Incidence of actionable findings on contrast enhanced magnetic resonance angiography ordered for pulmonary embolism evaluation

Schiebler, Mark L.; Ahuja, Jitesh; Repplinger, Michael D.; François, Christopher J.; Vigen, Karl K.; Grist, Thomas M.; Hamedani, Azita G.; Reeder, Scott B.; Nagle, Scott K.

doi:10.1016/j.ejrad.2016.05.008

Cited by 15 publications

(7 citation statements)

References 38 publications

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“…The rate of clinically significant IFs in our study was not different from that of a previous similar study, which identified actionable, incidental findings in 21.5% of patients receiving acute stroke intervention combined with CTA of the head and neck. [ 2 ] This might be expected, as we found some IFs, that is, pulmonary embolism, which were not reported before, even though our data of neck CTA cases have smaller coverage and fewer images.…”

Section: Discussionsupporting

confidence: 61%

“…With the rapid technological advance in image acquisition and spatial resolution, computed tomographic angiography (CTA) serves increasingly as a quick, accurate, and attractive noninvasive clinical procedure [ 1 , 2 ] and has largely replaced digital subtraction angiography (DSA). The latter has long been considered as standard diagnostic procedure, an imaging modality for assessing the vessels of lower extremity, [ 3 ] cardiac, [ 4 ] pulmonary artery.…”

Section: Introductionmentioning

confidence: 99%

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The undiagnosed potential clinically significant incidental findings of neck CTA

Chen

Xue

et al. 2020

Medicine

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To assess the prevalence and missed reporting rate of potential clinically-significant incidental findings (IFs) in the neck CTA scans. All consecutive patients undergoing neck CTA imaging, from January 1, 2017 to December 31, 2018, were retrospectively evaluated by a radiologist for the presence of incidental findings in the upper chest, lower head and neck regions. These incidental findings were subsequently classified into 3 categories in terms of clinical significance: Type I, highly significant, Type II, moderately significant; and Type III, mildly or not significant. Type I and Type II IFs were determined as potential clinically significant ones and were retrospectively analyzed by another 2 radiologists in consensus. The undiagnosed findings were designated as those that were not reported by the initial radiologists. The differences in the rate of unreported potential clinically significant IFs were compared between the chest group and head or neck group. A total of 376 potential clinically significant IFs were detected in 1,698 (91.19%) patients, of which 175 IFs were classified as highly significant findings (Type I), and 201 (53.46%) as moderately significant findings (Type II). The most common potential clinically significant findings included thyroid nodules (n = 88, 23.40%), pulmonary nodules (n = 56, 14.89%), sinus disease (n = 39, 10.37%), intracranial or cervical artery aneurysms (n = 30, 7.98%), enlarged lymph nodes (n = 24, 6.38%), and pulmonary embolism (n = 19, 5.05%). In addition, 184 (48.94%) of them were not mentioned in the initial report. The highest incidence of missed potential clinical findings were pulmonary embolism and pathologic fractures and erosions (100% for both). The unreported rate of the chest group was significantly higher than that of the head or neck one, regardless of Type I, Type II or all potential clinically significant IFs (χ 2 = 32.151, χ 2 = 31.211, χ 2 = 65.286, respectively; P < .001 for all). Important clinically significant incidental findings are commonly found in a proportion of patients undergoing neck CTA, in which nearly half of these patients have had potential clinically significant IFs not diagnosed in the initial report. Therefore, radiologists should beware of the importance of and the necessity to identify incidental findings in neck CTA scans.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

The undiagnosed potential clinically significant incidental findings of neck CTA

Chen

Xue

et al. 2020

Medicine

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“…The ancillary findings observed on CE-MRA exams in those patients without PE are similar to those of CTA (Figure 5 )[ 89 , 90 ]. The field of view is larger and the soft tissue contrast is better on CE-MRA exams than CTA.…”

Section: Ancillary Findingsmentioning

confidence: 58%

“…In a recent study, the incidence of actionable findings (requiring follow up) from CE-MRA exams was 17% (pleural effusion, pneumonia, malignancy, ascending aortic aneurysm, aortic dissection, pericardial effusion, heart failure, septic emboli, lung abscess, trauma, and sarcoidosis). While the incidence of incidental findings (those findings not requiring follow up) was 36% (mild dependent atelectasis, small pleural effusion, normal vascular variant, simple cysts in liver or kidney and post-surgical changes)[ 89 ].…”

Section: Ancillary Findingsmentioning

confidence: 99%

Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging

Tsuchiya¹,

Ej²,

Ohno³

et al. 2018

WJR

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Pulmonary contrast enhanced magnetic resonance angiography (CE-MRA) is useful for the primary diagnosis of pulmonary embolism (PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography (CTA). In this review, we discuss the strengths and weaknesses of CE-MRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multi-institutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women (< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness (patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.

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“…Dynamic Contrast Enhanced (DCE) perfusion imaging techniques using gadolinium-based contrast agents (GBCAs) have shown promise for more than a decade. Recently, translational advances have enabled the investigation of diseases such as pulmonary embolism (36,37), pulmonary hypertension (24)(25)(26), and CF in pediatric and young adult populations (38)(39)(40). In pulmonary DCE MRI contrast is injected and dynamic images are acquired prior and during the passage of the contrast bolus.…”

Section: Imaging Lung Function With Hyperpolarized 129 Xe Dce Perfusmentioning

confidence: 99%

“Structure-Function Imaging of Lung Disease Using Ultrashort Echo Time MRI”

et al. 2019

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The purpose of this review is to acquaint the reader with recent advances in ultra-short echo time (UTE) magnetic resonance imaging (MRI) of the lung and its implications for pulmonary MRI when used in conjunction with functional MRI techniques. UTE MRI has three critical advantages for lung applications: 1) high resolution, whole-lung morphological images without the use of ionizing radiation; 2) mitigation of the short transverse relaxation time constant (T2*) caused by magnetic susceptibility effects prominent at air-tissue interfaces; and 3) in conjunction with a radial acquisition and hard respiratory gating, mitigation of cardiac and respiratory motion artifacts, enabling free breathing exams. UTE MRI clearly shows the lung parenchymal changes due to idiopathic pulmonary fibrosis (IPF) and cystic fibrosis (CF). The use of UTE MRI, in conjunction with established functional lung MRI in chronic lung diseases, will serve to mitigate the need for computed tomography (CT) in children. Current limitations of UTE MRI include long scan times, poor delineation of thin walled structures (e.g. cysts and reticulation) due to limited spatial resolution, low signal to noise (SNR), and imperfect motion compensation. Despite these limitations, UTE MRI can now be considered as an alternative to multi-detector CT for the longitudinal follow up of the morphological changes from lung diseases in neonates, children and young adults, particularly as a complement to the unique functional capabilities of MRI.

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Incidence of actionable findings on contrast enhanced magnetic resonance angiography ordered for pulmonary embolism evaluation

Abstract: MRA as a first-line test for PE can identify actionable findings in those patients without PE, with an incidence similar to that reported in the literature for CTA.

Cited by 15 publications

References 38 publications

The undiagnosed potential clinically significant incidental findings of neck CTA

The undiagnosed potential clinically significant incidental findings of neck CTA

Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging

“Structure-Function Imaging of Lung Disease Using Ultrashort Echo Time MRI”

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