Contrast-enhanced pulmonary MRA for the primary diagnosis of pulmonary embolism: current state of the art and future directions

Abstract

CT pulmonary angiography (CTPA) is currently considered the imaging standard of care for the diagnosis of pulmonary embolism (PE). Recent advances in contrast-enhanced pulmonary MR angiography (MRA) techniques have led to increased use of this modality for the detection of PE in the proper clinical setting. This review is intended to provide an introduction to the state-of-the-art techniques used in pulmonary MRA for the detection of PE and to discuss possible future directions for this modality. This review discusses the following issues pertinent to MRA for the diagnosis of PE: (1) the diagnostic efficacy and clinical effectiveness for pulmonary MRA relative to CTPA, (2) the different pulmonary MRA techniques used for the detection of PE, (3) guidance for building a clinical service at their institution using MRA and (4) future directions of PE MRA. Our principal aim was to show how pulmonary MRA can be used as a safe, effective modality for the diagnosis of clinically significant PE, particularly for those patients where there are concerns about ionizing radiation or contraindications/allergies to the iodinated contrast material.

Diagnostic performance of contrast-enhanced and unenhanced combined pulmonary artery MRI and magnetic resonance venography techniques in the diagnosis of venous thromboembolism

“…Motion artifacts due to the heart beat and respiration and inadequate contrast were the leading causes of false positivity. 34 The use of cardiac and respiratory gating could have minimized the motion artifacts and decreased false-positive rate.…”

Magnetic Resonance Imaging as an Alternative to Contrast‐Enhanced Computed Tomography to Mitigate Iodinated Contrast Shortages in the United States: Recommendations From the International Society for Magnetic Resonance in Medicine

“…NCE‐MRI for evaluation of vertebral fracture and suspected compressive myelopathy 5 GBCA‐enhanced or NCE‐MRA of the thoracic aorta, abdominal aorta and its branches, including indications such as acute and chronic aortopathy, aneurysmal disease, and suspected acute aortic syndrome in a patient who is hemodynamically stable, 6 among others. GBCA‐enhanced or NCE‐MRA for acute or chronic aortic/iliac/femoral occlusive disease, that is, runoff, as an alternative to CTA of the lower extremities 7 GBCA‐enhanced MRA of the chest for the diagnosis of pulmonary embolus as an alternative to CTA 8 …”

Acute pulmonary embolism multimodality imaging prior to endovascular therapy

“…Pregnant or young patients may benefit from MRA instead of CTPA if acute PE is suspected due to the lack of ionizing radiation exposure. Patients with history of anaphylactoid reactions to iodine contrast media and those with chronic kidney disease may benefit from MRA as well [132].…”