title: Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) and the added benefit of unenhanced proton MR angiography compared with CT pulmonary angiography (CTPA) in patients with chronic thromboembolic disease (CTE).
  
  
  METHODS
  A 2 year retrospective study of 53 patients with chronic thromboembolic pulmonary hypertension who underwent CTPA and MRI for suspected pulmonary hypertension and a control group of 36 patients with no CT evidence of pulmonary embolism. The MRI was evaluated for CTE and the combined diagnostic accuracy of ce-MRA and unenhanced proton MRA was determined. CE-MRA generated lung perfusion maps were also assessed.
  
  
  RESULTS
  The overall sensitivity and specificity of CE-MRA in diagnosing proximal and distal CTE were 98% and 94%, respectively. The sensitivity improved from 50% to 88% for central vessel disease when CE-MRA images were analysed with unenhanced proton MRA. The CE-MRA identified more stenoses (29/18), post-stenosis dilatation (23/7) and occlusions (37/29) compared with CTPA. The CE-MRA perfusion images showed a sensitivity of 92% for diagnosing CTE.
  
  
  CONCLUSIONS
  CE-MRA has high sensitivity and specificity for diagnosing CTE. The sensitivity of CE-MRA for visualisation of adherent central and lobar thrombus significantly improves with the addition of unenhanced proton MRA which delineates the vessel wall.
authors: Unit of Academic Radiology, University of Sheffield, Sheffield, UK. s.rajaram@sheffield.ac.uk
authors: Smitha
authors: S
authors: Rajaram
authors: Andrew J
authors: AJ
authors: Swift
authors: David
authors: D
authors: Capener
authors: Adam
authors: A
authors: Telfer
authors: Christine
authors: C
authors: Davies
authors: Catherine
authors: C
authors: Hill
authors: Robin
authors: R
authors: Condliffe
authors: Charles
authors: C
authors: Elliot
authors: Judith
authors: J
authors: Hurdman
authors: David G
authors: DG
authors: Kiely
authors: Jim M
authors: JM
authors: Wild
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods*; D016477:Artifacts; D003287:Contrast Media / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010477:Perfusion; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013923:Thromboembolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media