Samuel Z. Goldhaber, MD
How accurate is magnetic resonance angiography (MRA), with and without magnetic resonance venography (MRV), for diagnosing pulmonary embolism (PE) in adults?
Blinded comparison of MRA, with or without MRV, and the reference standard (various tests). (Prospective Investigation of Pulmonary Embolism Diagnosis III [PIOPED III]). ClinicalTrials.gov NCT00241826.
7 hospitals and their emergency services in the USA and Canada.
371 patients who were ≥ 18 years of age (mean age 49 y, 56% women) and had PE diagnosed or excluded while hospitalized or in the emergency department. Exclusion criteria included contraindications to MRA or MRV.
MRA and MRV, using 1.5-T and 3.0-T systems, within 48 to 72 hours of diagnostic standard tests. PE was diagnosed by observation of partial occlusive intraluminal filling defect or complete arterial occlusion with termination of the column of contrast material in a meniscus that outlined the trailing edge of the embolus.
CT angiogram showing PE in a main or lobar pulmonary artery, CT angiogram showing PE in a segmental or subsegmental pulmonary artery in a patient with high clinical probability based on Wells criteria, or high-probability ventilation–perfusion (VQ) lung scan in a patient with intermediate or high clinical probability based on Wells criteria and no previous PE. PE was excluded by normal D-dimer in patients with low or intermediate clinical probability, negative CT angiogram in patients with low clinical probability, negative CT angiogram and CT venogram or venous ultrasonogram in patients with intermediate clinical probability, or normal VQ lung scan.
Included sensitivity and specificity averaged across clinical centers.
Diagnostic characteristics of MRA, with and without MRV (technically adequate tests only), are shown in the Table. 25% of MRAs and 52% of MRAs with MRVs were technically inadequate (Table).
Magnetic resonance angiography (MRA) with magnetic resonance venography (MRV) had high sensitivity and specificity for diagnosing pulmonary embolism in adults, but results were technically inadequate for 52% of patients. MRA without MRV was less sensitive.
Diagnostic test characteristics of magnetic resonance angiography (MRA), with and without magnetic resonance venography (MRV), for suspected pulmonary embolism*
*Diagnostic terms defined in Glossary.
Goldhaber SZ. Magnetic resonance angiography and venography were sensitive but had poor technical adequacy for diagnosing pulmonary embolism. Ann Intern Med. ;153:JC1–12. doi: 10.7326/0003-4819-153-2-201007200-02012
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Published: Ann Intern Med. 2010;153(2):JC1-12.
Emergency Medicine, Pulmonary Embolism, Pulmonary/Critical Care, Venous Thromboembolism.
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