Clinical outcomes after magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) for pulmonary embolism evaluation

Repplinger, Michael D.; Nagle, Scott K.; Harringa, John B.; Broman, Aimee Teo; Lindholm, Christopher R.; François, Christopher J.; Grist, Thomas M.; Reeder, Scott B.; Schiebler, Mark L.

doi:10.1007/s10140-018-1609-8

Cited by 16 publications

(13 citation statements)

References 28 publications

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“…An older study from 2004 found that an artifact called “transient interruption of contrast” occurs in 37% of CTPA studies, limiting the radiologist’s ability to interpret the study 11. Additionally, another recent study related to this subject found that 9.5% of CTPA studies were “technically limited.”12 In the end, because of variations in local radiology practice styles, differences in technique for the execution of CTPA, and differences in equipment, the rate of suboptimal CTPA likely varies a bit from hospital to hospital.…”

Section: Discussionmentioning

confidence: 99%

Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography

Marshall

Chen

Nguyen

et al. 2019

WestJEM

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Introduction Computed tomography pulmonary angiography (CTPA) is the test of choice for diagnosis of pulmonary embolism (PE) in the emergency department (ED), but this test may be indeterminate for technical reasons such as inadequate contrast filling of the pulmonary arteries. Many hospitals have requirements for intravenous (IV) catheter size or location for CTPA studies to reduce the chances of inadequate filling, but there is a lack of clinical data to support these requirements. The objective of this study was to determine if a certain size or location of IV catheter used for contrast for CTPA is associated with an increased chance of suboptimal CTPA. Methods This was a retrospective chart review of patients who underwent CTPA in the ED. A CTPA study was considered suboptimal if the radiology report indicated it was technically limited or inadequate to exclude a PE. The reason for the study being suboptimal, and the size and location of the IV catheter, were abstracted. We calculated the rate of inadequate contrast filling of the pulmonary vasculature and compared the rate for various IV catheter sizes and locations. In particular, we compared 20-gauge or larger IV catheters in the antecubital fossa or forearm to all other sizes and locations. Results A total of 19.3% of the 1500 CTPA reports reviewed met our criteria as suboptimal, and 51.6% of those were due to inadequate filling. Patients with a 20-gauge IV catheter or larger placed in the antecubital fossa or forearm had inadequate filling 9.2% of the time compared to 13.2% for patients who had smaller IVs or IVs in other locations (difference: 4.0% [95% confidence interval, −1.7%–9.7%]). There were also no statistically significant differences in the rates of inadequate filling when data were further stratified by IV catheter location and size. Conclusion We did not detect any statistically significant differences in the rate of inadequate contrast filling based on IV catheter locations or sizes. While small differences not detected in this study may exist, it seems prudent to proceed with CTPA in patients with difficult IV access who need emergent imaging even if they have a small or distally located IV.

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Section: Discussionmentioning

confidence: 99%

Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography

Marshall

Chen

Nguyen

et al. 2019

WestJEM

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“…This technique can be considered as an alternative to CT angiography for patients presenting with signs and symptoms of pulmonary embolism. In the clinical setting of suspected pulmonary embolism, single-center results for the primary use of MR angiography for the diagnosis of pulmonary embolism in 675 patients at low to intermediate risk showed patient outcomes using MR angiography as the primary diagnostic test were similar to CT angiography at 6 months of follow-up (104). Important technical developments since the Prospective Investigation of Pulmonary Embolism Diagnosis III study have improved the resolution and image quality of the MRI enhanced MR angiography has been used in the setting of chronic thromboembolic pulmonary hypertension for the diagnosis of proximal arterial enlargement, webs of chronic thrombi, and amputation of the smaller pulmonary arterial branches.…”

Section: Pulmonary Hypertension-the European Society Of Cardiology and European Respiratorymentioning

confidence: 99%

Expanding Applications of Pulmonary MRI in the Clinical Evaluation of Lung Disorders: Fleischner Society Position Paper

Hatabu¹,

Ohno²,

Gefter³

et al. 2020

Radiology

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120

111

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P ulmonary MRI has had limited clinical use for patients with lung disease, especially when compared with radiography, CT, and PET/CT. However, MRI has become practical in many countries due to advances in MRI pulse sequences, multicoil parallel imaging, and acceleration methods, along with the increased (but not universal) availability of postprocessing software. Recently, ultrashort echo time (UTE) and zero echo time proton MRI have extended the use of conventional or anatomic proton MRI for clinical examinations, and inhaled-gas methods have opened up avenues for functional lung imaging. The transition to MRI from radiography-based methods has been driven by the fact that MRI does not impart ionizing radiation, which is particularly important in younger patients with chronic illness (eg, cystic fibrosis [CF]), for young and pregnant women, or for those patients requiring extensive longitudinal follow-up (eg, severe asthma).The purpose of this Fleischner Society position paper is to familiarize our community with recent advances in pulmonary MRI and to provide a consensus expert opinion regarding appropriate clinical indications for this modality. These opinions were initially endorsed in consensus among the writing committee members, following which the manuscript was endorsed by the Society members at large and was approved by the Fleischner Society Publication Development and Oversight Committee and the Fleischner Executive Committee before submission to Radiology.Common clinical indications for pulmonary MRI were reviewed by members of the writing committee and have been divided into three groups: (a) group 1 indications are suggested for current clinical use of pulmonary MRI (four or more publications from multiple institutions with clinical studies of more than 100 patients); (b) group 2 indications are promising but require further validation or regulatory approval (two to three publications with fewer than 100 patients, those that use methods requiring further confirmation or regulatory approval, such as hyperpolarized gases); and (c) group 3 indications are appropriate for research investigations (clinical studies not meeting the above criteria or limited to preclinical research) (Table 1).

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“…Conventional pulmonary MRA with GBCAs is of high diagnostic yield and generally has high technical success using modern acquisition strategies . However, in the Prospective Investigation of Pulmonary Embolism Diagnosis III study, 25% of patients demonstrated insufficient image quality with coughing (primarily due to dyspnea) or faulty timing of contrast material administration .…”

Section: Discussionmentioning

confidence: 99%

Comparison of gadolinium‐enhanced and ferumoxytol‐enhanced conventional and UTE‐MRA for the depiction of the pulmonary vasculature

Knobloch

Colgan

Schiebler

et al. 2019

Magnetic Resonance in Med

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Purpose: To evaluate the feasibility of ferumoxytol (FE)-enhanced UTE-MRA for depiction of the pulmonary vascular and nonvascular structures. Methods: Twenty healthy volunteers underwent contrast-enhanced pulmonary MRA at 3 T during 2 visits, separated by at least 4 weeks. Visit 1: The MRA started with a conventional multiphase 3D T 1 -weighted breath-held spoiled gradient-echo MRA before and after the injection of 0.1 mmol/kg gadobenate dimeglumine (GD).Subsequently, free-breathing GD-UTE-MRA was acquired as a series of 3 flip angles (FAs) (6°, 12°, 18°) to optimize T 1 weighting. Visit 2: After the injection of 4 mg/kg FE, MRA was performed during the steady state, starting with a conventional 3D T 1 -weighted breath-held spoiled gradient-echo MRA and followed by freebreathing FE-UTE-MRA, both at 4 different FAs (6°, 12°, 18°, 24°). The optimal FA for best T 1 contrast was evaluated. Image quality at the optimal FA was compared between methods on a 4-point ordinal scale, using multiphase GD conventional pulmonary MRA (cMRA) as standard of reference. Results: Flip angle in the range of 18°-24° resulted in best T 1 contrast for FE cMRA and both UTE-MRA techniques (p > .05). At optimized FA, image quality of the vasculature was good/excellent with both FE-UTE-MRA and GD cMRA (98% versus 97%; p = .51). Both UTE techniques provided superior depiction of nonvascular structures compared with either GD-enhanced or FE-enhanced cMRA (p < .001). However, GD-UTE-MRA showed the lowest image quality of the angiogram due to low image contrast. | 1661 KNOBLOCH et aL. How to cite this article: Knobloch G, Colgan T, Schiebler ML, et al. Comparison of gadoliniumenhanced and ferumoxytol-enhanced conventional and UTE-MRA for the depiction of the pulmonary vasculature.

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Clinical outcomes after magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) for pulmonary embolism evaluation

Abstract: Within the inherent limitations of a retrospective case-controlled analysis, we observed that the rate of MAPE was lower (more favorable) for patients following pulmonary MRA for the primary evaluation of suspected PE than following CTA.

Cited by 16 publications

References 28 publications

Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography

Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography

Expanding Applications of Pulmonary MRI in the Clinical Evaluation of Lung Disorders: Fleischner Society Position Paper

Comparison of gadolinium‐enhanced and ferumoxytol‐enhanced conventional and UTE‐MRA for the depiction of the pulmonary vasculature

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