Time-resolved MR angiography: A primary screening examination of patients with suspected pulmonary embolism and contraindications to administration of iodinated contrast material
Time-resolved MR angiography: A primary screening examination of patients with suspected pulmonary embolism and contraindications to administration of iodinated contrast material
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DOI：
10.2214/ajr.06.0901
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发表时间：
2007-05-01
影响因子：
5
通讯作者：
Rybicki, Frank
中科院分区：
文献类型：
--
作者：
Ersoy, Hale;Goldhaber, Samuel Z.;Rybicki, Frank
OBJECTIVE.本研究的目的是评价单次屏气时间分辨三维磁共振血管造影技术在肺栓塞诊断中的效率和可重复性。27例临床疑似肺栓塞且禁忌使用碘化造影剂的连续登记患者在1.5 T下接受了时间分辨3D MR血管造影成像。不需要大剂量定时。两名评审员独立分析了MR血管造影片的整体图像质量和肺栓塞证据。其他成像技术，包括肺栓塞CT血管造影，通气-灌注（V/Q）肺扫描，静脉双功超声检查深静脉血栓形成，超声心动图右心室应变，以及30天和3个月的临床随访，以确认MR血管造影结果。在98%的肺叶、92 - 93%的节段和94 - 95%的通过节段分支的主肺动脉的所有血管部分的病例中，图像质量足以诊断，观察者之间的一致性极佳。MR血管造影结果与所有肺栓塞CT血管造影检查（n = 2）和7次V/Q肺扫描中的4次的异常解剖分布一致。时间分辨三维磁共振血管造影筛查允许96%的患者排除或纳入肺栓塞。时间分辨3D MR血管造影提供了高时间分辨率（9个相位，每3.3秒一个相位），并始终产生动脉相位图像。正如临床随访所发现的，从主肺动脉通过节段性分支的肺栓塞的可靠诊断可以纳入临床服务，作为对有碘化造影剂使用禁忌症的患者的筛查检查。
OBJECTIVE. The purpose of this study was to evaluate the efficiency and reproducibility of a single-breath-hold time-resolved 3D MR angiographic technique in the diagnosis of pulmonary embolism.MATERIAL AND METHODS. Twenty-seven consecutively registered patients with clinically suspected pulmonary embolism and contraindication to administration of iodinated contrast agents underwent imaging by time-resolved 3D MR angiography at 1.5 T. Bolus timing was not required. Two reviewers independently analyzed MR angiograms for overall image quality and evidence of pulmonary embolism. Additional imaging techniques, including pulmonary embolism CT angiography, ventilation - perfusion (V/Q) lung scanning, venous duplex sonography for deep venous thrombosis, and echocardiography for right ventricular strain, and 30-day and 3-month clinical follow-up were used to confirm the MR angiographic findings.RESULTS. Image quality was sufficient for diagnosis in the cases of 98% of lobar, 92 - 93% of segmental, and 94 - 95% of all vessel parts from the main pulmonary artery though the segmental branches with excellent interobserver agreement. Findings on MR angiography were concordant with the anatomic distribution of abnormalities for all pulmonary embolism CT angiographic examinations (n = 2) and four of seven V/Q lung scans. Screening with time- resolved 3D MR angiography allowed confident exclusion or inclusion of pulmonary embolism in 96% of patients.CONCLUSION. Time-resolved 3D MR angiography provides high temporal resolution ( nine phases, one phase per 3.3 seconds) and consistently yields arterial phase only images. As found with clinical follow-up, confident diagnosis of pulmonary embolism from the main pulmonary artery through the segmental branches can be incorporated into a clinical service as a screening examination of patients with contraindications to the use of iodinated contrast material.