Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Tumor Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
J Thromb Haemost. 2015 Sep;13(9):1623-34. doi: 10.1111/jth.13054. Epub 2015 Aug 11.
With ongoing technical developments, magnetic resonance imaging (MRI) has notably evolved for the assessment of the pulmonary vasculature. However, uncertainty persists about the performance of MRI for the diagnosis of acute pulmonary embolism (APE).
To clarify the comprehensive role of MRI in diagnosing APE.
Studies were identified through a search of Pubmed and Ovid databases, and the QUADAS-2 tool was applied for quality assessment of the included studies.
Fifteen studies based on patients and nine based on vessels were retrieved. The patient-based analysis yielded an overall sensitivity of 0.75 (95% confidence interval, 0.70-0.79) and 0.84 (0.80-0.87) for all patients and patients with technically adequate images, respectively, with an overall specificity of 0.80 (0.77-0.83) and 0.97 (0.96-0.98) and a pooled diagnostic odds ratio (DOR) of 51.07 (18.36-142.05) and 155.22 (86.83-277.47). On average, MRI was technically inadequate in 18.89% of patients (range, 2.10%-27.70%). A direct comparison of different MRI modalities showed that the combined MRI test had the highest pooled DOR and the lowest proportion of inconclusive images. Of note, heterogeneity and moderate quality were observed. On a vessel basis, the MRI had high sensitivity and specificity in larger-order vessels, but a significantly lower sensitivity of 0.55 (0.50-0.60) for subsegmental APE.
On a patient-based level, MRI yields high diagnostic accuracy for the detection of APE, especially in technically adequate images, and the inconclusive MRI examinations mainly result from motion artifact and poor arterial opacification. The combined MRI test appears to be a more promising diagnostic tool with greater power of discrimination than single techniques. From a vessel-based perspective, MRI exhibits a high diagnostic capability with proximal arteries, but lacks sensitivity for peripheral embolism.
随着技术的不断发展，磁共振成像（MRI）在评估肺血管方面取得了显著进展。然而，对于 MRI 在急性肺栓塞（APE）诊断中的性能仍存在不确定性。
阐明 MRI 在诊断 APE 中的综合作用。
通过搜索 Pubmed 和 Ovid 数据库确定研究，应用 QUADAS-2 工具评估纳入研究的质量。
共检索到 15 项基于患者的研究和 9 项基于血管的研究。基于患者的分析显示，所有患者和技术上图像质量足够的患者的总体敏感性分别为 0.75（95%置信区间，0.70-0.79）和 0.84（0.80-0.87），总体特异性分别为 0.80（0.77-0.83）和 0.97（0.96-0.98），汇总诊断比值比（DOR）分别为 51.07（18.36-142.05）和 155.22（86.83-277.47）。平均而言，MRI 技术上不充分的患者占 18.89%（范围，2.10%-27.70%）。不同 MRI 方式的直接比较显示，联合 MRI 检查具有最高的汇总 DOR 和最低比例的不确定图像。值得注意的是，观察到异质性和中等质量。基于血管，MRI 在较大的血管中具有较高的敏感性和特异性，但对于亚段 APE 的敏感性明显较低，为 0.55（0.50-0.60）。
基于患者水平，MRI 对 APE 的检测具有较高的诊断准确性，特别是在技术上图像质量足够的情况下，不确定的 MRI 检查主要是由于运动伪影和动脉显影不良所致。联合 MRI 检查似乎是一种更有前途的诊断工具，比单一技术具有更大的鉴别力。从血管角度来看，MRI 对近端动脉具有较高的诊断能力，但对周围栓塞缺乏敏感性。
Zotero 插件