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

  • Magnetic Resonance
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Abstract

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.

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Acknowledgements

The authors S.R. and D.C. are funded by Pfizer and Bayer respectively through unrestricted research grants. The UK EPSRC (J.M.W.) and the Sheffield Cardio Vascular Biomedical Research Unit (A.J.S.).

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Authors and Affiliations

  1. Unit of Academic Radiology, University of Sheffield, Sheffield, UK

    Smitha Rajaram, Andrew J. Swift, David Capener, Adam Telfer & Jim M. Wild

  2. Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    Robin Condliffe, Charles Elliot, Judith Hurdman & David G. Kiely

  3. Department of Radiology, Sheffield Teaching Hospitals Trust, Sheffield, UK

    Christine Davies & Catherine Hill

  4. Sheffield Cardiovascular Biomedical Research Unit, Sheffield, UK

    Andrew J. Swift, Robin Condliffe, Charles Elliot, David G. Kiely & Jim M. Wild

  5. Academic Unit of Radiology, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK

    Smitha Rajaram

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  1. Smitha Rajaram
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  2. Andrew J. Swift
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Correspondence to Smitha Rajaram.

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Rajaram, S., Swift, A.J., Capener, D. et al. Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension. Eur Radiol 22, 310–317 (2012). https://doi.org/10.1007/s00330-011-2252-x

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  • DOI: https://doi.org/10.1007/s00330-011-2252-x

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