Alessandro Squizzato1, Fulvio Pomero2, Attilio Allione3, Roberto Priotto4, Nicoletta Riva5, Menno V Huisman6, Frederikus A Klok6, Paul D Stein7, Luigina Guasti5, Luigi Fenoglio2, Francesco Dentali5, Walter Ageno5. 1. Research Center on Thromboembolic Disorders and Antithrombotic Therapies, Department of Medicine and Surgery, University of Insubria, Varese, Italy. Electronic address: alessandro.squizzato@uninsubria.it. 2. Department of Internal Medicine, 'Santa Croce e Carle' Hospital, Cuneo, Italy. 3. Emergency Department, 'Santa Croce e Carle' Hospital, Cuneo, Italy. 4. Radiology Department, Hospital 'Santa Croce e Carle', Cuneo, Italy. 5. Research Center on Thromboembolic Disorders and Antithrombotic Therapies, Department of Medicine and Surgery, University of Insubria, Varese, Italy. 6. Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands. 7. Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA.
Abstract
BACKGROUND: Computed tomographic pulmonary angiography (CTPA) has simplified the diagnostic approach to patients with clinically suspected pulmonary embolism (PE), but alternative imaging tests are still advocated. We aimed to systematically assess the diagnostic accuracy of magnetic resonance imaging (MRI) for PE diagnosis. METHODS: Studies evaluating the diagnostic accuracy of MRI for the diagnosis of PE were systematically searched in the PubMed and EMBASE databases (up to May 2016). QUADAS - 2 tool was used for the quality assessment of the primary studies. A bivariate random-effects regression approach was used for summary estimates of both sensitivity and specificity. RESULTS: Thirteen studies, for a total of 1170 patients, were included. Weighted mean prevalence of PE was 37% at random-effect model. Weighted mean inconclusive MRI results were 19% at random-effect model. After exclusion of technical inadequate results, MRI bivariate weighted mean sensitivity was 80.9% (95% confidence interval [CI] 68.2, 89.4%), with a bivariate weighted mean specificity of 96.4% (95% CI 92.4, 98.3%), CONCLUSIONS: MRI has high specificity but limited sensitivity for the diagnosis of PE. Inconclusive results are a major limitation to the practical application of MRI. Management studies are needed to more precisely define the role of MRI in the diagnostic workup of patients with suspected PE.
BACKGROUND: Computed tomographic pulmonary angiography (CTPA) has simplified the diagnostic approach to patients with clinically suspected pulmonary embolism (PE), but alternative imaging tests are still advocated. We aimed to systematically assess the diagnostic accuracy of magnetic resonance imaging (MRI) for PE diagnosis. METHODS: Studies evaluating the diagnostic accuracy of MRI for the diagnosis of PE were systematically searched in the PubMed and EMBASE databases (up to May 2016). QUADAS - 2 tool was used for the quality assessment of the primary studies. A bivariate random-effects regression approach was used for summary estimates of both sensitivity and specificity. RESULTS: Thirteen studies, for a total of 1170 patients, were included. Weighted mean prevalence of PE was 37% at random-effect model. Weighted mean inconclusive MRI results were 19% at random-effect model. After exclusion of technical inadequate results, MRI bivariate weighted mean sensitivity was 80.9% (95% confidence interval [CI] 68.2, 89.4%), with a bivariate weighted mean specificity of 96.4% (95% CI 92.4, 98.3%), CONCLUSIONS: MRI has high specificity but limited sensitivity for the diagnosis of PE. Inconclusive results are a major limitation to the practical application of MRI. Management studies are needed to more precisely define the role of MRI in the diagnostic workup of patients with suspected PE.