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Clinical outcomes after magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) for pulmonary embolism evaluation

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Abstract

Purpose

To compare patient outcomes following magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) ordered for suspected pulmonary embolism (PE).

Methods

In this IRB-approved, single-center, retrospective, case-control study, we reviewed the medical records of all patients evaluated for PE with MRA during a 5-year period along with age- and sex-matched controls evaluated with CTA. Only the first instance of PE evaluation during the study period was included. After application of our exclusion criteria to both study arms, the analysis included 1173 subjects. The primary endpoint was major adverse PE-related event (MAPE), which we defined as major bleeding, venous thromboembolism, or death during the 6 months following the index imaging test (MRA or CTA), obtained through medical record review. Logistic regression, chi-square test for independence, and Fisher’s exact test were used with a p < 0.05 threshold.

Results

The overall 6-month MAPE rate following MRA (5.4%) was lower than following CTA (13.6%, p < 0.01). Amongst outpatients, the MAPE rate was lower for MRA (3.7%) than for CTA (8.0%, p = 0.01). Accounting for age, sex, referral source, BMI, and Wells’ score, patients were less likely to suffer MAPE than those who underwent CTA, with an odds ratio of 0.44 [0.24, 0.80]. Technical success rate did not differ significantly between MRA (92.6%) and CTA (90.5%) groups (p = 0.41).

Conclusion

Within the inherent limitations of a retrospective case-controlled analysis, we observed that the rate of MAPE was lower (more favorable) for patients following pulmonary MRA for the primary evaluation of suspected PE than following CTA.

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Acknowledgements

We are very appreciative of the support of Azita Hamedani, MD, MPH. As chair of the Department of Emergency Medicine, she has provided important input necessary for successful implementation of this clinical program for patients presenting to the Emergency Department. Also, Karl Vigen, PhD has provided MRI medical physics support. Finally, we very much appreciate early discussions on the study design with Alejandro Munoz del Rio, PhD. The University of Wisconsin Department of Radiology also wishes to acknowledge research support from GE Healthcare and Bracco Diagnostics.

Funding

This study received support from the NIH, including the National Center for Advancing Translational Sciences grants UL1 TR000427 and KL2 TR000428 and the National Institute of Diabetes and Digestive and Kidney Diseases grants K08 DK111234 and K24 DK102595. The study also benefited from the University of Wisconsin - Madison’s Department of Radiology Research and Development Fund. None of the funding sources were involved in any component of the conduct, analysis, or reporting of this study.

Author information

Author notes

  1. Michael D. Repplinger and Scott K. Nagle contributed equally to this work.

Authors and Affiliations

  1. BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, 800 University Bay Drive, Suite 310, Mail Code 9123, Madison, WI, 53705, USA

    Michael D. Repplinger, John B. Harringa, Christopher J. François & Scott B. Reeder

  2. Department of Radiology, University of Wisconsin, Madison, WI, USA

    Michael D. Repplinger, Scott K. Nagle, Thomas M. Grist, Scott B. Reeder & Mark L. Schiebler

  3. Department of Medical Physics, University of Wisconsin, Madison, WI, USA

    Scott K. Nagle, Thomas M. Grist & Scott B. Reeder

  4. Department of Pediatrics, University of Wisconsin, Madison, WI, USA

    Scott K. Nagle & Scott B. Reeder

  5. School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    John B. Harringa

  6. Department of Biostatistics, University of Wisconsin, Madison, WI, USA

    Aimee T. Broman

  7. Department of Medicine, Dartmouth University, Geisel School of Medicine, Hanover, NH, USA

    Christopher R. Lindholm

  8. Department of Medicine, University of Wisconsin, Madison, WI, USA

    Christopher J. François & Scott B. Reeder

  9. Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA

    Thomas M. Grist & Scott B. Reeder

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  1. Michael D. Repplinger
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  2. Scott K. Nagle
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  9. Mark L. Schiebler
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Corresponding author

Correspondence to Michael D. Repplinger.

Ethics declarations

This study was approved by the University of Wisconsin Health Sciences Institutional Review Board and adhered to regulations as outlined in the Health Insurance Portability and Accountability Act.

Conflict of interest

The University of Wisconsin - Madison Department of Radiology receives research support from GE Healthcare and Bracco Diagnostics. Scott B. Reeder, MD, PhD has the following financial disclosures: Co-founder of Calimetrix; shareholder, Cellectar Biosciences and Elucent Medical; consultant for Parexel International. The other authors declare that they have no conflicts of interest.

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Repplinger, M.D., Nagle, S.K., Harringa, J.B. et al. Clinical outcomes after magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) for pulmonary embolism evaluation. Emerg Radiol 25, 469–477 (2018). https://doi.org/10.1007/s10140-018-1609-8

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