Clinical outcomes after magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) for
Michael D Repplinger1,2, Scott K Nagle3,4,5, John B Harringa6,7
1BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, 800 University Bay Drive, Suite 310, Mail Code 9123, Madison, WI, 53705, USA. mdrepplinger@wisc.edu.
Purpose:
To compare patient outcomes following magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) ordered for suspected pulmonary embolism (PE).
Methods:
In this IRB-approved, single-center, retrospective, case-control study, we reviewed the medical records of all patients evaluated for PE with MRA during a 5-year period along with age- and sex-matched controls evaluated with CTA. Only the first instance of PE evaluation during the study period was included. After application of our exclusion criteria to both study arms, the analysis included 1173 subjects. The primary endpoint was major adverse PE-related event (MAPE), which we defined as major bleeding, venous thromboembolism, or death during the 6 months following the index imaging test (MRA or CTA), obtained through medical record review. Logistic regression, chi-square test for independence, and Fisher's exact test were used with a p < 0.05 threshold.
Results:
The overall 6-month MAPE rate following MRA (5.4%) was lower than following CTA (13.6%, p < 0.01). Amongst outpatients, the MAPE rate was lower for MRA (3.7%) than for CTA (8.0%, p = 0.01). Accounting for age, sex, referral source, BMI, and Wells' score, patients were less likely to suffer MAPE than those who underwent CTA, with an odds ratio of 0.44 [0.24, 0.80]. Technical success rate did not differ significantly between MRA (92.6%) and CTA (90.5%) groups (p = 0.41).
Conclusion:
Within the inherent limitations of a retrospective case-controlled analysis, we observed that the rate of MAPE was lower (more favorable) for patients following pulmonary MRA for the primary evaluation of suspected PE than following CTA.
Insights
Magnetic resonance angiography (MRA) showed a lower rate of major adverse PE-related events than computed tomographic angiography (CTA) for diagnosing pulmonary embolism. This suggests MRA may offer a safer alternative for patients suspected of having PE.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Pulmonary Embolism Diagnosis
Background:
- Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
- Accurate and timely diagnosis of PE is crucial for effective patient management.
- Both computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) are used to evaluate for PE.
Purpose of the Study:
- To compare patient outcomes after magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) for suspected pulmonary embolism (PE).
- To determine if one imaging modality is associated with a lower incidence of major adverse PE-related events (MAPE).
Main Methods:
- Retrospective, case-control study of 1173 patients evaluated for PE using MRA or CTA.
- Primary endpoint: 6-month MAPE rate (major bleeding, venous thromboembolism, or death) following index imaging.
- Analysis included logistic regression and chi-square tests to compare outcomes between MRA and CTA groups.
Main Results:
- The 6-month MAPE rate was significantly lower following MRA (5.4%) compared to CTA (13.6%, p<0.01).
- Outpatients showed a lower MAPE rate with MRA (3.7%) versus CTA (8.0%, p=0.01).
- Adjusted analysis indicated patients undergoing MRA were less likely to experience MAPE (OR 0.44 [0.24, 0.80]).
Conclusions:
- Magnetic resonance angiography (MRA) is associated with a more favorable rate of major adverse PE-related events compared to computed tomographic angiography (CTA) for the initial evaluation of suspected pulmonary embolism.
- These findings, within the limitations of a retrospective study, suggest MRA may be a safer imaging choice for PE diagnosis.
- Technical success rates for both MRA and CTA were comparable.
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