PURPOSE: This study compares contrast-enhanced 3D-MR angiography (MRA) of the pulmonary arteries with selective intra-arterial DSA in patients with chronic thromboembolic pulmonary hypertension. MATERIALS AND METHODS: 20 patients preoperatively underwent a contrast-enhanced 3D-MRA of the pulmonary arteries at 1.5 T using the phased-array body coil. For MRA, we used a 3D-Flash-sequence after bolus timing. 2 radiologists analyzed the acquired image material in consensus with respect to the detection of central thromboembolic material and the visualization of the pulmonary arterial tree. Finally, the MR angiograms were compared with selective DSA images using surgical findings as the definitive standard. RESULTS: MRA demonstrated central thromboembolic material, vessel cut-offs and abnormal proximal-to-distal tapering in all patients. Compared to DSA, MRA depicted the pulmonary vessels up to the segmental level in all cases, it was inferior to DSA in delineation of the subsegmental arteries (sensitivity 87%, specificity 100%). The central beginning of the thromboembolic occlusions seen at MRA corresponded to the beginning of the deobliteration procedure during pulmonary thromboendarterectomy in every case. CONCLUSIONS: Contrast-enhanced 3D-MRA of the pulmonary arteries enables the reliable detection of central thromboembolic material in patients with CTPEH. It also allows identification of those patients who may be treated surgically.
PURPOSE: This study compares contrast-enhanced 3D-MR angiography (MRA) of the pulmonary arteries with selective intra-arterial DSA in patients with chronic thromboembolic pulmonary hypertension. MATERIALS AND METHODS: 20 patients preoperatively underwent a contrast-enhanced 3D-MRA of the pulmonary arteries at 1.5 T using the phased-array body coil. For MRA, we used a 3D-Flash-sequence after bolus timing. 2 radiologists analyzed the acquired image material in consensus with respect to the detection of central thromboembolic material and the visualization of the pulmonary arterial tree. Finally, the MR angiograms were compared with selective DSA images using surgical findings as the definitive standard. RESULTS: MRA demonstrated central thromboembolic material, vessel cut-offs and abnormal proximal-to-distal tapering in all patients. Compared to DSA, MRA depicted the pulmonary vessels up to the segmental level in all cases, it was inferior to DSA in delineation of the subsegmental arteries (sensitivity 87%, specificity 100%). The central beginning of the thromboembolic occlusions seen at MRA corresponded to the beginning of the deobliteration procedure during pulmonary thromboendarterectomy in every case. CONCLUSIONS: Contrast-enhanced 3D-MRA of the pulmonary arteries enables the reliable detection of central thromboembolic material in patients with CTPEH. It also allows identification of those patients who may be treated surgically.
Authors: Karl-Friedrich Kreitner; R Peter Kunz; Sebastian Ley; Katja Oberholzer; Daniel Neeb; Klaus K Gast; Claus-Peter Heussel; Balthasar Eberle; Eckhard Mayer; Hans-Ulrich Kauczor; Christoph Düber Journal: Eur Radiol Date: 2006-07-13 Impact factor: 5.315