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Published in: European Radiology 2/2012

01-02-2012 | Magnetic Resonance

Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension

Authors: Smitha Rajaram, Andrew J. Swift, David Capener, Adam Telfer, Christine Davies, Catherine Hill, Robin Condliffe, Charles Elliot, Judith Hurdman, David G. Kiely, Jim M. Wild

Published in: European Radiology | Issue 2/2012

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Abstract

Objective

To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) and the added benefit of unenhanced proton MR angiography compared with CT pulmonary angiography (CTPA) in patients with chronic thromboembolic disease (CTE).

Methods

A 2 year retrospective study of 53 patients with chronic thromboembolic pulmonary hypertension who underwent CTPA and MRI for suspected pulmonary hypertension and a control group of 36 patients with no CT evidence of pulmonary embolism. The MRI was evaluated for CTE and the combined diagnostic accuracy of ce-MRA and unenhanced proton MRA was determined. CE-MRA generated lung perfusion maps were also assessed.

Results

The overall sensitivity and specificity of CE-MRA in diagnosing proximal and distal CTE were 98% and 94%, respectively. The sensitivity improved from 50% to 88% for central vessel disease when CE-MRA images were analysed with unenhanced proton MRA. The CE-MRA identified more stenoses (29/18), post-stenosis dilatation (23/7) and occlusions (37/29) compared with CTPA. The CE-MRA perfusion images showed a sensitivity of 92% for diagnosing CTE.

Conclusion

CE-MRA has high sensitivity and specificity for diagnosing CTE. The sensitivity of CE-MRA for visualisation of adherent central and lobar thrombus significantly improves with the addition of unenhanced proton MRA which delineates the vessel wall.
Literature
1.
go back to reference Riedel M, Stanek V, Widimsky J, Prerovsky I (1982) Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. Chest 81:151–158PubMedCrossRef Riedel M, Stanek V, Widimsky J, Prerovsky I (1982) Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. Chest 81:151–158PubMedCrossRef
2.
go back to reference Moser KM, Bloor CM (1993) Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest 103:685–692PubMedCrossRef Moser KM, Bloor CM (1993) Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest 103:685–692PubMedCrossRef
3.
go back to reference Pengo V, Lensing AW, Prins MH et al (2004) Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 350:2257–2264PubMedCrossRef Pengo V, Lensing AW, Prins MH et al (2004) Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 350:2257–2264PubMedCrossRef
4.
go back to reference Wartski M, Collignon MA (2000) Incomplete recovery of lung perfusion after 3 months in patients with acute pulmonary embolism treated with antithrombotic agents. THESEE Study Group. Tinzaparin ou Heparin Standard: Evaluation dans l’Embolie Pulmonaire Study. J Nucl Med 41:1043–1048PubMed Wartski M, Collignon MA (2000) Incomplete recovery of lung perfusion after 3 months in patients with acute pulmonary embolism treated with antithrombotic agents. THESEE Study Group. Tinzaparin ou Heparin Standard: Evaluation dans l’Embolie Pulmonaire Study. J Nucl Med 41:1043–1048PubMed
5.
go back to reference Remy-Jardin M, Louvegny S, Remy J et al (1997) Acute central thromboembolic disease: posttherapeutic follow-up with spiral CT angiography. Radiology 203:173–180PubMed Remy-Jardin M, Louvegny S, Remy J et al (1997) Acute central thromboembolic disease: posttherapeutic follow-up with spiral CT angiography. Radiology 203:173–180PubMed
6.
go back to reference Ribeiro A, Lindmarker P, Johnsson H, Juhlin-Dannfelt A, Jorfeldt L (1999) Pulmonary embolism: one-year follow-up with echocardiography doppler and five-year survival analysis. Circulation 99:1325–1330PubMed Ribeiro A, Lindmarker P, Johnsson H, Juhlin-Dannfelt A, Jorfeldt L (1999) Pulmonary embolism: one-year follow-up with echocardiography doppler and five-year survival analysis. Circulation 99:1325–1330PubMed
7.
go back to reference Daily PO, Johnston GG, Simmons CJ, Moser KM (1980) Surgical management of chronic pulmonary embolism: surgical treatment and late results. J Thorac Cardiovasc Surg 79:523–531PubMed Daily PO, Johnston GG, Simmons CJ, Moser KM (1980) Surgical management of chronic pulmonary embolism: surgical treatment and late results. J Thorac Cardiovasc Surg 79:523–531PubMed
8.
go back to reference Jamieson SW, Auger WR, Fedullo PF et al (1993) Experience and results with 150 pulmonary thromboendarterectomy operations over a 29-month period. J Thorac Cardiovasc Surg 106:116–126, discussion 126–117PubMed Jamieson SW, Auger WR, Fedullo PF et al (1993) Experience and results with 150 pulmonary thromboendarterectomy operations over a 29-month period. J Thorac Cardiovasc Surg 106:116–126, discussion 126–117PubMed
9.
go back to reference Kauczor HU, Schwickert HC, Mayer E, Schweden F, Schild HH, Thelen M (1994) Spiral CT of bronchial arteries in chronic thromboembolism. J Comput Assist Tomogr 18:855–861PubMedCrossRef Kauczor HU, Schwickert HC, Mayer E, Schweden F, Schild HH, Thelen M (1994) Spiral CT of bronchial arteries in chronic thromboembolism. J Comput Assist Tomogr 18:855–861PubMedCrossRef
10.
go back to reference Wittram C, Kalra MK, Maher MM, Greenfield A, McLoud TC, Shepard JA (2006) Acute and chronic pulmonary emboli: angiography-CT correlation. AJR Am J Roentgenol 186:S421–S429PubMedCrossRef Wittram C, Kalra MK, Maher MM, Greenfield A, McLoud TC, Shepard JA (2006) Acute and chronic pulmonary emboli: angiography-CT correlation. AJR Am J Roentgenol 186:S421–S429PubMedCrossRef
11.
go back to reference Remy-Jardin M, Remy J, Wattinne L, Giraud F (1992) Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique–comparison with pulmonary angiography. Radiology 185:381–387PubMed Remy-Jardin M, Remy J, Wattinne L, Giraud F (1992) Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique–comparison with pulmonary angiography. Radiology 185:381–387PubMed
12.
go back to reference Kreitner KF, Kunz RP, Ley S et al (2007) Chronic thromboembolic pulmonary hypertension—assessment by magnetic resonance imaging. Eur Radiol 17:11–21PubMedCrossRef Kreitner KF, Kunz RP, Ley S et al (2007) Chronic thromboembolic pulmonary hypertension—assessment by magnetic resonance imaging. Eur Radiol 17:11–21PubMedCrossRef
13.
go back to reference Kreitner KF, Ley S, Kauczor HU et al (2004) Chronic thromboembolic pulmonary hypertension: pre- and postoperative assessment with breath-hold MR imaging techniques. Radiology 232:535–543PubMedCrossRef Kreitner KF, Ley S, Kauczor HU et al (2004) Chronic thromboembolic pulmonary hypertension: pre- and postoperative assessment with breath-hold MR imaging techniques. Radiology 232:535–543PubMedCrossRef
14.
go back to reference Lisbona R, Kreisman H, Novales-Diaz J, Derbekyan V (1985) Perfusion lung scanning: differentiation of primary from thromboembolic pulmonary hypertension. AJR Am J Roentgenol 144:27–30PubMed Lisbona R, Kreisman H, Novales-Diaz J, Derbekyan V (1985) Perfusion lung scanning: differentiation of primary from thromboembolic pulmonary hypertension. AJR Am J Roentgenol 144:27–30PubMed
15.
go back to reference Ryan KL, Fedullo PF, Davis GB, Vasquez TE, Moser KM (1988) Perfusion scan findings understate the severity of angiographic and hemodynamic compromise in chronic thromboembolic pulmonary hypertension. Chest 93:1180–1185PubMedCrossRef Ryan KL, Fedullo PF, Davis GB, Vasquez TE, Moser KM (1988) Perfusion scan findings understate the severity of angiographic and hemodynamic compromise in chronic thromboembolic pulmonary hypertension. Chest 93:1180–1185PubMedCrossRef
16.
go back to reference Stein PD, Athanasoulis C, Alavi A et al (1992) Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation 85:462–468PubMed Stein PD, Athanasoulis C, Alavi A et al (1992) Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation 85:462–468PubMed
17.
go back to reference Bergin CJ, Sirlin CB, Hauschildt JP et al (1997) Chronic thromboembolism: diagnosis with helical CT and MR imaging with angiographic and surgical correlation. Radiology 204:695–702PubMed Bergin CJ, Sirlin CB, Hauschildt JP et al (1997) Chronic thromboembolism: diagnosis with helical CT and MR imaging with angiographic and surgical correlation. Radiology 204:695–702PubMed
18.
go back to reference Schwickert HC, Schweden F, Schild HH et al (1994) Pulmonary arteries and lung parenchyma in chronic pulmonary embolism: preoperative and postoperative CT findings. Radiology 191:351–357PubMed Schwickert HC, Schweden F, Schild HH et al (1994) Pulmonary arteries and lung parenchyma in chronic pulmonary embolism: preoperative and postoperative CT findings. Radiology 191:351–357PubMed
19.
go back to reference Ley S, Grunig E, Kiely DG, van Beek E, Wild J (2010) Computed tomography and magnetic resonance imaging of pulmonary hypertension: pulmonary vessels and right ventricle. J Magn Reson Imaging 32:1313–1324PubMedCrossRef Ley S, Grunig E, Kiely DG, van Beek E, Wild J (2010) Computed tomography and magnetic resonance imaging of pulmonary hypertension: pulmonary vessels and right ventricle. J Magn Reson Imaging 32:1313–1324PubMedCrossRef
20.
go back to reference Sergiacomi G, Bolacchi F, Cadioli M et al (2010) Combined pulmonary fibrosis and emphysema: 3D time-resolved MR angiographic evaluation of pulmonary arterial mean transit time and time to peak enhancement. Radiology 254:601–608PubMedCrossRef Sergiacomi G, Bolacchi F, Cadioli M et al (2010) Combined pulmonary fibrosis and emphysema: 3D time-resolved MR angiographic evaluation of pulmonary arterial mean transit time and time to peak enhancement. Radiology 254:601–608PubMedCrossRef
21.
go back to reference Ohno Y, Hatabu H, Murase K et al (2007) Primary pulmonary hypertension: 3D dynamic perfusion MRI for quantitative analysis of regional pulmonary perfusion. AJR Am J Roentgenol 188:48–56PubMedCrossRef Ohno Y, Hatabu H, Murase K et al (2007) Primary pulmonary hypertension: 3D dynamic perfusion MRI for quantitative analysis of regional pulmonary perfusion. AJR Am J Roentgenol 188:48–56PubMedCrossRef
22.
go back to reference Ley S, Kreitner KF, Morgenstern I, Thelen M, Kauczor HU (2002) Bronchopulmonary shunts in patients with chronic thromboembolic pulmonary hypertension: evaluation with helical CT and MR imaging. AJR Am J Roentgenol 179:1209–1215PubMed Ley S, Kreitner KF, Morgenstern I, Thelen M, Kauczor HU (2002) Bronchopulmonary shunts in patients with chronic thromboembolic pulmonary hypertension: evaluation with helical CT and MR imaging. AJR Am J Roentgenol 179:1209–1215PubMed
23.
go back to reference Jahnke C, Paetsch I, Schnackenburg B et al (2004) Coronary MR angiography with steady-state free precession: individually adapted breath-hold technique versus free-breathing technique. Radiology 232:669–676PubMedCrossRef Jahnke C, Paetsch I, Schnackenburg B et al (2004) Coronary MR angiography with steady-state free precession: individually adapted breath-hold technique versus free-breathing technique. Radiology 232:669–676PubMedCrossRef
24.
go back to reference Deshpande VS, Shea SM, Laub G, Simonetti OP, Finn JP, Li D (2001) 3D magnetization-prepared true-FISP: a new technique for imaging coronary arteries. Magn Reson Med 46:494–502PubMedCrossRef Deshpande VS, Shea SM, Laub G, Simonetti OP, Finn JP, Li D (2001) 3D magnetization-prepared true-FISP: a new technique for imaging coronary arteries. Magn Reson Med 46:494–502PubMedCrossRef
25.
go back to reference Hui BK, Noga ML, Gan KD, Wilman AH (2005) Navigator-gated three-dimensional MR angiography of the pulmonary arteries using steady-state free precession. J Magn Reson Imaging 21:831–835PubMedCrossRef Hui BK, Noga ML, Gan KD, Wilman AH (2005) Navigator-gated three-dimensional MR angiography of the pulmonary arteries using steady-state free precession. J Magn Reson Imaging 21:831–835PubMedCrossRef
26.
go back to reference Ley S, Kauczor HU, Heussel CP et al (2003) Value of contrast-enhanced MR angiography and helical CT angiography in chronic thromboembolic pulmonary hypertension. Eur Radiol 13:2365–2371PubMedCrossRef Ley S, Kauczor HU, Heussel CP et al (2003) Value of contrast-enhanced MR angiography and helical CT angiography in chronic thromboembolic pulmonary hypertension. Eur Radiol 13:2365–2371PubMedCrossRef
Metadata
Title
Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension
Authors
Smitha Rajaram
Andrew J. Swift
David Capener
Adam Telfer
Christine Davies
Catherine Hill
Robin Condliffe
Charles Elliot
Judith Hurdman
David G. Kiely
Jim M. Wild
Publication date
01-02-2012
Publisher
Springer-Verlag
Published in
European Radiology / Issue 2/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-011-2252-x

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