Zhang Long Jiang, Luo Song, Yeh Benjamin M, Zhou Chang Sheng, Tang Chun Xiang, Zhao Yan'e, Li Lin, Zheng Ling, Huang Wei, Lu Guang Ming
Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
Int J Cardiol. 2013 Oct 12;168(5):4775-83. doi: 10.1016/j.ijcard.2013.07.228. Epub 2013 Aug 1.
Three-dimensional contrast-enhanced MR pulmonary angiography (MRPA) is a suitable option for pulmonary embolism (PE) detection. However, there have been few reports on the diagnostic accuracy of MRPA for PE detection in a 3-T MR system. The purpose of this study was to evaluate the accuracy of MRPA in a 3-T MR system to detect acute PE with multidetector CT pulmonary angiography (CTPA) as reference standard.
Twenty-seven patients (18 males and 9 females, mean age 38.9±14.4 years) underwent both MRPA and CTPA within 3 days (range, 0-3 days) for evaluating PE. Pulmonary emboli in MRPA were independently analyzed on a per-patient and per-lobe basis by two radiologists. CTPA was regarded as reference standard, which was evaluated by another two radiologists in consensus. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for PE detection were calculated. Weighted κ values were calculated to evaluate agreement between readers.
Twenty-four patients had PE in 55 lung lobes in CTPA, while 3 patients had no PE detected. Readers 1 and 2 correctly detected 47 and 46 lung lobes having clots in 24 and 23 patients, corresponding to sensitivities, specificities, PPV, NPV, and accuracies of 100%, 100%, 100%, 100%, 100%; 100%, 66.7%, 96.0%, 100%, 96.4% on a per-patient basis and 85.5%, 100%, 100%, 90.9%, 94.1%; 83.6%, 93.7%, 90.2%, 89.2%, 89.6% on a per-lobe basis; respectively. Excellent inter-reader agreement (κ values=1.00 and 0.934; both P<0.001) were found for detecting PE on a per-patient and per-lobe analysis.
Three-dimensional contrast-enhanced MRPA with a 3-T MR system is a suitable alternative modality to CTPA to detect PE on a per-patient basis based on this small cohort study.
三维对比增强磁共振肺血管造影（MRPA）是检测肺栓塞（PE）的一种合适方法。然而，关于在3-T磁共振系统中MRPA检测PE的诊断准确性的报道较少。本研究的目的是以多排螺旋CT肺血管造影（CTPA）作为参考标准，评估3-T磁共振系统中MRPA检测急性PE的准确性。
27例患者（18例男性，9例女性，平均年龄38.9±14.4岁）在3天内（范围0 - 3天）接受了MRPA和CTPA检查以评估PE。两位放射科医生对MRPA中的肺栓塞进行了逐患者和逐叶独立分析。CTPA被视为参考标准，由另外两位放射科医生共同评估。计算了PE检测的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。计算加权κ值以评估读者之间的一致性。
CTPA显示24例患者的55个肺叶有PE，3例患者未检测到PE。读者1和读者2分别在24例和23例患者中正确检测到47个和46个有血栓的肺叶，基于患者的敏感性、特异性、PPV、NPV和准确性分别为100%、100%、100%、100%、100%；100%、66.7%、96.0%、100%、96.4%；基于肺叶的分别为85.5%、100%、100%、90.9%、94.1%；83.6%、93.7%、90.2%、89.2%、89.6%。在逐患者和逐叶分析中检测PE时，读者间一致性极佳（κ值分别为1.00和0.934；P均<0.001）。
基于这项小样本队列研究，3-T磁共振系统的三维对比增强MRPA是一种在逐患者基础上检测PE的合适替代方法，可替代CTPA。
