Pulmonary embolism MRI: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
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| [[File:Siren.gif|30px|link=Pulmonary embolism resident survival guide]]|| <br> || <br> | |||
| [[Pulmonary embolism resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
|} | |||
{{Pulmonary embolism}} | {{Pulmonary embolism}} | ||
'''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto: | '''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; {{AE}} {{CZ}} | ||
==Overview== | ==Overview== | ||
Magnetic resonance pulmonary angiography should be considered in the setting of a pulmonary embolism only at centers that routinely perform it well and only for patients for whom standard tests are contraindicated. MRA has a sensitivity and specificity of | Magnetic resonance pulmonary angiography should be considered in the setting of a pulmonary embolism only at centers that routinely perform it well and only for patients for whom standard tests are contraindicated. MRA has a sensitivity and specificity of a range of 75-100% and 95-100%, respectively.<ref name="pmid9145679">{{cite journal |author=Meaney JF, Weg JG, Chenevert TL, Stafford-Johnson D, Hamilton BH, Prince MR |title=Diagnosis of pulmonary embolism with magnetic resonance angiography |journal=N. Engl. J. Med. |volume=336 |issue=20 |pages=1422–7 |year=1997 |month=May |pmid=9145679 |doi=10.1056/NEJM199705153362004 |url=http://dx.doi.org/10.1056/NEJM199705153362004 |accessdate=2011-12-14}}</ref> | ||
== | == MRI == | ||
=== Advantages === | |||
= | |||
*Non-invasive | *Non-invasive | ||
*No contrast exposure | *No contrast exposure | ||
*Sensitive in the detection of clot in the inferior vena cava (IVC) and pelvic veins | *Sensitive in the detection of clot in the inferior vena cava (IVC) and pelvic veins | ||
*Although MR is more expensive than V/Q scanning, when one takes into account the high number of indeterminate findings on V/Q, the effective cost per diagnosis may be cheaper with MR. | *Although MR is more expensive than V/Q scanning, when one takes into account the high number of indeterminate findings on V/Q, the effective cost per diagnosis may be cheaper with MR. | ||
* Magnetic resonance pulmonary angiography and magnetic resonance venography combined have a higher sensitivity than magnetic resonance pulmonary angiography alone in patients with technically adequate images. <ref name="pmid20368649">{{cite journal |author=Stein PD, Chenevert TL, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Jablonski KA, Leeper KV, Naidich DP, Sak DJ, Sostman HD, Tapson VF, Weg JG, Woodard PK |title=Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III) |journal=Ann. Intern. Med. |volume=152 |issue=7 |pages=434–43, W142–3 |year=2010 |month=April |pmid=20368649 |pmc=3138428 |doi=10.1059/0003-4819-152-7-201004060-00008 |url= |accessdate=2012-01-10}}</ref> | * Magnetic resonance pulmonary angiography and magnetic resonance venography combined have a higher sensitivity than magnetic resonance pulmonary angiography alone in patients with technically adequate images. <ref name="pmid20368649">{{cite journal |author=Stein PD, Chenevert TL, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Jablonski KA, Leeper KV, Naidich DP, Sak DJ, Sostman HD, Tapson VF, Weg JG, Woodard PK |title=Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III) |journal=Ann. Intern. Med. |volume=152 |issue=7 |pages=434–43, W142–3 |year=2010 |month=April |pmid=20368649 |pmc=3138428 |doi=10.1059/0003-4819-152-7-201004060-00008 |url= |accessdate=2012-01-10}}</ref> | ||
==Disadvantages== | === Disadvantages === | ||
* Although the criticism of using CT and MR angiography is that it lacks sensitivity when examining the subsegmental arteries, inter-reader agreement was only 66% with pulmonary angiography in the PIOPED Study. However, the clinical significance of undetected subsegmental PE is uncertain because they rarely cause severe symptoms.<ref name="pmid8297195">{{cite journal| author=Hull RD, Raskob GE, Ginsberg JS, Panju AA, Brill-Edwards P, Coates G et al.| title=A noninvasive strategy for the treatment of patients with suspected pulmonary embolism. | journal=Arch Intern Med | year= 1994 | volume= 154 | issue= 3 | pages= 289-97 | pmid=8297195 | doi= | pmc= | url= }} </ref> | * Although the criticism of using CT and MR angiography is that it lacks sensitivity when examining the subsegmental arteries, inter-reader agreement was only 66% with pulmonary angiography in the PIOPED Study. However, the clinical significance of undetected subsegmental PE is uncertain because they rarely cause severe symptoms.<ref name="pmid8297195">{{cite journal| author=Hull RD, Raskob GE, Ginsberg JS, Panju AA, Brill-Edwards P, Coates G et al.| title=A noninvasive strategy for the treatment of patients with suspected pulmonary embolism. | journal=Arch Intern Med | year= 1994 | volume= 154 | issue= 3 | pages= 289-97 | pmid=8297195 | doi= | pmc= | url= }} </ref> | ||
==ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance (DO NOT EDIT)<ref name="pmid20479157">{{cite journal| author=American College of Cardiology Foundation Task Force on Expert Consensus Documents. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA et al.| title=ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. | journal=Circulation | year= 2010 | volume= 121 | issue= 22 | pages= 2462-508 | pmid=20479157 | doi=10.1161/CIR.0b013e3181d44a8f | pmc=PMC3034132 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20479157 }} </ref>== | |||
{{cquote| | |||
CE-MRA may be used in patients with a strong suspicion of pulmonary embolism in whom the results of other tests are equivocal or for | |||
whom iodinated contrast material or ionizing radiation are relatively contraindicated. The writing committee agrees that data in the literature are insufficient to recommend where pulmonary CE-MRA should fit into a diagnostic pathway for pulmonary embolism. | |||
}} | |||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
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[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
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Latest revision as of 23:53, 29 July 2020
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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Magnetic resonance pulmonary angiography should be considered in the setting of a pulmonary embolism only at centers that routinely perform it well and only for patients for whom standard tests are contraindicated. MRA has a sensitivity and specificity of a range of 75-100% and 95-100%, respectively.[1]
MRI
Advantages
- Non-invasive
- No contrast exposure
- Sensitive in the detection of clot in the inferior vena cava (IVC) and pelvic veins
- Although MR is more expensive than V/Q scanning, when one takes into account the high number of indeterminate findings on V/Q, the effective cost per diagnosis may be cheaper with MR.
- Magnetic resonance pulmonary angiography and magnetic resonance venography combined have a higher sensitivity than magnetic resonance pulmonary angiography alone in patients with technically adequate images. [2]
Disadvantages
- Although the criticism of using CT and MR angiography is that it lacks sensitivity when examining the subsegmental arteries, inter-reader agreement was only 66% with pulmonary angiography in the PIOPED Study. However, the clinical significance of undetected subsegmental PE is uncertain because they rarely cause severe symptoms.[3]
ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance (DO NOT EDIT)[4]
| “ |
CE-MRA may be used in patients with a strong suspicion of pulmonary embolism in whom the results of other tests are equivocal or for whom iodinated contrast material or ionizing radiation are relatively contraindicated. The writing committee agrees that data in the literature are insufficient to recommend where pulmonary CE-MRA should fit into a diagnostic pathway for pulmonary embolism. |
” |
References
- ↑ Meaney JF, Weg JG, Chenevert TL, Stafford-Johnson D, Hamilton BH, Prince MR (1997). "Diagnosis of pulmonary embolism with magnetic resonance angiography". N. Engl. J. Med. 336 (20): 1422–7. doi:10.1056/NEJM199705153362004. PMID 9145679. Retrieved 2011-12-14. Unknown parameter
|month=ignored (help) - ↑ Stein PD, Chenevert TL, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Jablonski KA, Leeper KV, Naidich DP, Sak DJ, Sostman HD, Tapson VF, Weg JG, Woodard PK (2010). "Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III)". Ann. Intern. Med. 152 (7): 434–43, W142–3. doi:10.1059/0003-4819-152-7-201004060-00008. PMC 3138428. PMID 20368649. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Hull RD, Raskob GE, Ginsberg JS, Panju AA, Brill-Edwards P, Coates G; et al. (1994). "A noninvasive strategy for the treatment of patients with suspected pulmonary embolism". Arch Intern Med. 154 (3): 289–97. PMID 8297195.
- ↑ American College of Cardiology Foundation Task Force on Expert Consensus Documents. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA; et al. (2010). "ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents". Circulation. 121 (22): 2462–508. doi:10.1161/CIR.0b013e3181d44a8f. PMC 3034132. PMID 20479157.