Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT.
Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT.
复制标题
DOI：
10.2214/ajr.04.1814
复制
发表时间：
2006-07-01
期刊：
影响因子：
--
通讯作者：
Bachmann, Georg
中科院分区：
文献类型：
--
作者：
Kluge, Alexander;Luboldt, Wolfgang;Bachmann, Georg
目的：本研究的目的是评估MRI技术在急性肺栓塞病例中的单独和综合用途，并将这些技术与16-MDCT的用途进行比较。受试者和方法：62例有急性肺栓塞症状的患者接受了MRI检查，从实时MRI到MR灌注成像再到MR血管造影。并与16-MDCT作为参考标准进行比较。除肺栓塞外的其他胸部偶然诊断也可通过CT和MRI进行。结果：19例患者被CT诊断为肺栓塞，共涉及90条大叶动脉、245条节段动脉和434条亚节段动脉。在每位患者的基础上，实时MRI、MR血管造影、MR灌注成像和联合方案的敏感性分别为85%、77%、100%和100%。特异性分别为98%、100%、91%和93%。MR与CT的kappa值分别为0.89、0.87、0.86、0.9。在每个栓子的基础上，实时MRI、MR血管造影和MR灌注成像对大叶性肺栓塞的敏感性分别为79%、62%和100%。对节段性肺栓塞的敏感性分别为86%、83%和97%。MR灌注成像对亚节段性肺栓塞的敏感性为93%。在CT上发现的9个偶然发现中，有8个随后也被实时MRI诊断。MRI未发现一例肺气肿。MRI平均检查时间为9分56秒。结论：与16-MDCT相比，MR联合方案对肺栓塞的诊断可靠、灵敏。MR灌注成像对肺栓塞的检测是敏感的，而实时MR和MR血管造影是特异性的。
OBJECTIVE: The purpose of this study was to assess the individual and combined usefulness of MRI techniques in cases of acute pulmonary embolism and to compare the usefulness of these techniques with that of 16-MDCT.SUBJECTS AND METHODS: Sixty-two patients with symptoms indicating acute pulmonary embolism underwent an MRI protocol that progressed from real-time MRI through MR perfusion imaging to MR angiography. The results were compared with those of 16-MDCT, which was the reference standard. Thoracic incidental diagnoses other than pulmonary embolism also were sought with CT and MRI.RESULTS: Pulmonary embolism was diagnosed with CT in 19 patients for totals of 90 lobar, 245 segmental, and 434 subsegmental arteries. On a per-patient basis, the sensitivities of real-time MRI, MR angiography, MR perfusion imaging, and the combined protocol were 85%, 77%, 100%, and 100%, respectively. The specificities were 98%, 100%, 91%, and 93%. The kappa values in a comparison of the MR techniques with CT were 0.89, 0.87, 0.86, and 0.9. On a per-embolus basis, the sensitivities of real-time MRI, MR angiography, and MR perfusion imaging for lobar pulmonary embolism were 79%, 62%, and 100%. The sensitivities for segmental pulmonary embolism were 86%, 83%, and 97%, respectively. MR perfusion imaging had a sensitivity of 93% for subsegmental pulmonary embolism. Eight of nine incidental findings revealed on CT were also subsequently diagnosed with real-time MRI. MRI failed to reveal a case of emphysema. Mean MRI examination time was 9 minutes 56 seconds.CONCLUSION: The combined MR protocol is both reliable and sensitive in comparison with 16-MDCT in the diagnosis of pulmonary embolism. MR perfusion imaging is sensitive for the detection of pulmonary embolism, whereas real-time MR and MR angiography are specific.