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European Radiology

, Volume 22, Issue 2, pp 310–317 | Cite as

Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension

  • Smitha Rajaram
  • Andrew J. Swift
  • David Capener
  • Adam Telfer
  • Christine Davies
  • Catherine Hill
  • Robin Condliffe
  • Charles Elliot
  • Judith Hurdman
  • David G. Kiely
  • Jim M. Wild
Magnetic Resonance

Abstract

Objective

To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) and the added benefit of unenhanced proton MR angiography compared with CT pulmonary angiography (CTPA) in patients with chronic thromboembolic disease (CTE).

Methods

A 2 year retrospective study of 53 patients with chronic thromboembolic pulmonary hypertension who underwent CTPA and MRI for suspected pulmonary hypertension and a control group of 36 patients with no CT evidence of pulmonary embolism. The MRI was evaluated for CTE and the combined diagnostic accuracy of ce-MRA and unenhanced proton MRA was determined. CE-MRA generated lung perfusion maps were also assessed.

Results

The overall sensitivity and specificity of CE-MRA in diagnosing proximal and distal CTE were 98% and 94%, respectively. The sensitivity improved from 50% to 88% for central vessel disease when CE-MRA images were analysed with unenhanced proton MRA. The CE-MRA identified more stenoses (29/18), post-stenosis dilatation (23/7) and occlusions (37/29) compared with CTPA. The CE-MRA perfusion images showed a sensitivity of 92% for diagnosing CTE.

Conclusion

CE-MRA has high sensitivity and specificity for diagnosing CTE. The sensitivity of CE-MRA for visualisation of adherent central and lobar thrombus significantly improves with the addition of unenhanced proton MRA which delineates the vessel wall.

Keywords

Chronic thromboembolic pulmonary hypertension Pulmonary embolism Contrast-enhanced MR angiography Non-contrast-enhanced proton MR angiography Pulmonary hypertension 

Notes

Acknowledgements

The authors S.R. and D.C. are funded by Pfizer and Bayer respectively through unrestricted research grants. The UK EPSRC (J.M.W.) and the Sheffield Cardio Vascular Biomedical Research Unit (A.J.S.).

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Copyright information

© European Society of Radiology 2011

Authors and Affiliations

  • Smitha Rajaram
    • 1
    • 5
  • Andrew J. Swift
    • 1
    • 4
  • David Capener
    • 1
  • Adam Telfer
    • 1
  • Christine Davies
    • 3
  • Catherine Hill
    • 3
  • Robin Condliffe
    • 2
    • 4
  • Charles Elliot
    • 2
    • 4
  • Judith Hurdman
    • 2
  • David G. Kiely
    • 2
    • 4
  • Jim M. Wild
    • 1
    • 4
  1. 1.Unit of Academic Radiology, University of SheffieldSheffieldUK
  2. 2.Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
  3. 3.Department of RadiologySheffield Teaching Hospitals TrustSheffieldUK
  4. 4.Sheffield Cardiovascular Biomedical Research UnitSheffieldUK
  5. 5.Academic Unit of Radiology, C Floor, Royal Hallamshire HospitalSheffieldUK

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