) in the diagnosis of acute pulmonary embolism (PE) in relation to the radionuclide ventilation perfusion scan. It is important for the nuclear medicine, CT, and MR communities to develop a shared approach to this disorder. Triage using chest radiographs appears to be a practical method for enhancing both nuclear medicine and CT/MR performance. The realization that there is no clinically available gold standard for the diagnosis of PE suggests that the imaging community should replace impractical and idealistic discussions with more realistic outcome-oriented approaches. A simplified one-step evaluation of the pulmonary arteries and the lower extremity veins for deep venous thrombus can provide a comprehensive examination for PE. CT is currently a more practical diagnostic tool, whereas MR offers a scientific probe for pulmonary physiology including the regional mapping of ventilation-perfusion relationships. Nuclear medicine, CT, and MR thus form an imaging triad for the diagnosis of acute PE.