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Suspected pulmonary embolism: prospective evaluation with pulmonary MR angiography
M L Schiebler1, G A Holland, H Hatabu
1Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia.
Purpose:
To prospectively evaluate three magnetic resonance (MR) imaging techniques for detection of pulmonary embolism.
Materials And Methods:
Eighteen patients in whom the presence of acute or chronic pulmonary emboli was suspected underwent examination with the following pulse sequences: cardiac-gated spin echo, cine spatial modulation of magnetization, and two-dimensional time-of-flight pulmonary breath-hold (PBH) MR angiography. Three radiologists independently and blindly reviewed each case and graded a total of 518 arterial segments for each pulse sequence with a continuous scale of 0%-100% for likelihood of pulmonary embolism.
Results:
The overall sensitivity of PBH MR angiography for detection of acute pulmonary emboli was 0.85; for chronic emboli, which were smaller in anteroposterior (AP) diameter, the overall sensitivity was 0.42. Emboli larger than 1 cm in AP diameter were typically identified with > 75% confidence with all pulse sequences.
Conclusion:
Acute pulmonary emboli greater than 1 cm in AP diameter were as accurately identified on PBH MR angiograms obtained in 15 seconds as they were on MR images obtained with longer pulse sequences not dependent on breath holding.
Insights
Pulmonary embolism detection using magnetic resonance (MR) angiography showed high sensitivity for acute clots. Breath-hold MR angiography is effective for identifying acute pulmonary emboli larger than 1 cm.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Pulmonary Medicine
Background:
- Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
- Accurate and timely diagnosis of PE is crucial for effective treatment.
- Magnetic resonance (MR) imaging offers non-invasive visualization of pulmonary vasculature.
Purpose of the Study:
- To prospectively compare three MR imaging techniques for pulmonary embolism detection.
- To evaluate the sensitivity and accuracy of different MR pulse sequences in identifying acute and chronic PE.
Main Methods:
- Eighteen patients with suspected pulmonary embolism underwent MR imaging.
- Three pulse sequences were evaluated: cardiac-gated spin echo, cine spatial modulation of magnetization, and 2D time-of-flight pulmonary breath-hold (PBH) MR angiography.
- Radiologists independently assessed 518 arterial segments for PE likelihood.
Main Results:
- PBH MR angiography demonstrated an overall sensitivity of 0.85 for acute PE.
- Sensitivity for chronic PE was lower at 0.42, likely due to smaller clot size.
- Emboli >1 cm in anteroposterior diameter were confidently identified (>75%) across all sequences.
Conclusions:
- Acute pulmonary emboli >1 cm were accurately detected with 15-second PBH MR angiography.
- PBH MR angiography is a viable technique for identifying acute PE, comparable to longer, non-breath-hold sequences.