Tsuchiya Nanae, van Beek Edwin Jr, Ohno Yoshiharu, Hatabu Hiroto, Kauczor Hans-Ulrich, Swift Andrew, Vogel-Claussen Jens, Biederer Jürgen, Wild James, Wielpütz Mark O, Schiebler Mark L
Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0215, Japan.
Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom.
World J Radiol. 2018 Jun 28;10(6):52-64. doi: 10.4329/wjr.v10.i6.52.
Pulmonary contrast enhanced magnetic resonance angiography (CE-MRA) is useful for the primary diagnosis of pulmonary embolism (PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography (CTA). In this review, we discuss the strengths and weaknesses of CE-MRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multi-institutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women (< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness (patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.
肺部对比增强磁共振血管造影（CE-MRA）对肺栓塞（PE）的初步诊断很有用。由于计算机断层血管造影（CTA）的速度更快且效能更高，许多地方没有选择将CE-MRA作为PE的一线诊断工具。在本综述中，我们根据在该领域独特的多机构经验，讨论CE-MRA的优缺点以及PE初步诊断的合适成像方案。基于临床决策规则，该检查的最佳患者对PE的怀疑程度为低度至中度。处于危急状态的患者不适合进行此项检查。年轻女性（<35岁）和对碘造影剂过敏的患者采用这种检查方式最为合适。我们讨论了该检查的使用历史、最近的技术创新、伪影、PE的直接和间接表现、辅助表现以及CE-MRA排除PE的有效性（患者预后）。目前的预后数据表明，对于PE的初步诊断，CE-MRA和核医学通气/灌注（V/Q）扫描是CTA有效的替代检查方法。
