nach oben

Erschienen in:

01.08.2014 | Magnetic Resonance

Pulmonary MRA: Differentiation of pulmonary embolism from truncation artefact

verfasst von: Peter Bannas, Mark L. Schiebler, Utaroh Motosugi, Christopher J. François, Scott B. Reeder, Scott K. Nagle

Erschienen in: European Radiology | Ausgabe 8/2014

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Truncation artefact (Gibbs ringing) causes central signal drop within vessels in pulmonary magnetic resonance angiography (MRA) that can be mistaken for emboli, reducing diagnostic accuracy for pulmonary embolism (PE). We propose a quantitative approach to differentiate truncation artefact from PE.

Methods

Twenty-eight patients who underwent pulmonary computed tomography angiography (CTA) for suspected PE were recruited for pulmonary MRA. Signal intensity drops within pulmonary arteries that persisted on both arterial-phase and delayed-phase MRA were identified. The percent signal loss between the vessel lumen and central drop was measured. CTA served as the reference standard for presence of pulmonary emboli.

Results

A total of 65 signal intensity drops were identified on MRA. Of these, 48 (74 %) were artefacts and 17 (26 %) were PE, as confirmed by CTA. Truncation artefacts had a significantly lower median signal drop than PE on both arterial-phase (26 % [range 12–58 %] vs. 85 % [range 53–91 %]) and delayed-phase MRA (26 % [range 11–55 %] vs. 77 % [range 47–89 %]), p < 0.0001 for both. Receiver operating characteristic (ROC) analyses revealed a threshold value of 51 % (arterial phase) and 47 % signal drop (delayed phase) to differentiate between truncation artefact and PE with 100 % sensitivity and greater than 90 % specificity.

Conclusion

Quantitative signal drop is an objective tool to help differentiate truncation artefact and pulmonary embolism in pulmonary MRA.

Key points

• Inexperienced readers may mistake truncation artefacts for emboli on pulmonary MRA

• Pulmonary emboli have non-uniform signal drop

• 51 % (arterial phase) and 47 % (delayed phase) cut-off differentiates truncation artefact from PE

• Quantitative signal drop measurement enables more accurate pulmonary embolism diagnosis with MRA

Schiebler ML, Nagle SK, François CJ et al (2013) Effectiveness of MR angiography for the primary diagnosis of acute pulmonary embolism: clinical outcomes at 3 months and 1 year. J Magn Reson Imaging 38:914–925PubMedCentralPubMedCrossRef

François CJ, Hartung MP, Reeder SB et al (2013) MRI for acute chest pain: current state of the Art. J Magn Reson Imaging 37:1290–1300PubMedCrossRef

Kalb B, Sharma P, Tigges S et al (2012) 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 263:271–278PubMedCrossRef

Lum DP, Busse RF, François CJ et al (2009) Increased volume of coverage for abdominal contrast-enhanced MR angiography with two-dimensional autocalibrating parallel imaging: initial experience at 3.0 Tesla. J Magn Reson Imaging 30:1093–1100PubMedCrossRef

Londy FJ, Lowe S, Stein PD et al (2012) Comparison of 1.5 and 3.0 T for contrast-enhanced pulmonary magnetic resonance angiography. Clin Appl Thromb Hemost 18:134–139PubMedCentralPubMedCrossRef

Meaney JF, Weg JG, Chenevert TL et al (1997) Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med 336:1422–1427PubMedCrossRef

Stein PD, Fowler SE, Goodman LR et al (2006) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354:2317–2327PubMedCrossRef

Morelli JN, Runge VM, Ai F et al (2011) An image-based approach to understanding the physics of MR artifacts. Radiographics 31:849–866PubMedCrossRef

Stein PD (2010) Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med 152:434–443PubMedCentralPubMedCrossRef

10.

Revel MP, Sanchez O, Couchon S et al (2012) Diagnostic accuracy of magnetic resonance imaging for an acute pulmonary embolism: results of the “IRM-EP” study. J Thromb Haemost 10:743–750PubMedCrossRef

11.

Nagle SK, Schiebler ML, François CJ et al (2010) Common artifacts of pulmonary artery MRA and potential solutions. Proc Intl Soc Mag Reson Med 18:1378

12.

Kramer H, Nagle SK, François CJ et al (2013) Efficacy of 3D whole-lung single breath-hold contrast enhanced pulmonary MRA for detection of pulmonary embolism: comparison to CTA. Proc Intl Soc Mag Reson Med 21:1501

13.

Harris FJ (1978) On the use of windows for harmonic analysis with the discrete Fourier transform. Proc IEEE 66:51–83CrossRef

14.

Gottlieb D, Shu C-W (1997) On the Gibbs phenomenon and its resolution. SIAM Rev 39:644–668CrossRef

15.

Di Bella EVR, Parker DL, Sinusas AJ (2005) On the dark rim artifact in dynamic contrast-enhanced MRI myocardial perfusion studies. Magn Reson Med 54:1295–1299PubMedCentralPubMedCrossRef

16.

Sharif B, Dharmakumar R, LaBounty T et al (2013) Towards elimination of the dark-rim artifact in first-pass myocardial perfusion MRI: removing Gibbs ringing effects using optimized radial imaging. Magn Reson Med. doi:10.1002/mrm.24913

17.

Rakow-Penner R, Gold G, Daniel B et al (2008) Reduction of truncation artifacts in rapid 3D articular cartilage imaging. J Magn Reson Imaging 27:860–865PubMedCrossRef

18.

Erickson SJ, Waldschmidt JG, Czervionke LF, Prost RW (1996) Hyaline cartilage: truncation artifact as a cause of trilaminar appearance with fat-suppressed three-dimensional spoiled gradient-recalled sequences. Radiology 201:260–264PubMed

19.

Brau ACS, Beatty PJ, Skare S, Bammer R (2008) Comparison of reconstruction accuracy and efficiency among autocalibrating data-driven parallel imaging methods. Magn Reson Med 59:382–395PubMedCentralPubMedCrossRef

20.

Maki JH, Prince MR, Londy FJ, Chenevert TL (1996) The effects of time varying intravascular signal intensity and k-space acquisition order on three-dimensional MR angiography image quality. J Magn Reson Imaging 6:642–651PubMedCrossRef

21.

Wittram C, Yoo AJ (2007) Transient interruption of contrast on CT pulmonary angiography: proof of mechanism. J Thorac Imaging 22:125–129PubMedCrossRef

22.

Fink C, Ley S, Risse F et al (2005) Effect of inspiratory and expiratory breathhold on pulmonary perfusion: assessment by pulmonary perfusion magnetic resonance imaging. Investig Radiol 40:72–79CrossRef

Titel: Pulmonary MRA: Differentiation of pulmonary embolism from truncation artefact
verfasst von: Peter Bannas
Mark L. Schiebler
Utaroh Motosugi
Christopher J. François
Scott B. Reeder
Scott K. Nagle
Publikationsdatum: 01.08.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 8/2014
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3219-5

Neu im Fachgebiet Radiologie

18.04.2024 | Pädiatrische Notfallmedizin | Nachrichten

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Pulmonary MRA: Differentiation of pulmonary embolism from truncation artefact

Abstract

Purpose

Methods

Results

Conclusion

Key points

Neu im Fachgebiet Radiologie

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

„Nur wer sich gut aufgehoben fühlt, kann auch für Patientensicherheit sorgen“

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Studie bestätigt Potenzial von KI in der Radiologie

Update Radiologie

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Key points

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2014

Preoperative differentiation between T1a and ≥T1b gallbladder cancer: combined interpretation of high-resolution ultrasound and multidetector-row computed tomography

Erratum to: Preoperative lymph node staging in patients with primary prostate cancer: comparison and correlation of quantitative imaging parameters in diffusion-weighted imaging and 11C-choline PET/CT

A novel removable shield attached to C-arm units against scattered X-rays from a patient’s side

Intravoxel incoherent motion diffusion-weighted MR imaging in differentiation of lung cancer from obstructive lung consolidation: comparison and correlation with pharmacokinetic analysis from dynamic contrast-enhanced MR imaging

Erratum to: Underestimation rate of lobular intraepithelial neoplasia in vacuum-assisted breast biopsy

The value of diffusion-weighted imaging in the detection of prostate cancer: a meta-analysis

Neu im Fachgebiet Radiologie

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

„Nur wer sich gut aufgehoben fühlt, kann auch für Patientensicherheit sorgen“

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Studie bestätigt Potenzial von KI in der Radiologie

Update Radiologie