Acute Pulmonary Embolism: Diagnosis with MR Angiography

Gupta, Ashu; Frazer, Christopher; Ferguson, John; Kumar, Ashok B.; Davis, Stephen J.; Fallon, Michael J.; Morris, I.; Drury, P. J.; Cala, L.A.

doi:10.1148/radiology.210.2.r99fe53353

Cited by 202 publications

(104 citation statements)

References 33 publications

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“…It is wellrecognized that computed tomography (CT), especially helical CT (1-3) and electron beam tomography (4,5), and magnetic resonance (MR) angiography (6) are useful for the diagnosis of APE.Most of the major hospitals in Japan are equipped with CTand MR.In the management of APE, temporal inferior vena caval filters can be used. There are manyreports on the diagnosis and management of APE (7,8), but there have been no investigations concerning the actual conditions in which recent developments in diagnostic imaging techniques and therapies have been applied in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Recent Developments in Diagnostic Imaging Techniques and Management for Acute Pulmonary Embolism: Multicenter Registry by The Japanese Society of Pulmonary Embolism Research

et al. 2003

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Section: Introductionmentioning

confidence: 99%

Recent Developments in Diagnostic Imaging Techniques and Management for Acute Pulmonary Embolism: Multicenter Registry by The Japanese Society of Pulmonary Embolism Research

et al. 2003

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“…This technique allows simultaneous evaluation of lung perfusion and flow in the major pulmonary vasculature. On the other hand, submillimeter high-spatial-resolution pulmonary angiography has been achieved with bolus administration of gadolinium contrast agent and first-pass MR data acquisition during the arterial phase of the contrast agent (13)(14)(15). This contrast-enhanced pulmonary angiography shows high SNR and can depict pulmonary arteries beyond the subsegmental branches.…”

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confidence: 99%

Combined MR proton lung perfusion/angiography and helium ventilation: Potential for detecting pulmonary emboli and ventilation defects

Zheng

Leawoods

Nolte

et al. 2002

Magnetic Resonance in Med

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Three-dimensional (3D) perfusion imaging allows the assessment of pulmonary blood flow in parenchyma and main pulmonary arteries simultaneously. MRI using laser-polarized 3 He gas clearly shows the ventilation distribution with high signal-tonoise ratio (SNR). In this report, the feasibility of combined lung MR angiography, perfusion, and ventilation imaging is demonstrated in a porcine model. Ultrafast gradient-echo sequences have been used for 3D perfusion and angiographic imaging, in conjunction with the use of contrast agent injections. 2D multiple-section 3 He imaging was performed subsequently by inhalation of 450 ml of hyperpolarized 3 He gas. The MR techniques were examined in a series of porcine models with externally delivered pulmonary emboli and/or airway occlusions. The development of high-speed gradient systems and fast imaging methods has permitted ultrafast contrast-enhanced lung perfusion imaging with subsecond temporal resolution and millimeter spatial resolution (1-8). Imaging of the lung parenchyma suffers from low proton density, physiological motion (cardiac and respiratory motion adjacent to the lung), and short T* 2 from local magnetic field inhomogeneity due to multiple interfaces of air and soft tissues (3,9 -12); significantly reduced times TR and TE in the gradient-echo sequence allow dramatically improved SNR. Recently, bolus injection of gadolinium contrast agent in conjunction with an ultrafast 3D gradient-echo sequence has demonstrated volumetric lung parenchymal perfusion images with 2-3 sec temporal resolution (7). This technique allows simultaneous evaluation of lung perfusion and flow in the major pulmonary vasculature. On the other hand, submillimeter high-spatial-resolution pulmonary angiography has been achieved with bolus administration of gadolinium contrast agent and first-pass MR data acquisition during the arterial phase of the contrast agent (13-15). This contrast-enhanced pulmonary angiography shows high SNR and can depict pulmonary arteries beyond the subsegmental branches. Integration of perfusion and angiography may allow better evaluation of parenchymal blood flow states and vasculature involvement; this is particularly interesting when pulmonary emboli are studied (10,16).The ability of MR to image the lung air space is important for the diagnosis of a variety of pulmonary ventilation abnormalities. Recently, assessment of regional lung ventilation using hyperpolarized noble gas has emerged as an imaging technique for evaluating patients with lung disease, such as tumor, emphysema, bronchiectasis, cystic fibrosis, and asthma (17-24). Compared to O 2 -enhanced lung MRI (25,26), which has the advantage of needing no special equipment, 3 He MRI provides high SNR and contrast-to-noise ratio (CNR), with image intensity directly proportional to the local concentration of inhaled 3 He. It has long been recognized that both pulmonary perfusion and ventilation images are needed to identify and distinguish certain lung diseases. For example, mismatched and matched perfusi...

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“…73 In another study, the sensitivity and specificity for detection of lobar and segmental emboli was 87% and 97%, respectively. 74 In a subsequent study, sensitivity for detection of subsegmental emboli was only 68%, 75 making this technique inferior to CTPA or angiography.…”

Section: Mr Pulmonary Angiographymentioning

confidence: 99%

Role of Computed Tomography and Magnetic Resonance Imaging for Deep Venous Thrombosis and Pulmonary Embolism

2004

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Abstract-During the 1990s, computed tomography (CT) and magnetic resonance (MR) imaging underwent extensive technological advancement and expanded clinical use in patients with venous thromboembolic disease, particularly with regard to evaluation of the pulmonary vasculature. In many institutions, helical (spiral) CT pulmonary angiography has become the initial imaging study of choice to evaluate patients with suspected pulmonary embolism, supplanting ventilation/perfusion scintigraphy. In addition, CT venography of the pelvis and lower extremities is often incorporated into the CT angiography protocol to identify or exclude concurrent deep venous thrombosis. MR pulmonary angiography and MR venography are second-line diagnostic tools because of their higher cost, limited availability, and other logistical constraints. As the technology improves and becomes more widely available, MR imaging may play a greater role in the evaluation of patients with venous thromboembolic disease. Key Words: thrombosis Ⅲ pulmonary heart disease Ⅲ imaging Ⅲ MRI D uring the 1990s, technological advances in computed tomography (CT) and magnetic resonance (MR) imaging made these techniques applicable to the diagnosis of venous thromboembolic disease, particularly for the pulmonary vasculature in patients with suspected pulmonary embolism (PE). At the opening of the third millennium, in many institutions, helical (spiral) CT pulmonary angiography (CTPA) has become the initial imaging study of choice for evaluating patients with suspected PE, supplanting ventilation/perfusion (V/Q) scintigraphy by reducing indeterminate examinations. 1-4 CT venography (CTV) of the pelvic and lower extremity veins after CTPA of the pulmonary arteries has been advocated by some as an adjunct to helical CT for detection of concurrent deep venous thrombosis (DVT) using a single imaging technique for detection of venous thromboembolic disease.Although MR imaging produces high tissue contrast without ionizing radiation, currently, this technique is less popular than CT for evaluation of acute venous thromboembolism (VTE) because of technical limitations, higher costs, limited availability, and other logistical considerations. As technology improves, however, MR pulmonary angiography (MRPA) and MR venography (MRV) may play a greater role in the evaluation of patients with venous thromboembolic disease.This article reviews applications of CT and MR imaging in the clinical evaluation of patients with suspected venous thromboembolic disease. CT Pulmonary AngiographyCTPA has gained acceptance as a first-line imaging study in cases of suspected acute PE, replacing traditional V/Q scintigraphy at many institutions. In general, V/Q scanning is reserved for patients in whom motion artifact or poor right heart function limit the quality of CT examination and those with contraindications to intravenous radiographic contrast.After contrast administration, CTPA provides visualization of the pulmonary arterial system in the axial plane, and multiplanar and three-dimensional...

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Acute Pulmonary Embolism: Diagnosis with MR Angiography

Abstract: Performed without pulmonary arterial catheterization, iodinated contrast media, or ionizing radiation, pulmonary MR angiography had a high accuracy for depicting lobar and segmental emboli, but was unable to depict four of five subsegmental emboli.

Cited by 202 publications

References 33 publications

Recent Developments in Diagnostic Imaging Techniques and Management for Acute Pulmonary Embolism: Multicenter Registry by The Japanese Society of Pulmonary Embolism Research

Recent Developments in Diagnostic Imaging Techniques and Management for Acute Pulmonary Embolism: Multicenter Registry by The Japanese Society of Pulmonary Embolism Research

Combined MR proton lung perfusion/angiography and helium ventilation: Potential for detecting pulmonary emboli and ventilation defects

Role of Computed Tomography and Magnetic Resonance Imaging for Deep Venous Thrombosis and Pulmonary Embolism

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