title: Performance of perfusion-weighted Fourier decomposition MRI for detection of chronic pulmonary emboli.
abstract: OBJECTIVE
  To evaluate the test performance of perfusion-weighted Fourier-decomposition (pw-FD) magnetic resonance imaging (MRI) in comparison to dynamic contrast-enhanced (DCE)-MRI as a reference standard in patients with known or suspected chronic pulmonary embolism (PE).
  
  
  METHODS
  In 64 patients, chronic PE was ruled out or confirmed by DCE-MRI using a time-resolved angiography with stochastic trajectories (TWIST) sequence in one breath-hold. Pw-FD-MRI was performed using a 2D fast low-angle shot (FLASH) sequence in free-breathing. After a nonrigid image registration, FD was applied to generate pw-images. Lungs were scored by two radiologists (2 and 12 years of lung MRI experience) visually for each lobe and segment for hypoperfused areas. For intra- and interobserver variability, the MR images were analyzed 2 months after the first analysis, blinded to the results of the first reader.
  
  
  RESULTS
  PE was diagnosed by DCE-MRI in 39 patients. For the pw-FD MRI sensitivity, specificity, accuracy, and positive and negative predictive value for diagnosis of PE were 100%, 95%, 98%, 98%, and 100% on a per-patient basis, 94%, 94%, 94%, 95%, 94% on a per-lobe basis, and 82%, 92%, 88%, 88%, 88% on a segmental basis, respectively. Detection of subsegmental and segmental hypoperfusion using pw-FD MRI showed a moderate agreement with DCE-MRI (kappa of 0.68; 95% confidence interval: 0.64; 0.72).
  
  
  CONCLUSIONS
  Pw-FD of the lung is a feasible test to diagnose chronic PE on a per-patient level during free-breathing without the use of ionizing radiation or contrast agents.
authors.affiliation: Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schönfeld
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Serghei
authors.initials: S
authors.lastname: Cebotari
authors.affiliation: Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Voskrebenzev
authors.affiliation: Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Gutberlet
authors.affiliation: Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Hinrichs
authors.affiliation: Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
authors.forename: Julius
authors.identifier: http://orcid.org/0000-0003-3727-8180
authors.initials: J
authors.lastname: Renne
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, and German Centre of Lung Research (DLZ), Hannover, Germany.
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, and German Centre of Lung Research (DLZ), Hannover, Germany.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Olsson
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, and German Centre of Lung Research (DLZ), Hannover, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Wacker
authors.affiliation: Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Vogel-Claussen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002908:Chronic Disease; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005583:Fourier Analysis; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011655:Pulmonary Embolism / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D016037:Single-Blind Method
keywords: Fourier decomposition; dynamic contrast enhanced MRI; lung perfusion; pulmonary embolism