Ersoy Hale, Goldhaber Samuel Z, Cai Tianxi, Luu Tuan, Rosebrook Joshua, Mulkern Robert, Rybicki Frank
Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., ASB I-L1-004, Boston, MA 02115, USA.
AJR Am J Roentgenol. 2007 May;188(5):1246-54. doi: 10.2214/AJR.06.0901.
The purpose of this study was to evaluate the efficiency and reproducibility of a single-breath-hold time-resolved 3D MR angiographic technique in the diagnosis of pulmonary embolism.
Twenty-seven consecutively registered patients with clinically suspected pulmonary embolism and contraindication to administration of iodinated contrast agents underwent imaging by time-resolved 3D MR angiography at 1.5 T. Bolus timing was not required. Two reviewers independently analyzed MR angiograms for overall image quality and evidence of pulmonary embolism. Additional imaging techniques, including pulmonary embolism CT angiography, ventilation-perfusion (V/Q) lung scanning, venous duplex sonography for deep venous thrombosis, and echocardiography for right ventricular strain, and 30-day and 3-month clinical follow-up were used to confirm the MR angiographic findings.
Image quality was sufficient for diagnosis in the cases of 98% of lobar, 92-93% of segmental, and 94-95% of all vessel parts from the main pulmonary artery though the segmental branches with excellent interobserver agreement. Findings on MR angiography were concordant with the anatomic distribution of abnormalities for all pulmonary embolism CT angiographic examinations (n = 2) and four of seven V/Q lung scans. Screening with time-resolved 3D MR angiography allowed confident exclusion or inclusion of pulmonary embolism in 96% of patients.
Time-resolved 3D MR angiography provides high temporal resolution (nine phases, one phase per 3.3 seconds) and consistently yields arterial phase only images. As found with clinical follow-up, confident diagnosis of pulmonary embolism from the main pulmonary artery through the segmental branches can be incorporated into a clinical service as a screening examination of patients with contraindications to the use of iodinated contrast material.
本研究旨在评估单次屏气时间分辨三维磁共振血管造影技术在诊断肺栓塞中的效率和可重复性。
27例连续登记的临床怀疑肺栓塞且有碘造影剂使用禁忌证的患者接受了1.5T时间分辨三维磁共振血管造影成像。无需团注计时。两名阅片者独立分析磁共振血管造影图像的整体质量及肺栓塞证据。采用包括肺栓塞CT血管造影、通气灌注（V/Q）肺扫描、下肢深静脉血栓形成的静脉双功超声检查以及右心室应变的超声心动图检查等其他成像技术，并进行30天和3个月的临床随访以证实磁共振血管造影结果。
对于98%的肺叶、92 - 93%的肺段以及94 - 95%的从主肺动脉到肺段分支的所有血管部分，图像质量足以用于诊断，观察者间一致性良好。磁共振血管造影的结果与所有肺栓塞CT血管造影检查（n = 2）以及7例V/Q肺扫描中的4例的解剖异常分布一致。通过时间分辨三维磁共振血管造影进行筛查，96%的患者能够明确排除或纳入肺栓塞诊断。
时间分辨三维磁共振血管造影提供了高时间分辨率（九个时相，每3.3秒一个时相），且始终仅生成动脉期图像。正如临床随访所发现的，从主肺动脉到肺段分支对肺栓塞进行可靠诊断可作为对有碘造影剂使用禁忌证患者的筛查检查纳入临床服务。
