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Previous Volume 336:1422-1427 May 15, 1997 Number 20 Next

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ABSTRACT

Background Diagnosing pulmonary embolism may be difficult, because there is no reliable noninvasive imaging method. We compared a new noninvasive method, gadolinium-enhanced pulmonary magnetic resonance angiography, with standard pulmonary angiography for diagnosing pulmonary embolism.

Methods A total of 30 consecutive patients with suspected pulmonary embolism underwent both standard pulmonary angiography and magnetic resonance angiography during the pulmonary arterial phase at the time of an intravenous bolus of gadolinium. All magnetic resonance images were reviewed for the presence or absence of pulmonary emboli by three independent reviewers who were unaware of the findings on standard angiograms.

Results Pulmonary embolism was detected by standard pulmonary angiography in 8 of the 30 patients in whom pulmonary embolism was suspected. All 5 lobar emboli and 16 of 17 segmental emboli identified on standard angiograms were also identified on magnetic resonance images. Two of the three reviewers reported one false positive magnetic resonance angiogram each. As compared with standard pulmonary angiography, the three sets of readings had sensitivities of 100, 87, and 75 percent and specificities of 95, 100, and 95 percent, respectively. The interobserver correlation was good (k = 0.57 to 0.83 for all vessels, 0.49 to 1.0 for main and lobar vessels, and 0.40 to 0.81 for segmental vessels).

Conclusions In this preliminary study, gadolinium-enhanced magnetic resonance angiography of the pulmonary arteries, as compared with conventional pulmonary angiography, had high sensitivity and specificity for the diagnosis of pulmonary embolism. This new technique shows promise as a noninvasive method of diagnosing pulmonary embolism without the need for ionizing radiation or iodinated contrast material.

Source Information

From the Division of Magnetic Resonance Imaging (J.F.M.M., T.L.C., D.S.-J., B.H.H., M.R.P.), Department of Radiology, and the Pulmonary and Critical Care Medicine Division (J.G.W.), Department of Internal Medicine, University of Michigan Hospitals, Ann Arbor.

Address reprint requests to Dr. Meaney at the Division of Magnetic Resonance Imaging, Department of Radiology, University of Michigan Hospitals, 1500 E. Medical Center Dr., Ann Arbor, MI 48109.

Full Text of this Article

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N Engl J Med 1997; 337:859-860, Sep 18, 1997. Correspondence

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