Magnetic Resonance Imaging for the Evaluation of Pulmonary Embolism

Benson, D.; Schiebler, Mark L.; Nagle, Scott K.; François, Christopher J.

doi:10.1097/rmr.0000000000000133

Cited by 12 publications

(8 citation statements)

References 45 publications

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“…The main difference in interpreting MRI compared to CTPA is the artefacts. (60,63) In CTEPH the expected MRI findings are also similar to those seen on CTPA. An early study by Ley et al from 2003 showed that MRI is equal to CTPA on segmental level, but CTPA was superior on the subsegmental level and for evaluating intraluminal webs and thrombotic wall thickening (55).…”

Section: Magnetic Resonance Imagingsupporting

confidence: 52%

“…Nevertheless, CT has a higher sensitivity on the subsegmental level, in the detection of intraluminal webs and thrombotic wall thickening (55). In summary, the utility of MRI for diagnosing CTEPH has not been established as yet (63).…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…It has also been argued that MRI may be useful in CTEPH patients as it enables both assessment of pulmonary arteries and right ventricular function but the number of studies is limited, and the method must be validated. (9,46,63). The awareness of thoracic findings on MRI has increased in recent years and there are studies encouraging radiologists to look for thoracic findings such as PE on abdominal MRIs (67).…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

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Do radiologists detect chronic thromboembolic disease on computed tomography?

et al. 2019

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Background: Acute pulmonary embolism (APE) is a potentially severe medical condition with blood clots obstructing the pulmonary arterial vasculature. In most cases the APE resolves without any sequelae after anticoagulation therapy. In some patients, however, the emboli do not resolve upon treatment and the remnants cause increased vascular resistance, a condition known as chronic thromboembolic pulmonary hypertension (CTEPH). Both APE and CTEPH have a non-specific clinical presentation and imaging is an important part of the diagnosis. In APE computed tomography pulmonary angiography (CTPA) is the diagnostic gold standard, although the method is not suitable for all patients. CTPA has a high specificity for CTEPH, but the sensitivity remains under debate. At present CTPA is not recommended as a first line test among patients with a clinical suspicion of CTEPH. Purpose: To investigate unestablished imaging modalities in the diagnosis of APE (Study I) and CTEPH (Study III) including learning aspects (Study II) and knowledge (Study IV) of theses among radiologists. Regarding APE we studied magnetic resonance imaging (MRI) and in CTEPH we studied CTPA. Material and methods: Studies I-II were based on a prospective collection of 70 unenhanced MRI exams with CTPA as the gold standard. In Studies III-IV we used a retrospective material based on 43 CTPA exams from patients with confirmed CTEPH referred for presurgical assessment at a specialist centre, with a matched control with suspected APE. Results: All MRI exams were of diagnostic quality. Specificity was 100% for both readers and sensitivity 90% and 93% respectively with a nearly perfect inter-reader agreement (kappa 0.97) (Study I). Residents interpreting the MRI exams within the training program reached a clinically acceptable level after approximately 50 examinations and review time was halved during the training program (Study II). The sensitivity for CTEPH on CTPA reviewed by two experts was 100% and the specificity 100% (Study III), while the sensitivity based on the original reports from the same cases was 26% (Study IV). Conclusions: Unenhanced MRI has a high sensitivity and specificity for APE (Study I) and residents can learn to interpret such exams by using a self-directed training program (Study II). Enhanced CTPA has a high sensitivity when reviewed by experienced radiologists (Study III), but among radiologists in general the sensitivity is low (Study IV). LIST OF SCIENTIFIC PAPERS I. Detection of pulmonary embolism using repeated MRI acquisitions without respiratory gating: A preliminary study.

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Section: Magnetic Resonance Imagingsupporting

confidence: 52%

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

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Do radiologists detect chronic thromboembolic disease on computed tomography?

et al. 2019

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“…The routine protocol includes static steady-state free precession (SSFP) sequences, contrast-enhanced 3 D magnetic resonance angiography (MRA) using a T1-weighted gradient-echo (GRE) sequence, and a 2 D axial or 3 D T1-weighted GRE sequence post-contrast. If the patient tolerates the flat positioning in the MRI scanner well, an additional time-resolved, contrast-enhanced 3 D (i. e. 4 D) MRA prior to the 3 D MRA sequence is helpful to obtain dynamic perfusion information [14].…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…Contrast-enhanced 3 D MRA with high spatial resolution is obtained in coronal orientation during three inspiratory breath-holds for acquisition of pre-contrast images for subtraction purposes, arterial phase images and late arterial phase images (▶ Fig. 2) [14]. 0.1 mmol/kg gadolinium-based contrast agent is administered at a flow rate of 2 ml/s.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Acute Pulmonary Embolism: Imaging Techniques, Findings, Endovascular Treatment and Differential Diagnoses

Palm

Rengier

Rajiah

et al. 2019

Fortschr Röntgenstr

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Background Acute thrombotic pulmonary embolism (PE) is a common and potentially fatal event with imaging playing a pivotal role in the diagnosis and management of these patients. Method This review discusses imaging techniques, diagnostic algorithms, imaging findings and endovascular treatment of acute thrombotic PE, and illustrates important differential diagnoses relating to the spectrum of acute non-thrombotic PE and non-embolic pulmonary artery disease. The review emphasizes information relevant for everyday radiological practice and highlights recent advances that can be readily applied in the clinical routine. Results/Conclusion Computed tomography pulmonary angiography (CTPA) is the current reference standard for the diagnosis of acute PE. Ventilation and perfusion (VQ) scanning or – in centers with adequate expertise – magnetic resonance imaging (MRI) is indicated in pregnant or young patients and patients with contraindications to iodinated contrast. Invasive angiography is reserved for patients with intended endovascular treatment. Artifacts, acute non-thrombotic PE, chronic PE and non-embolic pulmonary artery diseases should always be considered as differential diagnoses. Key points: Citation Format

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Pediatric Pulmonary Embolism

Winant

Lee

2019

Imaging in Pediatric Pulmonology

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Magnetic Resonance Imaging for the Evaluation of Pulmonary Embolism

Cited by 12 publications

References 45 publications

Do radiologists detect chronic thromboembolic disease on computed tomography?

Do radiologists detect chronic thromboembolic disease on computed tomography?

Acute Pulmonary Embolism: Imaging Techniques, Findings, Endovascular Treatment and Differential Diagnoses

Pediatric Pulmonary Embolism

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