Diagnostic accuracy of magnetic resonance angiography for acute pulmonary embolism - a systematic review and meta-analysis

Abstract

Abstract. Background: The aim of this meta-analysis was to evaluate the diagnostic accuracy of magnetic resonance angiography (MRA) for acute pulmonary embolism (PE). Methods: A systematic literature search was conducted that included studies from January 2000 to August 2015 using the electronic databases PubMed, Embase and Springer link. The summary receiver operating characteristic (SROC) curve, sensitivity, specificity, positive likelihood ratios (PLR), negative likelihood ratios (NLR), and diagnostic odds ratio (DOR) as well as the 95 % confidence intervals (CIs) were calculated to evaluate the diagnostic accuracy of MRA for acute PE. Meta-disc software version 1.4 was used to analyze the data. Results: Five studies were included in this meta-analysis. The pooled sensitivity (86 %, 95 % CI: 81 % to 90 %) and specificity (99 %, 95 % CI: 98 % to 100 %) demonstrated that MRA diagnosis had limited sensitivity and high specificity in the detection of acute PE. The pooled estimate of PLR (41.64, 95 % CI: 17.97 to 96.48) and NLR (0.17, 95 % CI: 0.11 to 0.27) provided evidence for the low missed diagnosis and misdiagnosis rates of MRA for acute PE. The high diagnostic accuracy of MRA for acute PE was demonstrated by the overall DOR (456.51, 95 % CI: 178.38 - 1168.31) and SROC curves (AUC = 0.9902 ± 0.0061). Conclusions: MRA can be used for the diagnosis of acute PE. However, due to limited sensitivity, MRA cannot be used as a stand-alone test to exclude acute PE.

Do radiologists detect chronic thromboembolic disease on computed tomography?

“…Increasing technical development has made MRI less susceptible to these limitations. It has been suggested that MRI could emerge as a diagnostic option regarding APE, particularly in patients not suitable for CTPA (6,61). Nevertheless, MRI is not fully accepted yet as a diagnostic test in patients with suspected APE due to limited sensitivity (7,61).…”

Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

“…However, the nature of numerous tissue air transitions and significant artifacts limit the use of traditional MRI in detection of small pulmonary emboli, 78 leading to concerns about sensitivity in detection. 79,80 The utility of Gadolinium enhanced MRI in clot detection was evaluated systematically in the PIOPED III study which demonstrated great specificity (99%) but low sensitivity (78%) and further highlighted the variations between centers in terms of the adequacy imaging acquired. 81 …”