MR-angiography in the diagnosis of pulmonary embolism
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The purpose of this article is to describe the role of 3 dimensional (3D), breath-hold, contrast enhanced magnetic resonance angiography (MRA) in the diagnosis of acute pulmonary embolism. In a volunteer study, two MRA techniques were adopted. One of which enabled acquisition of the pulmonary vasculature in 18 s. The other technique was coupled with a higher spatial resolution, leading to a scan time of 23 s. Additionally, the impact of breathing motion on vessel delineation was assessed. The breathheld 23 second scans revealed excellent image quality and near complete visualization of central and segmental, as well as 81 % of subsegmental, pulmonary arteries. Imaging time can be shortened to 18 seconds with only marginal loss in visualization performance (p < 0.05). Respiratory motion was found to cause significant worsening of image quality and vessel detectability. To maintain relevance in a clinical setting, imaging time can be minimized at the cost of a reduction in spatial resolution. According to data available from patient studies, the sensitivity, specificity, positive and negative predictive values of 3D MRA in comparison to conventional angiography amounts to 100,95,87, and 100 %, respectively.
However, breathhold duration and spatial resolution need further optimization if 3D MRA should replace conventional angiography as the gold standard in the future.
Conclusion: The preliminary experience suggest that gadoliniumenhanced, three dimensional, breathhold, magnetic resonance angiography shows promise as a safe, rapid, accurate and cost-effective imaging technique for the diagnosis of pulmonary embolism. In combination with its ability to perform deep venous studies and the potential aspect of MR-perfusion studies of the lung parenchyma, pulmonary MRA might in the future turn out to be the “one stop shop” for diagnosing pulmonary embolism.
Key wordsPulmonary magnetic resonance imaging 3 dimensional magnetic resonance angiography pulmonary embolism contrast enhanced magnetic resonance imaging
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- 2.Evans AJ, Sostman HD, Knelson MH, Spritzer CE, Newman GE, Paine SS, Beam CA (1993) Detection of deep venous thrombosis: prospective comparison of MR imaging with contrast venography. Amer J Roentgenol 161:131–140Google Scholar
- 5.Gefter WB, Hatabu H (1993) Evaluation of pulmonary vascular anatomy and blood flow by magnetic resonance. J Thorac Imaging 7:208–225Google Scholar
- 6.Goodman LR, Curtin JJ, Mewissen MW, Foley WD, Lipchik RJ, Crain MR, Sagar KB, Collies BD (1995) Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography. Amer J Roentgenol 164:1369–1374Google Scholar
- 8.Grist TM, Sproat IA, Kennel TW, Korosec FR, Swan JS (1996) MR angiography of the renal arteries during a breath-hold using gadolinium-enhanced 3D TOF with k-space zero-filling and a contrast timing scan (abstr.). In: Book of abstracts: Society of Magnetic Resonance in Medicine 1996. New York, NY: Society of Magnetic Resonance in Medicine, pp 163Google Scholar
- 9.Hany TF, Schmidt M, Steiner P, Debatin JF (in press) Optimization of contrast dosage for gadolinium-enhanced 3D MRA of the pulmonary and renal arteries. Magnetic Resonance ImagingGoogle Scholar
- 11.Kauzcor HU, Hofmann D, Kreitner KF, Nilgens H, Surkau R, Thelen M (1996) MR imaging assessment of pulmonary ventilation with inhalation of hyperpolarized He-3 gas: Work in progress. Radiology 201 (P):201Google Scholar
- 12.Korosec FR, Grist TM, Frayne R, Polacin JA, Mistretta CA (1996) Timeresolved contrast-enhanced 3D MR angiography (abstr.) In: Book of abstracts: Society of Magnetic Resonance in Medicine 1996. New York, NY: Society of Magnetic Resonance in Medicine, pp. 238Google Scholar
- 13.Leung DA, McKinnon GE, Davis CP, Pfammatter T, Krestin GP, Debatin JF (1996) Breath-hold, contrast enhanced, three dimensional MR angiography. Radiology 201:569–571Google Scholar
- 29.Wielopolski PA, Oudkerk M, De Bruin HG (1996) Three dimensional MR pulmonary perfusion imaging with Gadopentate Dimeglumine. Radiology 201 (P): 230Google Scholar