Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension

• Published in: European radiology 2012-02, Vol.22 (2), p.310-317
• Main Authors: Rajaram, Smitha, Swift, Andrew J., Capener, David, Telfer, Adam, Davies, Christine, Hill, Catherine, Condliffe, Robin, Elliot, Charles, Hurdman, Judith, Kiely, David G., Wild, Jim M.
• Format: Article
• Language: English
• Subjects: Accuracy; Aged; Angiography - methods; Blood clots; Contrast agents; Contrast Media - pharmacology; Diagnostic Radiology; Female; Humans; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - pathology; Imaging; Internal Medicine; Interventional Radiology; Lung - diagnostic imaging; Lung - pathology; Magnetic Resonance; Magnetic Resonance Angiography - methods; Magnetic resonance imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Observer Variation; Perfusion; Pulmonary arteries; Pulmonary embolisms; Pulmonary hypertension; Radiology; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Teaching hospitals; Thromboembolism; Thromboembolism - diagnosis; Thromboembolism - diagnostic imaging; Thromboembolism - pathology; Tomography, X-Ray Computed - methods; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-011-2252-x

Objective To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) and the added benefit of unenhanced proton MR angiography compared with CT pulmonary angiography (CTPA) in patients with chronic thromboembolic disease (CTE). Methods A 2 year retrospective study of 53 patients with chronic thromboembolic pulmonary hypertension who underwent CTPA and MRI for suspected pulmonary hypertension and a control group of 36 patients with no CT evidence of pulmonary embolism. The MRI was evaluated for CTE and the combined diagnostic accuracy of ce-MRA and unenhanced proton MRA was determined. CE-MRA generated lung perfusion maps were also assessed. Results The overall sensitivity and specificity of CE-MRA in diagnosing proximal and distal CTE were 98% and 94%, respectively. The sensitivity improved from 50% to 88% for central vessel disease when CE-MRA images were analysed with unenhanced proton MRA. The CE-MRA identified more stenoses (29/18), post-stenosis dilatation (23/7) and occlusions (37/29) compared with CTPA. The CE-MRA perfusion images showed a sensitivity of 92% for diagnosing CTE. Conclusion CE-MRA has high sensitivity and specificity for diagnosing CTE. The sensitivity of CE-MRA for visualisation of adherent central and lobar thrombus significantly improves with the addition of unenhanced proton MRA which delineates the vessel wall.