Pulmonary embolism MRI

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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Cafer Zorkun, M.D., Ph.D. [2]

## Overview

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Magnetic resonance pulmonary angiography should be considered in the setting of a pulmonary embolism only at centers that routinely perform it well and only for patients for whom standard tests are contraindicated. MRA has a sensitivity and specificity of a range of 75-100% and 95-100%, respectively.[1]

## MRI

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### Advantages

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* Non-invasive
* No contrast exposure
* Sensitive in the detection of clot in the inferior vena cava (IVC) and pelvic veins
* Although MR is more expensive than V/Q scanning, when one takes into account the high number of indeterminate findings on V/Q, the effective cost per diagnosis may be cheaper with MR.
* Magnetic resonance pulmonary angiography and magnetic resonance venography combined have a higher sensitivity than magnetic resonance pulmonary angiography alone in patients with technically adequate images. [2]

### Disadvantages

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* Although the criticism of using CT and MR angiography is that it lacks sensitivity when examining the subsegmental arteries, inter-reader agreement was only 66% with pulmonary angiography in the PIOPED Study. However, the clinical significance of undetected subsegmental PE is uncertain because they rarely cause severe symptoms.[3]

## ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance (DO NOT EDIT)[4]

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CE-MRA may be used in patients with a strong suspicion of pulmonary embolism in whom the results of other tests are equivocal or for whom iodinated contrast material or ionizing radiation are relatively contraindicated. The writing committee agrees that data in the literature are insufficient to recommend where pulmonary CE-MRA should fit into a diagnostic pathway for pulmonary embolism.

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## References

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1. ↑ Meaney JF, Weg JG, Chenevert TL, Stafford-Johnson D, Hamilton BH, Prince MR (1997). "Diagnosis of pulmonary embolism with magnetic resonance angiography". N. Engl. J. Med. 336 (20): 1422–7. doi:10.1056/NEJM199705153362004. PMID 9145679. Retrieved 2011-12-14. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
2. ↑ Stein PD, Chenevert TL, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Jablonski KA, Leeper KV, Naidich DP, Sak DJ, Sostman HD, Tapson VF, Weg JG, Woodard PK (2010). "Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III)". Ann. Intern. Med. 152 (7): 434–43, W142–3. doi:10.1059/0003-4819-152-7-201004060-00008. PMC 3138428. PMID 20368649. Unknown parameter `|month=` ignored (help); `|access-date=` requires `|url=` (help)CS1 maint: Multiple names: authors list (link)
3. ↑ Hull RD, Raskob GE, Ginsberg JS, Panju AA, Brill-Edwards P, Coates G; et al. (1994). "A noninvasive strategy for the treatment of patients with suspected pulmonary embolism". Arch Intern Med. 154 (3): 289–97. PMID 8297195.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
4. ↑ American College of Cardiology Foundation Task Force on Expert Consensus Documents. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA; et al. (2010). "ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents". Circulation. 121 (22): 2462–508. doi:10.1161/CIR.0b013e3181d44a8f. PMC 3034132. PMID 20479157.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) CS1 maint: PMC format (link)

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