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Magnetic resonance imaging evaluation of pulmonary vascular malformations
J M Silverman1, P J Julien, R J Herfkens
1Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, Calif 90048.
Objective:
The purpose of our study was to establish magnetic resonance imaging (MRI) criteria for the diagnosis of pulmonary vascular malformations (PVMs).
Materials And Methods:
Since 1987, 11 patients have been referred for chest MRI at our institution because of findings suggestive of a PVM. They were evaluated with a 1.5-T MRI system, incorporating a combination of spin-echo, gradient-recalled echo (GRE) cine, and 2-D phase contrast (PC) cine sequences. We used the following MRI criteria to diagnose PVM: (1) flow void or intermediate gray signal on spine-echo sequences; (2) bright signal on GRE cine sequences; and (3) bright signal consistent with flow detected on PC cine sequences using relatively low velocity ranges. Twelve patients not suspected of having a PVM served as controls; all had both MRI and pulmonary angiography to evaluate for central pulmonary embolus.
Results:
Eight patients in the study group had PVM as determined with MRI using these criteria. In four of these patients, a PVM was confirmed by subsequent pulmonary angiography. Three patients did not have PVM utilizing these criteria; two had neoplasms and one had presumed mucus plugging and/or atelectasis that resolved spontaneously. The smallest vascular malformation detected by MRI was 1 cm. None of the control patients had PVM by MRI or pulmonary angiography.
Conclusion:
Utilizing these criteria, we believe that MRI is potentially an excellent noninvasive modality to evaluate PVM, and we stress that some form of PC cine sequence must be performed to determine if indeed there is blood flow within a suspicious lesion.
Insights
Magnetic resonance imaging (MRI) criteria can effectively diagnose pulmonary vascular malformations (PVMs). Phase contrast cine sequences are crucial for confirming blood flow in suspicious lesions.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Pulmonary vascular malformations (PVMs) require accurate diagnostic methods.
- Established criteria for MRI diagnosis of PVMs are needed.
Purpose of the Study:
- To establish magnetic resonance imaging (MRI) criteria for diagnosing pulmonary vascular malformations (PVMs).
Main Methods:
- Evaluated 11 patients with suspected PVMs using a 1.5-T MRI system.
- Employed spin-echo, gradient-recalled echo (GRE) cine, and 2-D phase contrast (PC) cine sequences.
- Defined diagnostic criteria including signal characteristics on different sequences and flow detection on PC cine sequences.
Main Results:
- MRI criteria correctly identified PVM in 8 of 11 patients; 4 were confirmed by angiography.
- Three patients were correctly excluded from having PVMs (neoplasms, mucus plugging/atelectasis).
- The smallest detected PVM measured 1 cm; control group showed no PVMs.
Conclusions:
- MRI, with specific criteria, is a potentially excellent noninvasive tool for PVM evaluation.
- Phase contrast cine sequences are essential for detecting blood flow in suspected PVMs.