OBJECTIVES: To independently evaluate unenhanced, contrast-enhanced perfusion and angiographic MR sequences for pulmonary embolism (PE) diagnosis. METHODS: Prospective investigation, including 274 patients who underwent perfusion, unenhanced 2D steady-state-free-precession (SSFP) and contrast-enhanced 3D angiographic MR sequences on a 1.5-T unit, in addition to CTA (CT angiography). Two independent readers evaluated each sequence independently in random order. Sensitivity, specificity, predictive values and inter-reader agreement were calculated for each sequence, excluding sequences judged inconclusive. Sensitivity was also calculated according to PE location. RESULTS: Contrast-enhanced angiographic sequences showed the highest sensitivity (82.9 and 89.7 %, reader 1 and reader 2, respectively), specificity (98.5 and 100 %) and agreement (kappa value 0.77). Unenhanced angiographic sequences, although less sensitive overall (68.7 and 76.4 %), were sensitive for the detection of proximal PE (92.7 and 100 %) and showed high specificity (96.1 and 99.1 %) and good agreement (kappa value 0.62). Perfusion sequences showed lower sensitivity (75.0 and 79.3 %), specificity (84.8 and 89.7 %) and agreement (kappa value 0.51), and a negative predictive value of 84.8 % at best. CONCLUSIONS: Compared with contrast-enhanced angiographic sequences, unenhanced sequences demonstrate lower sensitivity, except for proximal PE, but high specificity and agreement. The negative predictive value of perfusion sequences was insufficient to safely rule out PE. KEY POINTS: • Unenhanced angiographic MR sequences are very specific and can identify proximal PE. • Contrast-enhanced MR angiographic sequences show high sensitivity for PE diagnosis. • A normal MR perfusion result does not exclude PE. • Inter-reader agreement is better for angiographic than perfusion MR sequences.
OBJECTIVES: To independently evaluate unenhanced, contrast-enhanced perfusion and angiographic MR sequences for pulmonary embolism (PE) diagnosis. METHODS: Prospective investigation, including 274 patients who underwent perfusion, unenhanced 2D steady-state-free-precession (SSFP) and contrast-enhanced 3D angiographic MR sequences on a 1.5-T unit, in addition to CTA (CT angiography). Two independent readers evaluated each sequence independently in random order. Sensitivity, specificity, predictive values and inter-reader agreement were calculated for each sequence, excluding sequences judged inconclusive. Sensitivity was also calculated according to PE location. RESULTS: Contrast-enhanced angiographic sequences showed the highest sensitivity (82.9 and 89.7 %, reader 1 and reader 2, respectively), specificity (98.5 and 100 %) and agreement (kappa value 0.77). Unenhanced angiographic sequences, although less sensitive overall (68.7 and 76.4 %), were sensitive for the detection of proximal PE (92.7 and 100 %) and showed high specificity (96.1 and 99.1 %) and good agreement (kappa value 0.62). Perfusion sequences showed lower sensitivity (75.0 and 79.3 %), specificity (84.8 and 89.7 %) and agreement (kappa value 0.51), and a negative predictive value of 84.8 % at best. CONCLUSIONS: Compared with contrast-enhanced angiographic sequences, unenhanced sequences demonstrate lower sensitivity, except for proximal PE, but high specificity and agreement. The negative predictive value of perfusion sequences was insufficient to safely rule out PE. KEY POINTS: • Unenhanced angiographic MR sequences are very specific and can identify proximal PE. • Contrast-enhanced MR angiographic sequences show high sensitivity for PE diagnosis. • A normal MR perfusion result does not exclude PE. • Inter-reader agreement is better for angiographic than perfusion MR sequences.
Authors: Patrick M Bossuyt; Johannes B Reitsma; David E Bruns; Constantine A Gatsonis; Paul P Glasziou; Les M Irwig; David Moher; Drummond Rennie; Henrica C W de Vet; Jeroen G Lijmer Journal: Ann Intern Med Date: 2003-01-07 Impact factor: 25.391
Authors: Bobby Kalb; Puneet Sharma; Stefan Tigges; Gaye L Ray; Hiroumi D Kitajima; James R Costello; Zhengjia Chen; Diego R Martin Journal: Radiology Date: 2012-04 Impact factor: 11.105
Authors: M P Revel; O Sanchez; S Couchon; B Planquette; A Hernigou; R Niarra; G Meyer; G Chatellier Journal: J Thromb Haemost Date: 2012-05 Impact factor: 5.824
Authors: Patrick M Bossuyt; Johannes B Reitsma; David E Bruns; Constantine A Gatsonis; Paul P Glasziou; Les M Irwig; Jeroen G Lijmer; David Moher; Drummond Rennie; Henrica C W de Vet Journal: Ann Intern Med Date: 2003-01-07 Impact factor: 25.391
Authors: Sven F Thieme; Thorsten R C Johnson; Christopher Lee; Justin McWilliams; Christoph R Becker; Maximilian F Reiser; Konstantin Nikolaou Journal: AJR Am J Roentgenol Date: 2009-07 Impact factor: 3.959
Authors: Paul D Stein; Alexander Gottschalk; H Dirk Sostman; Thomas L Chenevert; Sarah E Fowler; Lawrence R Goodman; Charles A Hales; Russell D Hull; Emanuel Kanal; Kenneth V Leeper; David P Nadich; Daniel J Sak; Victor F Tapson; Thomas W Wakefield; John G Weg; Pamela K Woodard Journal: Semin Nucl Med Date: 2008-11 Impact factor: 4.446
Authors: Mona Salehi Ravesh; Karolin Tesch; Annett Lebenatus; Ioannis Koktzoglou; Robert R Edelman; Matthias Eden; Patrick Langguth; Joachim Graessner; Olav Jansen; Marcus Both Journal: J Magn Reson Imaging Date: 2020-06-14 Impact factor: 4.813