Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan.
Jpn J Radiol. 2011 Nov;29(9):667-72. doi: 10.1007/s11604-011-0609-3. Epub 2011 Sep 29.
The aim of this study was to assess the potential diagnostic value of three-dimensional T2-weighted imaging using the dark blood method for detecting pulmonary embolism (PE).
Ten consecutive patients with already diagnosed acute PE (five men, five women; mean age 58.6 years, range 35-79 years) were prospectively enrolled in this study. All patients underwent lung magnetic resonance imaging (MRI) with a 1.5-T scanner. MRI was performed on the same day as CT angiography (CTA), which was undertaken to monitor treatment. Two radiologists performed a consensus evaluation of MRI followed by CTA on a per-vessel basis: the main pulmonary artery (PA), lobar PA, segmental PA, and subsegmental PA. Each modality was evaluated independently on separate days (at least 8 weeks apart). The accuracy of MRI for detecting PE was determined by comparing it with CTA results, which were used as a reference standard. Cohen's kappa analysis was used for statistical analyses.
Among the 10 patients, pulmonary emboli were seen in 6 of 20 main arteries, 22 of 60 lobar arteries, 35 of 180 segmental arteries, and 8 of 410 subsegmental arteries on CTA. The sensitivities/specificities of MRI were 100%/100% for the main PA, 90.9%/97.3% for the lobar PA, and 74.2%/97.9% for the segmental PA, respectively. Altogether, 304 (83%) of 410 subsegmental arteries were not visualized on MRI and only 1 of the 8 emboli in the subsegmental branches was depicted. The kappa values for the main, lobar, and segmental arteries were 1.0, 0.89, and 0.77, respectively.
Three-dimensional T2-weighted imaging using the dark blood method appears to be principally useful for diagnosing main, lobar, and segmental PEs.
本研究旨在评估使用黑血法三维 T2 加权成像检测肺栓塞（PE）的潜在诊断价值。
本研究前瞻性纳入 10 例已确诊急性 PE 的连续患者（5 名男性，5 名女性；平均年龄 58.6 岁，范围 35-79 岁）。所有患者均在 1.5-T 扫描仪上进行肺磁共振成像（MRI）检查。MRI 是在 CT 血管造影（CTA）的同一天进行的，CTA 用于监测治疗。两名放射科医生对 MRI 进行了共识评估，然后对每根血管（主肺动脉（PA）、叶肺动脉、段肺动脉和亚段肺动脉）进行 CTA 评估。每种方式都是在单独的日子进行独立评估（至少相隔 8 周）。通过将 MRI 与 CTA 结果进行比较来确定 MRI 检测 PE 的准确性，CTA 结果被用作参考标准。采用 Cohen's kappa 分析进行统计学分析。
在 10 例患者中，CTA 显示 6 例主肺动脉、22 例叶肺动脉、35 例段肺动脉和 8 例亚段肺动脉有肺栓塞。MRI 的敏感性/特异性分别为主肺动脉 100%/100%、叶肺动脉 90.9%/97.3%和段肺动脉 74.2%/97.9%。共有 410 个亚段肺动脉中的 304 个（83%）在 MRI 上未显示，只有 8 个亚段分支中的 1 个栓塞被显示。主、叶和段肺动脉的 kappa 值分别为 1.0、0.89 和 0.77。
使用黑血法的三维 T2 加权成像似乎主要用于诊断主、叶和段 PEs。
