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MR-angiography in the diagnosis of pulmonary embolism

  • P. Steiner
  • T. H. Hany
  • G. McKinnon
  • F. Follath
  • J. F. Debatin
Chapter
  • 87 Downloads

Summary

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 words

Pulmonary magnetic resonance imaging 3 dimensional magnetic resonance angiography pulmonary embolism contrast enhanced magnetic resonance imaging 

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References

  1. 1.
    Come PC (1992) Echocardiographic evaluation of pulmonary embolism and its response to therapeutic interventions. Chest 101:151S–162SPubMedGoogle Scholar
  2. 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
  3. 3.
    Franck A, Selby K, van Tyen R, Nordell B, Saloner D (1995) Cardiac-gated MR angiography of pulsatile flow: k-space strategies. J Magn Reson Imag 5:297–307CrossRefGoogle Scholar
  4. 4.
    Foo KF, MacFall JR, Sostman HD, Hayes CE (1993) Single-breath-hold venous or arterial flow-suppressed pulmonary vascular MR imaging with phased-array coils. J Magn Reson Imag 3:611–616CrossRefGoogle Scholar
  5. 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. 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
  7. 7.
    Grist TM, Sostman HD, MacFall JR, Foo TKF, Spritzer OE, Witty L, Newman GE, Debatin JF, Tapson V, Saltzman HA (1993) Pulmonary angiography with MR imaging: Preliminary clinical experience. Radiology 189:523–530PubMedGoogle Scholar
  8. 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. 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
  10. 10.
    Hatabu H, Gefter WB, Axel L, Palevsky HI, Cope C, Reichek N, Dougherty L, Listernd J, Kressel HY (1994) MR imaging with spatial modulation of magnetization in the evaluation of chronic central pulmonary thrombemboli. Radiology 190:791–796PubMedGoogle Scholar
  11. 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. 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. 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
  14. 14.
    Lin W, Haacke EM, Masaryk TJ, Smith AS (1992) Automated local maximumintensity projection with three-dimensional vessel tracking. J Magn Reson Imag 2:519–526CrossRefGoogle Scholar
  15. 15.
    Meaney JFM, Weg JG, Chenevert TL, Stafford-Jonson D, Hamilton BH, Prince MR (1997) Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med 336:1422–1427PubMedCrossRefGoogle Scholar
  16. 16.
    PIOPED investigators: Value of ventilation/perfusion scan in acute pulmonary embolism. J Amer Med Assoc 1990; 263:2753–2759CrossRefGoogle Scholar
  17. 17.
    Prince MR (1994) Gadolinium-enhanced MR aortography. Radiology 191:155–164PubMedGoogle Scholar
  18. 18.
    Prince MR, Narasimham DL, Stanley JC, Chenevert TL, Williams DM, Marx MV, Cho KJ (1995) Breath-hold gadolinium enhanced MR arteriography of the abdominal aorta and its major branches. Radiology 197:785–792PubMedGoogle Scholar
  19. 19.
    Prince MR, Yucel EK, Kaufmann JA, Harrison DC, Geller SC (1993) Dynamic gadolinium-enhanced three dimensional abdominal MR arteriography. JMRI 3:877–881PubMedCrossRefGoogle Scholar
  20. 20.
    Remy-Jardin M, Remy J, Wattinne L, Giraud F (1992) Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single breathhold technique — comparison with pulmonary angiography. Radiology 185:381–387PubMedGoogle Scholar
  21. 21.
    Royal HD (1989) Radionuclide imaging of the lung. Curr Opin Radiol 1:446–459PubMedGoogle Scholar
  22. 22.
    Sostman HD, Debatin JF, Spritzer CE, Coleman RE, Grist TM, MacFall JR (1993) MRI in venous thromboembolic disease. Eur Radiol 3:53–61CrossRefGoogle Scholar
  23. 23.
    Stein PD, Athanasoulis C, Alavi A et al. (1992) Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation 85:462–468PubMedGoogle Scholar
  24. 24.
    Steiner P, McKinnon GC, Romanowski B, Goehde SC, Hany T, Debatin JF (1997) Contrast-enhanced, ultra-fast 3D pulmonary MR angiography in a single breath-hold: Initial assessment of imaging perfomance. JMRI 7:177–182PubMedCrossRefGoogle Scholar
  25. 25.
    Stewart JR, Greenfield LJ (1982) Transvenous vena caval filtration and pulmonary embolectomy. Surg Clin North Am 62:411–430PubMedGoogle Scholar
  26. 26.
    Teigen CL, Maus TP, Sheedy PF, Stanson AW, Johnson CM, Breen JF, McKusick MA (1995) Pulmonary embolism: Diagnosis with contrastenhanced electron-beam CT and comparison with pulmonary angiography. Radiology 194:313–319PubMedGoogle Scholar
  27. 27.
    Wang Y, Rossman PJ, Grimm RC, Riederer SJ, Ehman RL (1996) Navigator-echo-based real-time respiratory gating and triggering for reduction of respiration effects in three-dimensional coronary MR angiography. Radiology 198:55–60PubMedGoogle Scholar
  28. 28.
    Wielopolski PA, Haacke EM, Adler LP (1992) Three dimensional MR pulmonary vascular imaging: preliminary experience. Radiology 183:465–472PubMedGoogle Scholar
  29. 29.
    Wielopolski PA, Oudkerk M, De Bruin HG (1996) Three dimensional MR pulmonary perfusion imaging with Gadopentate Dimeglumine. Radiology 201 (P): 230Google Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt 2000

Authors and Affiliations

  • P. Steiner
    • 3
  • T. H. Hany
    • 1
  • G. McKinnon
    • 1
  • F. Follath
    • 2
  • J. F. Debatin
    • 1
  1. 1.MR-Center, Department of Diagnostic RadiologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of Internal MedicineUniversity Hospital ZurichZurichSwitzerland
  3. 3.Department of Diagnostic RadiologyUniversity Hospital HamburgHamburgGermany

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