Pulmonary embolism MRI
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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 imaging (MRI) is a medical imaging modality that uses strong magnetic fields and radio waves to produce cross-sectional images of organs and internal structures in the body. Because the signal detected by an MRI machine varies depending on the water content and local magnetic properties of a particular area of the body, different tissues or structures can be distinguished from one another in the image that is produced. MRI produces a different level of imaging than can be obtained by a standard x-ray, ultrasound, or computed tomography (CT) exam. Magnetic resonance pulmonary angiography should be considered in the setting of a pulmonary embolism
1) Only at centers that routinely perform it well and
2) Only for patients for whom standard tests are contraindicated.
ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance[1] (DO NOT EDIT)
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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. |
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Magnetic Resonance Imaging
- Gadolinium-enhanced MRI is a non-invasive diagnostic modality that has the advantage of no contrast exposure.
- A study examined 30 patients with suspected PE via angiography and Magnetic Resonance Angigraphy (MRA).[2]
- 8 patients had + PA grams, and MRA identified all 5 lobar emboli, in addition to 16 of 17 segmental emboli.
- Another potential benefit of MR, is that is incredibly sensitive, perhaps even better than contrast venography, in imaging clot in the inferior vena cava (IVC) and pelvic veins, and these images can be obtained at the same time as the lung scan.
- Additionally, 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.
- A study examined 30 patients with suspected PE via angiography and Magnetic Resonance Angigraphy (MRA).[2]
- It needs to be pointed out, that although the criticism of using CT and MR angio lacks sensitivity when examining the subsegmental arteries, inter-reader agreement was only 66% with pulmonary angiography in PIOPED Study. However, the clinical significance of undetected subsegmental PE is uncertain because they rarely cause severe symptoms.[3]
- 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, but it is more difficult to obtain technically adequate images with the 2 procedures.[4]
- Technically adequate MRA has a sensitivity and specificity of 78% and 99% respectively.
References
- ↑ 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.
- ↑ 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) - ↑ 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.
- ↑ 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
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