title: Effectiveness of MR angiography for the primary diagnosis of acute pulmonary embolism: clinical outcomes at 3 months and 1 year.
abstract: OBJECTIVE
  To determine the effectiveness of MR angiography for pulmonary embolism (MRA-PE) in symptomatic patients.
  
  
  METHODS
  We retrospectively reviewed all patients whom were evaluated for possible pulmonary embolism (PE) using MRA-PE. A 3-month and 1-year from MRA-PE electronic medical record (EMR) review was performed. Evidence for venous thromboembolism (VTE) (or death from PE) within the year of follow-up was the outcome surrogate for this study.
  
  
  RESULTS
  There were 190 MRA-PE exams performed with 97.4% (185/190) of diagnostic quality. There were 148 patients (120 F: 28 M) that had both a diagnostic MRA-PE exam and 1 complete year of EMR follow-up. There were 167 patients (137 F: 30 M) with 3 months or greater follow-up. We found 83% (139/167) and 81% (120/148) MRA-PE exams negative for PE at 3 months and 1 year, respectively. Positive exams for PE were seen in 14% (23/167). During the 1-year follow-up period, five patients (false negative) were diagnosed with DVT (5/148 = 3.4 %), and one of these patients also experienced a non-life-threatening PE. The negative predictive value (NPV) for MRA-PE was 97% (92-99; 95% CI) at 3 months and 96% (90-98; 95% CI) with 1 year of follow-up.
  
  
  CONCLUSIONS
  The NPV of MRA-PE, when used for the primary diagnosis of pulmonary embolism in symptomatic patients, were found to be similar to the published values for CTA-PE. In addition, the technical success rate and safety of MRA-PE were excellent.
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Schiebler
authors.forename: Scott K
authors.initials: SK
authors.lastname: Nagle
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: François
authors.forename: Michael D
authors.initials: MD
authors.lastname: Repplinger
authors.forename: Azita G
authors.initials: AG
authors.lastname: Hamedani
authors.forename: Karl K
authors.initials: KK
authors.lastname: Vigen
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Yarlagadda
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Grist
authors.forename: Scott B
authors.initials: SB
authors.lastname: Reeder
mesh_terms: D000208:Acute Disease; D000328:Adult; D057286:Electronic Health Records; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000473:pathology; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000473:pathology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000473:pathology; D055815:Young Adult
keywords: effectiveness, outcomes analysis; magnetic resonance angiography; negative predictive value; pulmonary embolism
references.citation: Clin Appl Thromb Hemost. 2012 Jan-Feb;18(1):20-6
references.pmid: 21949040
references.citation: Radiology. 1997 Nov;205(2):453-8
references.pmid: 9356628
references.citation: JAMA. 2007 Dec 19;298(23):2788-9
references.pmid: 18165674
references.citation: Thromb Haemost. 2005 Mar;93(3):503-11
references.pmid: 15735802
references.citation: Radiology. 1993 Oct;189(1):125-31
references.pmid: 8372181
references.citation: Ann Intern Med. 2012 Jan 17;156(2):147-9
references.pmid: 22250146
references.citation: Radiology. 1987 Sep;164(3):731-3
references.pmid: 3303121
references.citation: Lancet. 2012 Aug 4;380(9840):499-505
references.pmid: 22681860
references.citation: Am J Med. 2006 Dec;119(12):1048-55
references.pmid: 17145249
references.citation: Radiology. 1993 Nov;189(2):523-30
references.pmid: 8210385
references.citation: Arch Intern Med. 2011 May 9;171(9):831-7
references.pmid: 21555660
references.citation: JAMA. 2007 Jul 18;298(3):317-23
references.pmid: 17635892
references.citation: BMC Health Serv Res. 2008 Feb 14;8:40
references.pmid: 18275605
references.citation: Radiology. 2002 May;223(2):461-7
references.pmid: 11997553
references.citation: Lancet. 2008 Apr 19;371(9621):1343-52
references.pmid: 18424324
references.citation: J Vasc Interv Radiol. 1999 Jun;10(6):707-12
references.pmid: 10392937
references.citation: Acta Radiol. 2002 Sep;43(5):486-91
references.pmid: 12423459
references.citation: AJR Am J Roentgenol. 2004 Jul;183(1):91-8
references.pmid: 15208117
references.citation: Clin Radiol. 2008 Apr;63(4):381-6
references.pmid: 18325357
references.citation: AJR Am J Roentgenol. 2007 May;188(5):1246-54
references.pmid: 17449767
references.citation: Radiology. 1997 Nov;205(2):447-52
references.pmid: 9356627
references.citation: AJR Am J Roentgenol. 2006 Jun;186(6):1686-96
references.pmid: 16714660
references.citation: J Magn Reson Imaging. 2009 Nov;30(5):1093-100
references.pmid: 19856443
references.citation: J Thromb Haemost. 2012 May;10(5):743-50
references.pmid: 22321816
references.citation: Arch Intern Med. 1998 Mar 23;158(6):585-93
references.pmid: 9521222
references.citation: Eur Radiol. 2011 Feb;21(2):318-25
references.pmid: 20694795
references.citation: Eur J Radiol. 2011 Oct;80(1):2-8
references.pmid: 21458187
references.citation: JAMA. 2006 Jan 11;295(2):172-9
references.pmid: 16403929
references.citation: Ann Intern Med. 2010 Apr 6;152(7):434-43, W142-3
references.pmid: 20368649
references.citation: Am J Med. 2001 Jan;110(1):16-21
references.pmid: 11152860
references.citation: Radiology. 2011 Jun;259(3):862-74
references.pmid: 21467251
references.citation: BMJ. 2012 Sep 06;345:e5660
references.pmid: 22956590
references.citation: N Engl J Med. 1997 May 15;336(20):1422-7
references.pmid: 9145679
references.citation: AJR Am J Roentgenol. 1999 Jun;172(6):1627-31
references.pmid: 10350303
references.citation: Radiology. 2008 Dec;249(3):980-90
references.pmid: 19011192
references.citation: Magn Reson Med. 2008 Feb;59(2):382-95
references.pmid: 18228603
references.citation: Arch Intern Med. 1997 Dec 8-22;157(22):2593-8
references.pmid: 9531228
references.citation: Circ Cardiovasc Imaging. 2009 Jul;2(4):339-48
references.pmid: 19808615
references.citation: Ann Intern Med. 2001 Jul 17;135(2):88-97
references.pmid: 11453707
references.citation: Radiology. 1999 Feb;210(2):353-9
references.pmid: 10207414
references.citation: Chest. 1995 Jan;107(1 Suppl):39S-44S
references.pmid: 7813328
references.citation: Eur Radiol. 2012 Feb;22(2):310-7
references.pmid: 21887483
references.citation: Radiology. 2012 Apr;263(1):271-8
references.pmid: 22438448
references.citation: Lancet. 2002 May 11;359(9318):1643-7
references.pmid: 12020524
references.citation: N Engl J Med. 2005 Apr 28;352(17):1760-8
references.pmid: 15858185
references.citation: AJR Am J Roentgenol. 2006 Jul;187(1):W7-14
references.pmid: 16794142
references.citation: Radiology. 2000 May;215(2):535-42
references.pmid: 10796937
references.citation: J Magn Reson Imaging. 1996 Jul-Aug;6(4):642-51
references.pmid: 8835958
references.citation: Clin Imaging. 2006 May-Jun;30(3):166-72
references.pmid: 16632150