BACKGROUND: Magnetic resonance imaging (MRI) has not been validated as an alternative diagnostic test to computed tomography angiography (CTA) in patients with suspicion of a pulmonary embolism (PE). OBJECTIVES: To evaluate performance of current MRI technology in diagnosing PE, in reference to a 64-detector CTA. PATIENTS/ METHODS: Prospective investigation including 300 patients with a suspected PE, referred for CTA after assessment of clinical probability and D-dimer testing. MRI protocol included unenhanced, perfusion and angiographic sequences. MRI results were interpreted by two independent readers, to evaluate inter-reader agreement. Sensitivity and specificity were evaluated globally and according to PE location and to clinical probability category. RESULTS: Of 300 enrolled patients, 274 were analyzed and 103 (37.5%) had a PE diagnosed by CTA. For patients with conclusive MRI results (72% for reader 1, 70% for reader 2), sensitivity and specificity were 84.5% (95% confidence interval [CI], 74.9-91.4%) and 99.1% (95% CI, 95.1-100.0%), respectively, for reader 1, and 78.7% (95% CI, 68.2-87.1%) and 100% (95% CI, 96.7-100.0%) for reader 2. After exclusion of inconclusive MRI results for both readers, inter-reader agreement was excellent (kappa value: 0.93, 95% CI: 0.88-0.99). Sensitivity was better for proximal (97.7-100%) than for segmental (68.0-91.7%) and sub-segmental (21.4-33.3%) PE (P < 0.0001). Sensitivity was similar for both readers within each clinical probability category. CONCLUSIONS: Current MRI technology demonstrates high specificity and high sensitivity for proximal PE, but still limited sensitivity for distal PE and 30% of inconclusive results. Although a positive result can aid in clinical decision making, MRI cannot be used as a stand-alone test to exclude PE.
BACKGROUND: Magnetic resonance imaging (MRI) has not been validated as an alternative diagnostic test to computed tomography angiography (CTA) in patients with suspicion of a pulmonary embolism (PE). OBJECTIVES: To evaluate performance of current MRI technology in diagnosing PE, in reference to a 64-detector CTA. PATIENTS/ METHODS: Prospective investigation including 300 patients with a suspected PE, referred for CTA after assessment of clinical probability and D-dimer testing. MRI protocol included unenhanced, perfusion and angiographic sequences. MRI results were interpreted by two independent readers, to evaluate inter-reader agreement. Sensitivity and specificity were evaluated globally and according to PE location and to clinical probability category. RESULTS: Of 300 enrolled patients, 274 were analyzed and 103 (37.5%) had a PE diagnosed by CTA. For patients with conclusive MRI results (72% for reader 1, 70% for reader 2), sensitivity and specificity were 84.5% (95% confidence interval [CI], 74.9-91.4%) and 99.1% (95% CI, 95.1-100.0%), respectively, for reader 1, and 78.7% (95% CI, 68.2-87.1%) and 100% (95% CI, 96.7-100.0%) for reader 2. After exclusion of inconclusive MRI results for both readers, inter-reader agreement was excellent (kappa value: 0.93, 95% CI: 0.88-0.99). Sensitivity was better for proximal (97.7-100%) than for segmental (68.0-91.7%) and sub-segmental (21.4-33.3%) PE (P < 0.0001). Sensitivity was similar for both readers within each clinical probability category. CONCLUSIONS: Current MRI technology demonstrates high specificity and high sensitivity for proximal PE, but still limited sensitivity for distal PE and 30% of inconclusive results. Although a positive result can aid in clinical decision making, MRI cannot be used as a stand-alone test to exclude PE.
Authors: Marie Pierre Revel; Olivier Sanchez; Catherine Lefort; Guy Meyer; Sophie Couchon; Anne Hernigou; Ralph Niarra; Gilles Chatellier; Guy Frija Journal: Eur Radiol Date: 2013-05-08 Impact factor: 5.315
Authors: Peter Bannas; Mark L Schiebler; Utaroh Motosugi; Christopher J François; Scott B Reeder; Scott K Nagle Journal: Eur Radiol Date: 2014-05-28 Impact factor: 5.315
Authors: Mark L Schiebler; Scott K Nagle; Christopher J François; Michael D Repplinger; Azita G Hamedani; Karl K Vigen; Rajkumar Yarlagadda; Thomas M Grist; Scott B Reeder Journal: J Magn Reson Imaging Date: 2013-04-01 Impact factor: 4.813
Authors: Madan M Rehani; Emily R Melick; Raza M Alvi; Ruhani Doda Khera; Salma Batool-Anwar; Tomas G Neilan; Michael Bettmann Journal: Eur Radiol Date: 2019-12-02 Impact factor: 5.315