Fig 1 - uploaded by Qing Fu
Content may be subject to copyright.
65-year-old female with right leg swelling and chest pain for 16 days MR pulmonary angiography (contrast-enhanced VIBE) depicted embolus in the left pulmonary arteries, left lower lobe (A) and segmental pulmonary arteries (C). CT pulmonary angiography confirmed the emboli in the same pulmonary arteries (B, D). CPR images of lower extremities (E) and transverse images (F, G) showed thrombus in the right posterior tibial veins.
Source publication
MR pulmonary angiography (MRPA) combined with indirect MR venography (MRV) was attempted by using 3D contrast-enhanced MR volume interpolated body examination (VIBE) sequence. Agreement rate for deep venous thrombosis (DVT) detection between MRV and duplex sonography (DUS) was evaluated; the potential of this method for venous thromoembolism (VTE)...
Context in source publication
Context 1
... pelvic, and lower extremity MRV showed that all the patients had DVT (fig. 1); multiple venous segments were presented with DVT for every patient, no isolated thrombus or one single vein involvement was detected. MRV achieved 100% consistency in diagnosing DVT compared to DUS for each patient analysis. Table 1 ...
Similar publications
Objectives
Pulmonary thromboembolism is a severe but probably underdiagnosed disorder. Patients with lower limb fractures are at high risk for pulmonary thromboembolism. This study aimed to demonstrate the early identification strategies for occult pulmonary thromboembolism.
Methods
From January to December 2022, 18 patients diagnosed with pulmona...
Citations
... Pulmonary MRA was also not recommended in the Prospective Investigation of Pulmonary Embolism Diagnosis III (PIOPED III) report due to technical difficulties at many sites resulting in non-diagnostic studies [14]. The results of this report raise the possibility that it might be used at sites with greater technical expertise [15]. Although it may be suggested that one should compare pulmonary MRA with the gold-standard CTA, we find it unethical to postpone treatment by performing a subsequent CTA study if definite conclusiveness can be reached with MRA at our institution. ...
... The contrast-enhanced MRA of the pulmonary arteries is an alternative to CTA-as well as digital subtraction angiography-for the assessment of vascular morphology and function [15,19,[29][30][31][32]. MRV can be used to accurately diagnose acute pelvic vein (including internal iliac vein and inferior vena cava) thrombosis better than CT and Doppler ultrasound [6,15,19,30,32]. ...
... The contrast-enhanced MRA of the pulmonary arteries is an alternative to CTA-as well as digital subtraction angiography-for the assessment of vascular morphology and function [15,19,[29][30][31][32]. MRV can be used to accurately diagnose acute pelvic vein (including internal iliac vein and inferior vena cava) thrombosis better than CT and Doppler ultrasound [6,15,19,30,32]. While ultrasound may suffer from low resolution or because the patient is obese, CT suffers from needing radiation exposure. ...
Background:
The aim of this single-center combined prospective/retrospective cohort study was to analyze Gadolinium (Gd)-enhanced MRA (magnetic resonance angiography) and MRV (MR venography) for the diagnosis of pulmonary artery embolism and deep venous thrombosis. The gold standard methods result in major exposure to radiation and a high amount of nephrotoxic iodinated contrast media. This is the first larger contrast-enhanced MR imaging study of acute and chronic venous thromboembolic disease of various stages.
Methods:
We prospectively examined 88 patients presenting clinical signs of deep vein thrombosis and/or pulmonary artery embolism. A single-session, one-stop shop Gd-enhanced MRA/MRV at 1.5 Tesla, using gradient echo sequences with very short repetition and echo times as well as low flip angles with subtraction and three-dimensional reconstruction, was performed. A diagnosis was made with the consensus of two experienced radiologists.
Results:
We observed excellent MRA image quality in 87% and even higher diagnostic image quality of MRV in 90% of our examinations. Pulmonary artery embolism occurred with deep vein thrombosis in 22%.
Conclusions:
Gd-enhanced MRA/MRV provided excellent image quality for the diagnosis of venous thromboembolic disease in the majority of cases. It may be particularly useful to plan and follow-up filter implantation and retrieval in the inferior caval vein.
... Therefore, it is necessary to determine the sequence with the most accurate results. When patients have difficulty in completely cooperating for the whole MR scanning protocol, contrast-enhanced VIBE is adequate only with 2-3 times of breath-hold for axial and coronal PE imaging (31). However, among the excluded vessels in the per-vessel analysis, including 15.3% (87/567) of the pulmonary arteries from MRPA, 6.5% (37/567) of those from VIBE and an overall 5.1% (29/567) of the pulmonary arteries from the combined MR protocol, 38.6% (61/158) of the vessels affected by emboli were still missed by MRI; these results also supported the lower diagnostic performance of MRI as compared with that of CTPA for PE diagnosis. ...
The diagnostic performance of magnetic resonance (MR) sequences for displaying different levels of pulmonary artery involvement in pulmonary embolism (PE) has rarely been reported but is essential for critically ill and emergency patients. The aim of the present study was to analyze the diagnostic accuracy of true fast imaging with steady-state precession (true FISP), MR pulmonary angiography (MRPA) and volume-interpolated body examination (VIBE) for PE detection in comparison to CT pulmonary angiography (CTPA), which is the reference standard. A total of 21 patients with confirmed deep venous thrombosis suspected of having PE were enrolled. Emboli were evaluated on per-patient and per-vessel bases. The evidence of PE on a per-vessel basis was classified into central, lobar and segmental levels, and 27 vessel segments per patient were analyzed for a total of 567 vessel segments in all patients. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Receiver operating characteristic curves were drawn to compare differences in sequences. A total of 158 pulmonary vessels were involved with emboli on CTPA, 58 of which were identified by true FISP, 63 by MRPA and 94 by VIBE. On per-patient and per-vessel bases, the sensitivity was 81.3 and 36.7%, respectively, for true FISP, 82.4 and 56.3%, respectively, for MRPA, and 94.4 and 68.1%, respectively, for VIBE; the specificity was 80.0 and 99.8%, respectively, for true FISP, 100 and 99.2%, respectively, for MRPA, and 100 and 99.2%, respectively, for VIBE. The respective PPV was 92.9 and 98.3% for true FISP, 100 and 95.5% for MRPA, 100 and 96.9% for VIBE. The NPV was 57.1 and 80.3%, respectively, for true FISP, 50.0 and 88.2%, respectively, for MRPA, and 75.0 and 89.8%, respectively, for VIBE. In conclusion, enhanced VIBE surpassed the other two sequences in revealing PE, particularly in segmental analysis, which is essential for emergency patients who have contraindications for receiving iodinated contrast and those who have concerns about the ionizing radiation.
