Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK.
Pulmonary Vascular Institute, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK.
J Magn Reson Imaging. 2017 Dec;46(6):1693-1697. doi: 10.1002/jmri.25714. Epub 2017 Apr 4.
To assess the diagnostic accuracy of magnetic resonance imaging (MRI) perfusion against perfusion single photon emission tomography (SPECT) screening for chronic thromboembolic pulmonary hypertension (CTEPH). Ventilation/perfusion (V/Q) scintigraphy is recommended to screen for suspected CTEPH. It has previously been shown that 3D dynamic contrast-enhanced (DCE) lung perfusion MRI has a similar sensitivity for diagnosing CTEPH in comparison to planar perfusion scintigraphy; however, planar scintigraphy has now been largely replaced by SPECT, due to higher spatial resolution and sensitivity.
Consecutive patients with suspected CTEPH or unexplained pulmonary hypertension attending a referral center, who underwent lung DCE perfusion MRI at 1.5T, perfusion SPECT, and computed tomography pulmonary angiography (CTPA) within 14 days of right heart catheterization, from April 2013 to April 2014, were included. DCE-MR, SPECT, and CTPA were independently analyzed by two blinded radiologists. Disagreements were corrected by consensus. The gold standard reference for the diagnosis of chronic thromboemboli was based on a review of multimodality imaging and clinical findings.
In all, 74 patients with suspected CTEPH underwent all three modalities. Forty-six were diagnosed with CTEPH (36) or chronic thromboembolic disease (CTED) (10). 3D DCE perfusion MRI correctly identified all patients (sensitivity of 100%), compared with a 97% sensitivity for SPECT.
DCE lung perfusion MRI has increased sensitivity when compared with perfusion scintigraphy in screening for CTEPH. As MRI does not use ionizing radiation, it should be considered as a first-line imaging modality in suspected CTEPH.
3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1693-1697.
评估磁共振成像（MRI）灌注与灌注单光子发射断层扫描（SPECT）筛查慢性血栓栓塞性肺动脉高压（CTEPH）的诊断准确性。通气/灌注（V/Q）闪烁显像被推荐用于筛查疑似 CTEPH。先前的研究表明，与平面灌注闪烁显像相比，3D 动态对比增强（DCE）肺部灌注 MRI 对 CTEPH 的诊断具有相似的敏感性；然而，由于空间分辨率和敏感性更高，平面闪烁显像现已在很大程度上被 SPECT 取代。
连续入选 2013 年 4 月至 2014 年 4 月期间在我院就诊并经右心导管检查的疑似 CTEPH 或不明原因肺动脉高压患者，所有患者均在 14 天内行肺部 DCE 灌注 MRI、灌注 SPECT 和计算机断层肺动脉造影（CTPA）检查。DCE-MR、SPECT 和 CTPA 由两位盲法阅片的放射科医生独立分析。有分歧的病例通过共识进行纠正。慢性血栓栓塞的金标准参考是基于多模态影像学和临床发现的综合评估。
共有 74 例疑似 CTEPH 的患者进行了所有三种检查。46 例患者诊断为 CTEPH（36 例）或慢性血栓栓塞性疾病（CTED）（10 例）。与 SPECT 的 97%的敏感性相比，3D DCE 灌注 MRI 正确识别了所有患者（敏感性为 100%）。
与灌注闪烁显像相比，DCE 肺部灌注 MRI 筛查 CTEPH 的敏感性更高。由于 MRI 不使用电离辐射，因此应被视为疑似 CTEPH 的首选影像学检查方法。
3 级技术疗效：3 级 J. Magn. Reson. Imaging 2017;46:1693-1697.
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