European Radiology

, Volume 15, Issue 9, pp 1969–1977 | Cite as

MRI for short-term follow-up of acute pulmonary embolism. Assessment of thrombus appearance and pulmonary perfusion: a feasibility study

  • Alexander Kluge
  • Tibo Gerriets
  • Uwe Lange
  • George Bachman
Chest

Abstract

Tha aim of this study was to demonstrate the feasibility of MRI for short-term follow-up examinations in patients with acute pulmonary embolism (PE), and to assess temporal changes of pulmonary perfusion and thrombus characteristics that may be helpful in determining thrombus age. Thirty-three patients (15 female, 18 male, mean age 59.4 years) with acute PE were examined initially and 1 week later using both 16-row computed tomography (CT) and MRI with magnetic resonance angiography (MRA), real-time MRI and magnetic resonance (MR) pulmonary perfusion imaging. MRA and MR pulmonary perfusion used contrast-enhanced 3D flash sequences, and real-time MRI used true fast imaging with steady-state precession sequences (repetition time/echo time 3.1/1.5, bandwidth 975 Hz, 256 matrix size, acquisition time 0.4 s per image) in three orthogonal planes. Follow-up examinations were feasible for all patients. Diagnosis of PE was concordant between MRI and CT in all patients. The signal intensity of embolic material increased after 1 week for real-time MRI [132±5 vs. 232±22 (standard error of the mean), p<0.001], but not significantly for MRA. MR pulmonary perfusion of areas affected by PE increased (area under the curve initially 9.6±7.4, at follow-up 40.7±7.6, p<0.001). A decreasing time-to-peak in normal lung areas (15.7±0.96 and 13.2±0.55, respectively, p<0.05) indicated systemic circulatory effects of PE, and subsiding pulmonary artery obstruction improved arterial inflow for the entire lung. Follow-up examinations of patients with acute PE are feasible with MRI, and a relation between thrombus appearance and thrombus age can be implied.

Keywords

Pulmonary embolism Magnetic resonance perfusion imaging Magnetic resonance angiography 

References

  1. 1.
    Schibany N, Fleischmann D, Thallinger C et al (2001) Equipment availability and diagnostic strategies for suspected pulmonary embolism in Austria. Eur Radiol 11:2287–2294CrossRefPubMedGoogle Scholar
  2. 2.
    Meaney JF, Weg JG, Chenevert TL, StaffordJohnson D, Hamilton BH, Prince MR (1997) Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med 336:1422–1427CrossRefPubMedGoogle Scholar
  3. 3.
    Gupta A, Frazer CK, Ferguson JM et al (1999) Acute pulmonary embolism: diagnosis with MR angiography. Radiology 210:353–359PubMedGoogle Scholar
  4. 4.
    Reittner P, Coxson HO, Nakano Y et al (2001) Pulmonary embolism: comparison of gadolinium-enhanced MR angiography with contrast-enhanced spiral Ct in a porcine model. Acad Radiol 8:343–350CrossRefPubMedGoogle Scholar
  5. 5.
    Oudkerk M, van Beek EJ, Wielopolski P et al (2002) Comparison of contrast-enhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: a prospective study. Lancet 359:1643–1647CrossRefPubMedGoogle Scholar
  6. 6.
    Van Beek EJ, Wild JM, Fink C, Moody AR, Kauczor HU, Oudkerk M (2003) MRI for the diagnosis of pulmonary embolism. J Magn Reson Imaging 18:627–640CrossRefPubMedGoogle Scholar
  7. 7.
    Amundsen T, Kvaerness J, Jones RA et al (1997) Pulmonary embolism: detection with MR perfusion imaging of lung—a feasibility study. Radiology 203:181–185PubMedGoogle Scholar
  8. 8.
    Matsuoka S, Uchiyama K, Shima H et al (2001) Detectability of pulmonary perfusion defect and influence of breath holding on contrast-enhanced thick-slice 2d and on 3d MR pulmonary perfusion images. J Magn Reson Imaging 14:580–585CrossRefPubMedGoogle Scholar
  9. 9.
    Amundsen T, Torheim G, Kvistad KA et al (2002) Perfusion abnormalities in pulmonary embolism studied with perfusion mri and ventilation-perfusion scintigraphy: an intra-modality and inter-modality agreement study. J Magn Reson Imaging 15:386–394CrossRefPubMedGoogle Scholar
  10. 10.
    Ohno Y, Higashino T, Takenaka D et al (2004) Mr angiography with sensitivity encoding (sense) for suspected pulmonary embolism: comparison with mdct and ventilation-perfusion scintigraphy. Am J Roentgenol 183:91–98Google Scholar
  11. 11.
    Kluge A, Mueller C, Hansel J, Gerriets T, Bachmann G (2004) Real time MR with Truefisp for the detection of acute pulmonary embolism: initial clinical experience. Eur Radiol 14:709–718CrossRefPubMedGoogle Scholar
  12. 12.
    Haage P, Piroth W, Krombach G et al (2003) Pulmonary embolism: comparison of angiography with spiral computed tomography, magnetic resonance angiography, and real-time magnetic resonance imaging. Am J Respir Crit Care Med 167:729–34CrossRefPubMedGoogle Scholar
  13. 13.
    Remy-Jardin M, Louvegny S, Remy J et al (1997) Acute central thromboembolic disease: posttherapeutic follow-up with spiral CT angiography. Radiology 203:173–180PubMedGoogle Scholar
  14. 14.
    Mastora I, Remy-Jardin M, Masson P et al (2003) Severity of acute pulmonary embolism: evaluation of a new spiral CT angiographic score in correlation with echocardiographic data. Eur Radiol 13:29–35PubMedGoogle Scholar
  15. 15.
    Kluge A, Dill T, Ekinci O et al (2004) Decreased pulmonary perfusion in pulmonary vein stenosis after radio-frequency ablation: assessment with dynamic MR perfusion imaging. Chest 126:428–437CrossRefPubMedGoogle Scholar
  16. 16.
    Diederich S (2003) Radiation dose in helical CT for detection of pulmonary embolism. Eur Radiol 13:1491–1493CrossRefPubMedGoogle Scholar
  17. 17.
    Fuchs F, Laub G, Othomo K (2003) Truefisp—technical considerations and cardiovascular applications. Eur J Radiol 46:28–32CrossRefPubMedGoogle Scholar
  18. 18.
    Wagenvoort CA (1995) Pathology of pulmonary thromboembolism. Chest 107:10S–17SPubMedGoogle Scholar
  19. 19.
    Qanadli SD, El Hajjam M, Vieillard-Baron A et al (2001) New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. Am J Roentgenol 176:1415–1420Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Alexander Kluge
    • 1
  • Tibo Gerriets
    • 1
  • Uwe Lange
    • 1
    • 2
  • George Bachman
    • 1
  1. 1.Department of Diagnostic RadiologyKerckhoff Heart CenterBad NauheimGermany
  2. 2.Department of RheumatologyKerckhoff Heart CenterBad NauheimGermany

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