Combined MR Imaging for Pulmonary Embolism and Deep Venous Thrombosis by Contrast-enhanced MR Volume Interpolated Body Examination

Abstract

MR pulmonary angiography (MRPA) combined with indirect MR venography (MRV) was attempted by using 3D contrast-enhanced MR volume interpolated body examination (VIBE) sequence. Agreement rate for deep venous thrombosis (DVT) detection between MRV and duplex sonography (DUS) was evaluated; the potential of this method for venous thromoembolism (VTE) was also investigated. Thirty-four patients with DUS-identified DVT were enrolled in this study. MRI was performed after a single administration of Gadopentetate dimeglumine. Fat-suppressed 3D VIBE was applied for visualizing pulmonary arteries, abdominal veins, pelvic and leg veins, ranging from lung apex to ankle level. Two radiologists observed the MR images in consensus, recorded the location and number of emboli. MRV images were assessed based on per-vein segment. The agreement rate between MRV and DUS for venous segment-to-segment comparison was analyzed by Wilcoxon rank sum test. All the patients were diagnosed as having DVT by MRV. MRV detected 55 more venous segments with thrombi than DUS based on per-vein segment analysis. Twenty-three patients with pulmonary embolism (PE) were detected by MRPA. Twenty-one patients underwent both pulmonary CT angiography and MRPA, and consistency for PE detection was 100%. Total examination time of the combined MR protocol was 7 min for each patient. The contrast-enhanced VIBE sequence proves to be a feasible and reliable method for VTE diagnosis in one-stop MR scanning procedure, and contrast-enhanced VIBE performs better to depict DVT than DUS on per-vein segment basis.

Keywords

magnetic resonance imaging / pulmonary embolism / deep venous thrombosis / venous thromoembolism

References

[1] TorbickiA, PerrierA, KonstantinidesS, et al.. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J, 2008, 29(18): 2276-2315

[2] JaffMR, McMurtryMS, ArcherSL, et al.. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation, 2011, 123(16): 1788-1830

[3] GulsunA M, GoodmanLR. Imaging of pulmonary thromboembolism. Clin Chest Med, 2008, 29(1): 107-116

[4] KearonC. Natural history of venous thromboembolism. Circulation, 2003, 107(23Suppl1): I22-I30

[5] LoudPA, GrossmanZD, KlippensteinDL, et al.. Combined CT venography and pulmonary angiography: a new diagnostic technique for suspected thromboembolic disease. Am J Roentgenol, 1998, 170(4): 951-954

[6] LoudPA, KatzDS, BruceDA, et al.. Deep venous thrombosis with suspected pulmonary embolism: detection with combined CT venography and pulmonary angiography. Radiology, 2001, 219(2): 498-502

[7] FuQ, LiuYH, LeiZQ, et al.. The clinical application of combined dual-energy CT pulmonary angiography and indirect venography. Chin J Radiol (Chinese), 2013, 47(1): 39-43

[8] JohnsonJC, BrownMD, McCulloughN, et al.. CT lower extremity venography in suspected pulmonary embolism in the ED. Emerg Radiol, 2006, 12(4): 160-163

[9] RademakerJ, GriesshaberV, HidajatN, et al.. Combined CT Pulmonary Angiography and Venography for Diagnosis of Pulmonary Embolism and Deep Vein Thrombosis: Radiation Dose. J Thorac Imag, 2001, 16(4): 297-299

[10] LoudPA, KatzDS, KlippensteinDL, et al.. Combined CT venography and pulmonary angiography in suspected thromboembolic disease: diagnostic accuracy for deep venous evaluation. Am J Roentgenol, 2000, 174(1): 61-65

[11] YankelevitzDF, GamsuG, ShahA, et al.. Optimization of combined CT pulmonary angiography with lower extremity CT venography. Am J Roentgenol, 2000, 174(1): 67-69

[12] JiangT, QiuCY, JiangH. Pulmonary embolism and pelvic-lower limb deep venous thrombosis: initial experience with magnetic resonance angiography. Chin J Radiol (Chinese), 2004, 38(8): 85-89

[13] BruceD, LoudPA, KlippensteinDL, et al.. Combined CT venography and pulmonary angiography:how much venous enhancement is routinely obtained?. Am J Roentgenol, 2001, 176(5): 1281-1285

[14] DillmanJR, EllisJH, CohanRH, et al.. Frequency and severity of acute allergic-like reactions to gadolinium-containing i.v. contrast media in children and adults. Am J Roentgenol, 2007, 189(6): 1533-1538

[15] HanschA, BetgeS, PoehlmannG, et al.. Combined magnetic resonance imaging of deep venous thrombosis and pulmonary arteries after a single injection of a blood pool contrast agent. Eur Radiol, 2011, 21(2): 318-325

[16] KlugeA, MuellerC, StrunkJ, et al.. Experience in 207 combined MRI examinations for acute pulmonary embolism and deep vein thrombosis. Am J Roentgenol, 2006, 186(6): 1686-1696

[17] ObernostererA, AschauerM, PortugallerH, et al.. Three-dimensional gadolinium-enhanced magnetic resonance angiography used as a “one-stop shop” imaging procedure for venous thromboembolism: a pilot study. Angiology, 2005, 56(4): 423-430

[18] KayaF, UfukF, KarabulutN. Diagnostic performance of contrast-enhanced and unenhanced combined pulmonary artery MRI and magnetic resonance venography techniques in the diagnosis of venous thromboembolism. Br J Radiol, 2019, 92(1095): 20180695

[19] PressaccoJ, PapasK, LambertJ, et al.. Magnetic resonance angiography imaging of pulmonary embolism using agents with blood pool properties as an alternative to computed tomography to avoid radiation exposure. Eur J Radiol, 2019, 113: 165-173

[20] KillewichLA, BedfordGR, BeachKW, et al.. Diagnosis of deep venous thrombosis. A prospective study comparing duplex scanning to contrast venography. Circulation, 1989, 79(4): 810-814

[21] MamloukMD, Van SonnenbergE, GosaliaR, et al.. Pulmonary embolism at CT angiography: implications for appropriateness, cost, and radiation exposure in 2003 patients. Radiology, 2010, 256(2): 625-632

[22] KalbB, SharmaP, TiggesS, et al.. MR imaging of pulmonary embolism: diagnostic accuracy of contrast-enhanced 3D MR pulmonary angiography, contrast-enhanced low-flip angle 3D GRE, and nonenhanced free-induction FISP sequences. Radiology, 2012, 263(1): 271-278

[23] SampsonFC, GoodacreSW, ThomasSM, et al.. The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis. Eur Radio, 2007, 17(1): 175-181

[24] RofskyNM, LeeVS, LaubG, et al.. Abdominal MR imaging with a volumetric interpolated breath-hold examination. Radiology, 1999, 212(3): 876-884

[25] PfeilA, BetgeS, PoehlmannG, et al.. Magnetic resonance VIBE venography using the blood pool contrast agent gadofosveset trisodium-An interrater reliability study. Eur J Radiol, 2012, 81(3): 547-552

[26] CarpenterJP, HollandGA, BaumRA, et al.. Magnetic resonance venography for the detection of deep venous thrombosis: Comparison with contrast venography and duplex Doppler ultrasonography. J Vasc Surg, 1993, 18(5): 734-741

[27] Üzbudak, EroğullariI, ÜgğşC, et al.. Doppler ultrasonography versus venography in the detection of deep vein thrombosis in patients with pulmonary embolism. J Thromb Thrombolys, 2006, 21(2): 159-162

[28] LabropoulosN, BorgeM, PierceK, et al.. Criteria for defining significant central vein stenosis with duplex ultrasound. J Vasc Surg, 2007, 46(1): 101-107

[29] OhnoY, YoshikawaT, KishidaY, et al.. Unenhanced and contrast-enhanced MR angiography and perfusion imaging for suspected pulmonary thromboembolism. Am J Roentgenol, 2017, 208: 517-530

[30] NagleSK, SchieblerML, RepplingerMD, et al.. Contrast enhanced pulmonary magnetic resonance angiography for pulmonary embolism: Building a successful program. Eur J Radiol, 2016, 85(3): 553-563

[31] SteinPD, ChenevertTL, FowlerSE, et al.. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med, 2010, 152(7): 434-443

[32] HoschW, SchlieterM, LeyS, et al.. Detection of acute pulmonary embolism: feasibility of diagnostic accuracy of MRI using a stepwise protocol. Emerg Radiol, 2014, 21: 151-158