Schönfeld Christian, Cebotari Serghei, Voskrebenzev Andreas, Gutberlet Marcel, Hinrichs Jan, Renne Julius, Hoeper Marius M, Olsson Karen M, Welte Tobias, Wacker Frank, Vogel-Claussen Jens
Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
J Magn Reson Imaging. 2015 Jul;42(1):72-9. doi: 10.1002/jmri.24764. Epub 2014 Sep 17.
To evaluate the test performance of perfusion-weighted Fourier-decomposition (pw-FD) magnetic resonance imaging (MRI) in comparison to dynamic contrast-enhanced (DCE)-MRI as a reference standard in patients with known or suspected chronic pulmonary embolism (PE).
In 64 patients, chronic PE was ruled out or confirmed by DCE-MRI using a time-resolved angiography with stochastic trajectories (TWIST) sequence in one breath-hold. Pw-FD-MRI was performed using a 2D fast low-angle shot (FLASH) sequence in free-breathing. After a nonrigid image registration, FD was applied to generate pw-images. Lungs were scored by two radiologists (2 and 12 years of lung MRI experience) visually for each lobe and segment for hypoperfused areas. For intra- and interobserver variability, the MR images were analyzed 2 months after the first analysis, blinded to the results of the first reader.
PE was diagnosed by DCE-MRI in 39 patients. For the pw-FD MRI sensitivity, specificity, accuracy, and positive and negative predictive value for diagnosis of PE were 100%, 95%, 98%, 98%, and 100% on a per-patient basis, 94%, 94%, 94%, 95%, 94% on a per-lobe basis, and 82%, 92%, 88%, 88%, 88% on a segmental basis, respectively. Detection of subsegmental and segmental hypoperfusion using pw-FD MRI showed a moderate agreement with DCE-MRI (kappa of 0.68; 95% confidence interval: 0.64; 0.72).
Pw-FD of the lung is a feasible test to diagnose chronic PE on a per-patient level during free-breathing without the use of ionizing radiation or contrast agents.
将灌注加权傅里叶分解（pw-FD）磁共振成像（MRI）与动态对比增强（DCE）-MRI作为参考标准进行比较，评估其在已知或疑似慢性肺栓塞（PE）患者中的检测性能。
对64例患者进行研究，采用屏气一次的时间分辨随机轨迹血管造影（TWIST）序列，通过DCE-MRI排除或确诊慢性PE。使用二维快速低角度激发（FLASH）序列在自由呼吸状态下进行pw-FD-MRI检查。在进行非刚性图像配准后，应用傅里叶分解生成pw图像。由两名放射科医生（分别有2年和12年肺部MRI经验）对每个肺叶和肺段的灌注减低区域进行视觉评分。为评估观察者内和观察者间的变异性，在首次分析2个月后对MR图像进行再次分析，且第二位读者对第一位读者的结果不知情。
DCE-MRI诊断出39例PE患者。pw-FD MRI诊断PE的敏感度、特异度、准确度、阳性预测值和阴性预测值，在患者层面分别为100%、95%、98%、98%和100%；在肺叶层面分别为94%、94%、94%、95%和94%；在肺段层面分别为82%、92%、88%、88%和88%。使用pw-FD MRI检测亚段和段性灌注减低与DCE-MRI显示出中度一致性（kappa值为0.68；95%置信区间：0.64；0.72）。
肺部的pw-FD是一种可行的检测方法，可在自由呼吸状态下对患者个体诊断慢性PE，无需使用电离辐射或造影剂。
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