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Pierre-Yves Salaun, MD, PhD; Pierre-Yves Le Roux, MD; Gregoire Le Gal, MD, PhD
Author and Funding Information

From the Université Européenne de Bretagne (Drs Salaun, Le Roux, and Le Gal); the Université de Brest (Drs Salaun, Le Roux, and Le Gal); the Service de médecine nucléaire (Drs Salaun and Le Roux), and the Département de médecine interne et de pneumologie (Dr Le Gal), CHU de la Cavale Blanche.

Correspondence to: Grégoire Le Gal, MD, PhD, Département de Médecine Interne et de Pneumologie, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest, France; e-mail: gregoire.legal@chu-brest.fr


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):1391-1392. doi:10.1378/chest.10-3031
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To the Editor:

We would like to thank Dr Hochhegger and colleagues for highlighting, relevantly, the potential role of magnetic resonance in pulmonary embolism (PE) diagnosis. However, through September 2009, few studies have investigated MRI in PE diagnosis, and most of them had <20 patients with PE.1-6

More recently, Stein et al7 performed a large multicenter prospective study—the Prospective Investigation of Pulmonary Embolism (PIOPED) III study—that evaluated the diagnostic accuracy of magnetic resonance angiography (MRA) and thigh vein magnetic resonance venography (MRV) in patients with suspected PE. This study compared MRA and MRV with the standard reference test and showed that in patients with adequate image quality MRA had a sensitivity of 78% and a specificity of 99% to detect PE. When MRV was performed along with MRA, the sensitivity increased to 92%. MRA, however, was technically inadequate in 25% of patients (11%-52% according to the center), which led to detection of only 57% of patients with PE and might hamper the broad applicability of the test. The authors conclude: “Magnetic resonance pulmonary angiography should be considered only at centers that routinely perform it well and only for patients for whom standard tests are contraindicated.”7

Most of all, to date no management study demonstrated the safety of making clinical decisions, and particularly of ruling out PE, on the basis of a diagnostic algorithm that includes MRI. Therefore, although certainly of potential interest, MRI is not a fully validated method to diagnose PE and its use in routine clinical practice cannot be recommended for now. On the other hand, diagnostic strategies using ventilation-perfusion ratio scanning remain a safe and reliable alternative for the study of acute PE.8

Meaney JF, Weg JG, Chenevert TL, Stafford-Johnson D, Hamilton BH, Prince MR. Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med. 1997;33620:1422-1427 [CrossRef] [PubMed]
 
Gupta A, Frazer CK, Ferguson JM, et al. Acute pulmonary embolism: diagnosis with MR angiography. Radiology. 1999;2102:353-359 [PubMed]
 
Loubeyre P, Revel D, Douek P, et al. Dynamic contrast-enhanced MR angiography of pulmonary embolism: comparison with pulmonary angiography. AJR Am J Roentgenol. 1994;1625:1035-1039 [PubMed]
 
Ohno Y, Higashino T, Takenaka D, et al. MR angiography with sensitivity encoding (SENSE) for suspected pulmonary embolism: comparison with MDCT and ventilation-perfusion scintigraphy. AJR Am J Roentgenol. 2004;1831:91-98 [PubMed]
 
Pleszewski B, Chartrand-Lefebvre C, Qanadli SD, et al. Gadolinium-enhanced pulmonary magnetic resonance angiography in the diagnosis of acute pulmonary embolism: a prospective study on 48 patients. Clin Imaging. 2006;303:166-172 [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]
 
Salaun P-Y, Couturaud F, Le Duc-Pennec A, et al. Noninvasive diagnosis of pulmonary embolism. Chest. 2011;1396:1294-1298 [CrossRef] [PubMed]
 

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References

Meaney JF, Weg JG, Chenevert TL, Stafford-Johnson D, Hamilton BH, Prince MR. Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med. 1997;33620:1422-1427 [CrossRef] [PubMed]
 
Gupta A, Frazer CK, Ferguson JM, et al. Acute pulmonary embolism: diagnosis with MR angiography. Radiology. 1999;2102:353-359 [PubMed]
 
Loubeyre P, Revel D, Douek P, et al. Dynamic contrast-enhanced MR angiography of pulmonary embolism: comparison with pulmonary angiography. AJR Am J Roentgenol. 1994;1625:1035-1039 [PubMed]
 
Ohno Y, Higashino T, Takenaka D, et al. MR angiography with sensitivity encoding (SENSE) for suspected pulmonary embolism: comparison with MDCT and ventilation-perfusion scintigraphy. AJR Am J Roentgenol. 2004;1831:91-98 [PubMed]
 
Pleszewski B, Chartrand-Lefebvre C, Qanadli SD, et al. Gadolinium-enhanced pulmonary magnetic resonance angiography in the diagnosis of acute pulmonary embolism: a prospective study on 48 patients. Clin Imaging. 2006;303:166-172 [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]
 
Salaun P-Y, Couturaud F, Le Duc-Pennec A, et al. Noninvasive diagnosis of pulmonary embolism. Chest. 2011;1396:1294-1298 [CrossRef] [PubMed]
 
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