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Rivista di Medicina Nucleare e Imaging Molecolare

A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the Society of Radiopharmaceutical Sciences and to the International Research Group of Immunoscintigraphy
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Guest Editors: Pistolesi M. and Pupi A.

The Quarterly Journal of Nuclear Medicine 2001 Dicembre;45(4):311-23

lingua: Inglese

MRA for diagnosis of venous thromboembolism

Sostman H. D.

From the ­Chair of ­Radiology Weill Med­ical Col­lege of Cor­nell Uni­ver­sity, New ­York, USA


Direct ­imaging of pul­mo­nary embo­lism (PE) and ­deep ­vein throm­bosis (DVT) ­with CT, and poten­tially ­with MR, ­will con­tinue to ­replace V/Q scin­tig­raphy. ­Venous ­imaging ­with MR far ­detecting DVT is ­used in a few cen­ters, and ­their pub­lished accu­racy fig­ures are impres­sive. ­Recent ­studies of MR pul­mo­nary angio­graphy for PE ­reported ­that sen­si­tivity of MRA was 85-100%, spec­i­ficity 95-96%, but ­this ­data ­must be con­firmed in ­other cen­ters and ­patient pop­u­la­tions. MR has advan­tages com­pared ­with CT, ­which ­make it worth­while to con­tinue MR devel­op­ment. Ion­iz- ing radi­a­tion and iod­i­nated con­trast mate­rial are not ­used. ­Imaging the pul­mo­nary ­arteries and ­then ­imaging which­ever ­venous ­region is of clin­ical ­interest is prac­tical in a ­single exam­ina­tion. ­Repeated exam­ina­tions can be per­formed ­safely. New con­trast mate­rials ­will facil­i­tate the prac­ti­cality and accu­racy of the MR tech­nique and per­fu­sion ­imaging may ­increase sen­si­tivity. MR ­also has dis­ad­van­tages com­pared ­with CT. It ­does not ­image effec­tively the non-vas­cular com­part­ment of the ­lungs. It is ­more expen­sive, ­patient mon­i­toring is ­more cum­ber­some, and a rou­tine tech­nique, ­which ­embodies all of ­MR’s poten­tial advan­tages, has not ­been pack­aged and ­tested. Accord­ingly, hel­ical CT is a ­realistic ­option in clin­ical man­age­ment of ­patients ­with sus­pected PE in ­most cen­ters, ­while clin­ical appli­ca­tion of MR is lim­ited to cen­ters ­with appro­priate MR exper­tise and tech­nology. How­ever, MR has a ­number of fun­da­mental char­ac­ter­is­tics ­that ­make it a poten­tially ­ideal ­modality for eval­u­ating ­patients ­with sus­pected ­acute ­venous throm­boem­bolic dis­ease and fur­ther clin­ical ­research ­with MRA is war­ranted.

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