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[Indirect MR venography: contrast medium protocols, postprocessing and combination in diagnosing pulmonary emboli
A Kluge1, M Rominger, M Schönburg
1Diagnostische Radiologie, Kerckhoff-Klinik, Bad Nauheim. alexander.kluge@kerckhoff-klinik.de
Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
|July 9, 2004
Summary
Magnetic resonance (MR) venography offers a more complete visualization of leg veins than conventional venography for diagnosing pulmonary embolism (PE). This integrated MR protocol is feasible and accurate, using 0.25 mmol/kg Gd-DTPA for optimal results.
Area of Science:
- Radiology
- Vascular Imaging
- Diagnostic Accuracy
Background:
- Pulmonary embolism (PE) diagnosis often requires evaluating deep vein thrombosis (DVT).
- Conventional venography has limitations in visualizing superficial and deep leg veins.
- Magnetic resonance (MR) imaging offers non-invasive visualization of vascular structures.
Purpose of the Study:
- To integrate MR venography into a comprehensive MR imaging protocol for suspected PE.
- To evaluate contrast media dosage, timing, and postprocessing for optimal diagnostic accuracy.
- To compare the diagnostic performance of MR venography against conventional venography.
Main Methods:
- Forty-eight inpatients with suspected PE/DVT underwent MR venography using varying protocols (contrast dosage, timing).
- Protocols included MR venography alone, combined MR angiography/venography with full or reduced contrast dose.
- Image quality, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and visualized vascular segments were assessed and compared to conventional venography.
Main Results:
- MR venography achieved diagnostic quality in all 48 patients within 10 minutes, surpassing conventional venography's feasibility (43/48 patients).
- MR venography visualized significantly more superficial and deep leg veins (94%) compared to conventional venography (83%).
- Sensitivity and specificity for MR venography were 100% and 92%, respectively. Higher contrast dosage (0.25 mmol/kg Gd-DTPA) yielded significantly better image quality.
Conclusions:
- An integrated MR protocol for evaluating pulmonary arteries and leg veins in suspected PE is feasible.
- MR venography with 0.25 mmol/kg Gd-DTPA provides more complete depiction of the leg venous system than conventional venography.
- MR venography offers equivalent or superior diagnostic confidence for venous system evaluation in suspected PE.