Pleszewski Bartlomiej, Chartrand-Lefebvre Carl, Qanadli Salah D, Déry Renée, Perreault Pierre, Oliva Vincent L, Prenovault Julie, Belblidia Assia, Soulez Gilles
Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc, Radiology Department, St-Denis Street, Montreal, Quebec, Canada H2X 3J4.
Clin Imaging. 2006 May-Jun;30(3):166-72. doi: 10.1016/j.clinimag.2005.10.005.
Gadolinium-enhanced pulmonary magnetic resonance angiography (MRA) can be an option in patients with a history of previous adverse reaction to iodinated contrast material and renal insufficiency. Radiation is also avoided. The aim of this study is to prospectively compare the diagnostic value of MRA with that of a diagnostic strategy, taking into account catheter angiography, computed tomography angiography (CTA), and lung scintigraphy [ventilation-perfusion (VQ)].
Magnetic resonance angiography was done in 48 patients with clinically suspected pulmonary embolism (PE) using fast gradient echo coronal acquisition with gadolinium. Interpretation was done with native coronal images and multiplanar maximum intensity projection reconstructions. Results were compared to catheter angiography (n=15), CTA (n=34), VQ (n=45), as well as 6-12 months clinical follow-ups, according to a sequenced reference tree.
The final diagnosis of PE was retained in 11 patients (23%). There were two false negatives and no false positive results with MRA. Computed tomography angiography resulted in no false negatives or false positives. Magnetic resonance angiography had a sensitivity of 82% and a specificity of 100%.
In our study, pulmonary MRA had a sensitivity of 82% and a specificity of 100% for the diagnosis of PE, with slightly less sensitivity than CTA. In the diagnostic algorithm of PE, pulmonary MRA should be considered as an alternative to CTA when iodine contrast injection or radiation is a significant matter.
对于有碘造影剂既往不良反应史和肾功能不全的患者，钆增强肺磁共振血管造影（MRA）可能是一种选择。同时也避免了辐射。本研究的目的是前瞻性地比较MRA与一种诊断策略（考虑导管血管造影、计算机断层血管造影（CTA）和肺闪烁显像[通气-灌注（VQ）]）的诊断价值。
对48例临床怀疑肺栓塞（PE）的患者进行了磁共振血管造影，采用钆快速梯度回波冠状位采集。通过原始冠状位图像和多平面最大强度投影重建进行解读。根据顺序参考树，将结果与导管血管造影（n = 15）、CTA（n = 34）、VQ（n = 45）以及6 - 12个月的临床随访结果进行比较。
11例患者（23%）最终诊断为PE。MRA有2例假阴性，无假阳性结果。CTA无假阴性或假阳性。磁共振血管造影的敏感性为82%，特异性为100%。
在我们的研究中，肺MRA对PE诊断的敏感性为82%，特异性为100%，敏感性略低于CTA。在PE的诊断算法中，当碘造影剂注射或辐射是重要问题时，肺MRA应被视为CTA的替代方法。
