Meaney J F, Weg J G, Chenevert T L, Stafford-Johnson D, Hamilton B H, Prince M R
Department of Internal Medicine, University of Michigan Hospitals, Ann Arbor 48109, USA.
N Engl J Med. 1997 May 15;336(20):1422-7. doi: 10.1056/NEJM199705153362004.
Diagnosing pulmonary embolism may be difficult, because there is no reliable noninvasive imaging method. We compared a new noninvasive method, gadolinium-enhanced pulmonary magnetic resonance angiography, with standard pulmonary angiography for diagnosing pulmonary embolism.
A total of 30 consecutive patients with suspected pulmonary embolism underwent both standard pulmonary angiography and magnetic resonance angiography during the pulmonary arterial phase at the time of an intravenous bolus of gadolinium. All magnetic resonance images were reviewed for the presence or absence of pulmonary emboli by three independent reviewers who were unaware of the findings on standard angiograms.
Pulmonary embolism was detected by standard pulmonary angiography in 8 of the 30 patients in whom pulmonary embolism was suspected. All 5 lobar emboli and 16 of 17 segmental emboli identified on standard angiograms were also identified on magnetic resonance images. Two of the three reviewers reported one false positive magnetic resonance angiogram each. As compared with standard pulmonary angiography, the three sets of readings had sensitivities of 100, 87, and 75 percent and specificities of 95, 100, and 95 percent, respectively. The interobserver correlation was good (k=0.57 to 0.83 for all vessels, 0.49 to 1.0 for main and lobar vessels, and 0.40 to 0.81 for segmental vessels).
In this preliminary study, gadolinium-enhanced magnetic resonance angiography of the pulmonary arteries, as compared with conventional pulmonary angiography, had high sensitivity and specificity for the diagnosis of pulmonary embolism. This new technique shows promise as a noninvasive method of diagnosing pulmonary embolism without the need for ionizing radiation or iodinated contrast material.
由于缺乏可靠的非侵入性成像方法，诊断肺栓塞可能存在困难。我们将一种新的非侵入性方法——钆增强肺磁共振血管造影，与标准肺血管造影在诊断肺栓塞方面进行了比较。
共有30例连续的疑似肺栓塞患者在静脉推注钆时的肺动脉期接受了标准肺血管造影和磁共振血管造影。三位独立的阅片者在不知标准血管造影结果的情况下，对所有磁共振图像进行了肺栓塞有无的评估。
30例疑似肺栓塞患者中，标准肺血管造影检测出8例存在肺栓塞。标准血管造影所发现的所有5个叶性栓子和17个节段性栓子中的16个，在磁共振图像上也被识别出来。三位阅片者中有两位各报告了1例假阳性磁共振血管造影结果。与标准肺血管造影相比，三组读数的敏感性分别为100%、87%和75%，特异性分别为95%、100%和95%。观察者间的相关性良好（所有血管的k值为0.57至0.83，主血管和叶血管的k值为0.49至1.0，节段血管的k值为0.40至0.81）。
在这项初步研究中，与传统肺血管造影相比，钆增强肺动脉磁共振血管造影对肺栓塞的诊断具有较高的敏感性和特异性。这项新技术有望成为一种无需电离辐射或碘化造影剂的非侵入性肺栓塞诊断方法。
