Mark L. Schiebler MD, Presenter: Shareholder, Novelos Therapeutics, Inc

Christopher Jean-Pierre Francois MD, Abstract Co-Author: Nothing to Disclose

Michael D Repplinger MD, Abstract Co-Author: Nothing to Disclose

Karl Vigen PhD, Abstract Co-Author: Nothing to Disclose

Scott Brian Reeder MD, PhD, Abstract Co-Author: Nothing to Disclose

Harald Kramer MD, Abstract Co-Author: Nothing to Disclose

Thomas Martin Grist MD, Abstract Co-Author: Research Support, General Electric Company Research Support, Bracco Group Research Support, Siemens AG Research Support, Hologic, Inc Consultant, Guerbet SA Consultant, Bayer AG Consultant, Bracco Group Stockholder, NeuWave Medical Inc Stockholder, Novelos Therapeutics, Inc

Alejandro Munoz Del Rio PhD, Abstract Co-Author: Nothing to Disclose

Azita Hamedani MD, Abstract Co-Author: Nothing to Disclose

Scott K. Nagle MD, PhD, Abstract Co-Author: Stockholder, General Electric Company

Determine the effectiveness of using pulmonary magnetic resonance imaging as the primary test for the determination of pulmonary embolism (MRA-PE) in a symptomatic population.

We performed a retrospective review of our experience with 578 consecutive symptomatic patients studied over a five year period with MRA-PE for the primary diagnosis of pulmonary embolism (PE). Contrast enhanced MRA images were performed in a single breath hold at 1.5 Tesla. The negative predictive value at three months and Kaplan-Meier analysis were calculated from the available time to venous thromboembolism (VTE) follow up data obtained from the electronic medical record.

There were 578 consecutive symptomatic patients who underwent pulmonary MRA as their primary examination for the determination of PE. There were 467 females (average age ± 1S.D: 36.6 years, ± 16), and 111 males (average age ± 1S.D: 44.9 years± 19.5). Out of 578 MRA exams, 25 were non-diagnostic due to motion. Of the remaining 553 patients, 53 were positive and treated on the basis of MRA findings alone. Of the 500 negative MRA’s, 76 were lost to 3-month follow up, leaving 424 patients with an initial negative MRA and 3 months of complete EMR follow up. Of these, 8 were found to have VTE during F/U. The negative predictive value for MRA-PE at three months was 98% (97-99, 95% CI). Kaplan-Meier estimate values, for time to VTE at one year, was found to be 0.98 (97-0.99, 95% C.I).

In this single site retrospective study, MRA-PE was found to be effective as a primary imaging modality for the diagnosis of PE in symptomatic patients with a high rate of technical success. At those sites with sufficient technical expertise in performing pulmonary MRA, and knowledgeable  of the artifacts associated with this technique, should consider use of this modality where appropriate clinical settings warrant.

MRA-PE can be safely used for the primary diagnosis of pulmonary embolism in symptomatic patients. This test should be considered as an acceptable alternative to CTA-PE for vulnerable patients.

Schiebler, M, Francois, C, Repplinger, M, Vigen, K, Reeder, S, Kramer, H, Grist, T, Munoz Del Rio, A, Hamedani, A, Nagle, S, Effectiveness of Pulmonary MRA for the Primary Diagnosis of Pulmonary Embolism: Outcomes Analysis of 578 Consecutive Symptomatic Patients.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13044126.html