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Correspondence |

MRI in Acute Pulmonary EmbolismMRI in Acute Pulmonary Embolism: A Valuable Alternative in the Assessment of Suspected Acute Pulmonary Embolism FREE TO VIEW

Bruno Hochhegger, MD, PhD; Gláucia Zanetti, MD, PhD; Edson Marchiori, MD, PhD
Author and Funding Information

From the Department of Radiology, the Federal University of Rio de Janeiro.

Correspondence to: Bruno Hochhegger, MD, PhD, Rua Vinte e Quatro de outubro, 925, CEP 25685.120, Porto Alegre Rio grande do Sul, Brazil; e-mail: brunohochhegger@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1391. doi:10.1378/chest.10-2793
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To the Editor:

We congratulate Salaun et al1 for their important article recently published in CHEST (June 2011). The article shows that ventilation-perfusion ratio (/) scanning can be an alternative for the study of acute pulmonary embolism (APE). However, we would like to highlight the importance of MRI in APE diagnosis.

Diagnostic strategies for APE have evolved over the last several decades with the development of new methods. Initially, the time required for an MRI, and the lack of MRI-compatible monitoring devices hindered the broad clinical acceptance of this method. Recently, however, significant technical developments in pulmonary magnetic resonance angiography (MRA) have occurred. Improvements include the use of parallel imaging, time-resolved echo-shared angiography,2 and pulmonary perfusion. These techniques have shortened the acquisition time of MRA, improved spatial resolution, and made it less susceptible to motion artifacts.

A meta-analysis of studies that adopted gadolinium-enhanced MRI for APE used conventional pulmonary angiography as the reference standard. A broad range of sensitivities, from 77% to 100%, was reported, with uniformly high specificities of 95% to 98%.3 For suspected APE, the accuracy of MRI studies that use a state-of-the-art protocol with pulmonary perfusion was both reliable and sensitive compared with multidetector CT (MDCT) scanning.4 The average MRI examination time was approximately 10 min.4 Pulmonary perfusion is the most promising technique for the diagnosis of APE.4 However, even in protocols without pulmonary perfusion, large studies have shown good results using MRI.5

The increased use of MDCT scanning and / scanning has raised concerns about overall radiation exposure in the population and have highlighted the need in the radiology community for optimized scanning protocols.4 MRI does not require ionizing radiation, or iodinated contrast media, and is associated with less renal impairment than MDCT.

Therefore, MRI has some potential advantages over MDCT scanning and / scanning (eg, a radiation-free method, a better safety profile for MRI contrast media, the capability of functional imaging). In certain patient groups, MRI might be considered a valuable alternative for assessing suspected APE.

Salaun P-Y, Couturaud F, Le Duc-Pennec A, et al. Noninvasive diagnosis of pulmonary embolism. Chest. 2011;1396:1294-1298 [CrossRef] [PubMed]
 
Fink C, Ley S, Kroeker R, Requardt M, Kauczor HU, Bock M. Time-resolved contrast-enhanced three-dimensional magnetic resonance angiography of the chest: combination of parallel imaging with view sharing (TREAT). Invest Radiol. 2005;401:40-48 [PubMed]
 
Stein PD, Woodard PK, Hull RD, et al. Gadolinium-enhanced magnetic resonance angiography for detection of acute pulmonary embolism: an in-depth review. Chest. 2003;1246:2324-2328 [CrossRef] [PubMed]
 
Kluge A, Luboldt W, Bachmann G. Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT. AJR Am J Roentgenol. 2006;1871:W7-14 [CrossRef] [PubMed]
 
Stein PD, Chenevert TL, Fowler SE, et al. PIOPED III (Prospective Investigation of Pulmonary Embolism Diagnosis III) Investigators. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med. 2010;1527:434-443 [PubMed]
 

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References

Salaun P-Y, Couturaud F, Le Duc-Pennec A, et al. Noninvasive diagnosis of pulmonary embolism. Chest. 2011;1396:1294-1298 [CrossRef] [PubMed]
 
Fink C, Ley S, Kroeker R, Requardt M, Kauczor HU, Bock M. Time-resolved contrast-enhanced three-dimensional magnetic resonance angiography of the chest: combination of parallel imaging with view sharing (TREAT). Invest Radiol. 2005;401:40-48 [PubMed]
 
Stein PD, Woodard PK, Hull RD, et al. Gadolinium-enhanced magnetic resonance angiography for detection of acute pulmonary embolism: an in-depth review. Chest. 2003;1246:2324-2328 [CrossRef] [PubMed]
 
Kluge A, Luboldt W, Bachmann G. Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT. AJR Am J Roentgenol. 2006;1871:W7-14 [CrossRef] [PubMed]
 
Stein PD, Chenevert TL, Fowler SE, et al. PIOPED III (Prospective Investigation of Pulmonary Embolism Diagnosis III) Investigators. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med. 2010;1527:434-443 [PubMed]
 
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