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Updated: May 14, 2026
Phase-Resolved Functional Lung MRI for Pulmonary Ventilation and Perfusion (V/Q) Assessment
Published on: August 9, 2024
3D contrast-enhanced lung perfusion MRI is an effective screening tool for chronic thromboembolic pulmonary
Smitha Rajaram1, Andrew J Swift, Adam Telfer
1Academic Unit of Radiology, University of Sheffield, Sheffield, UK.
Insights
Lung perfusion MRI is a highly sensitive and specific imaging tool for diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). This radiation-free MRI offers an attractive alternative to scintigraphy for initial CTEPH assessment.
Area of Science:
- Cardiovascular Imaging
- Pulmonary Hypertension Diagnostics
- Medical Physics
Background:
- Chronic thromboembolic pulmonary hypertension (CTEPH) is a surgically curable complication of pulmonary embolism.
- Perfusion scintigraphy is the current standard for CTEPH exclusion due to high sensitivity.
- Lung perfusion MRI's diagnostic utility for CTEPH requires evaluation.
Discussion:
- Lung perfusion MRI demonstrates high sensitivity (97%) and specificity (92%) in diagnosing CTEPH.
- Performance of lung perfusion MRI is comparable to perfusion scintigraphy and CT pulmonary angiography (CTPA).
- No surgically accessible CTEPH cases were missed by lung perfusion MRI or scintigraphy.
Key Insights:
- Lung perfusion MRI offers diagnostic accuracy equivalent to perfusion scintigraphy for CTEPH.
- Lung perfusion MRI avoids ionizing radiation, a significant advantage over scintigraphy.
- Lung perfusion MRI is a viable and attractive initial imaging modality for suspected CTEPH.
Outlook:
- Further research could explore the integration of lung perfusion MRI into clinical guidelines.
- Long-term outcomes and cost-effectiveness of lung perfusion MRI for CTEPH screening warrant investigation.
- Advancements in MRI technology may further enhance its role in diagnosing pulmonary vascular diseases.
Background:
Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism potentially curable by surgery. Perfusion scintigraphy is currently advocated as the imaging modality of choice to exclude CTEPH due to its high sensitivity. We have evaluated the diagnostic utility of lung perfusion MRI.
Methods:
Consecutive patients attending a pulmonary hypertension referral centre undergoing lung perfusion MRI, perfusion scintigraphy, CT pulmonary angiography (CTPA) and right heart catheterisation within 14 days were identified.
Results:
Of 132 patients, 78 were diagnosed as having CTEPH. Lung perfusion MRI correctly identified 76 patients as having CTEPH with an overall sensitivity of 97%, specificity 92%, positive predictive value 95% and negative predictive value 96% compared with perfusion scintigraphy (sensitivity 96%, specificity 90%) and CTPA (sensitivity 94%, specificity 98%). No cases of surgically accessible CTEPH were missed with either modality.
Conclusions:
Lung perfusion MRI has high sensitivity equivalent to perfusion scintigraphy in diagnosing CTEPH but does not require ionising radiation, making it an attractive initial imaging modality to assess patients with suspected CTEPH.
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