Review
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jun 28, 2018; 10(6): 52-64
Published online Jun 28, 2018. doi: 10.4329/wjr.v10.i6.52
Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging
Nanae Tsuchiya, Edwin JR van Beek, Yoshiharu Ohno, Hiroto Hatabu, Hans-Ulrich Kauczor, Andrew Swift, Jens Vogel-Claussen, Jürgen Biederer, James Wild, Mark O Wielpütz, Mark L Schiebler
Nanae Tsuchiya, Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0215, Japan
Nanae Tsuchiya, Mark L Schiebler, Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, United States
Edwin JR van Beek, Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
Yoshiharu Ohno, Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
Hiroto Hatabu, Department of Radiology, Brigham and Women’s Hospital, Boston, MA 02115, United States
Hans-Ulrich Kauczor, Mark O Wielpütz, Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg 69120, Germany
Andrew Swift, Department of Radiology, Royal Hallamshire Hospital, University of Sheffield, Sheffield S10 2JF, United Kingdom
Jens Vogel-Claussen, Department of Radiology, Carl-Neuberg Strasse 1, Hannover-Gr-Buchholz 30625, Germany
Jürgen Biederer, Radiology Darmstadt, Gross-Gerau County Hospital, Gross-Gerau 64521, Germany
James Wild, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2JF, United Kingdom
Author contributions: Tsuchiya N contributed to design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version; van Beek EJR, Hatabu H and Kauczor HU contributed to conception and design of the study, drafting and critical revision and editing, and final approval of the final version; Ohno Y, Vogel-Claussen J, Wild J and Schiebler ML contributed to conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version; Swift A and Wielpütz MO contributed to literature review and analysis, drafting and critical revision and editing, and final approval of the final version; Biederer J contributed to conception of study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: There are no conflicts of interest related to this work. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mark L Schiebler, MD, Professor, Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, United States. mschiebler@uwhealth.org
Telephone: +1-608-2657250 Fax: +1-608-2631229
Received: January 27, 2018
Peer-review started: January 30, 2018
First decision: March 19, 2018
Revised: April 25, 2018
Accepted: May 30, 2018
Article in press: May 30, 2018
Published online: June 28, 2018
Abstract

Pulmonary contrast enhanced magnetic resonance angiography (CE-MRA) is useful for the primary diagnosis of pulmonary embolism (PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography (CTA). In this review, we discuss the strengths and weaknesses of CE-MRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multi-institutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women (< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness (patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.

Keywords: Female, Lung, Neoplasms, Hypersensitivity, Pulmonary embolism, Magnetic resonance angiography, Radiation induced, Outcome assessment (health care), Artifacts, Computerized tomography angiography

Core tip: Pulmonary contrast enhanced magnetic resonance angiography (CE-MRA) is an effective alternative test for the primary diagnosis of pulmonary embolism (PE). In outcomes studies the negative predictive value of CE-MRA at 6 mo was 99%, which is similar to the negative predictive value of multidetector computerized tomographic angiography. The optimal patient selection is for younger female patients with a low to intermediate risk of PE or those with iodinated contrast allergies.