Mark L. Schiebler MD, Presenter: Shareholder, Cellectar Biosciences, Inc

1) Technique is critical. 2) Understand the promise of MRA in the pulmonary vasculature. 3) Beware of the limitations. 4) Who can benefit from MRA-PE exams.

Abstract There has recently been the development of some uncertainty with regards to the need for the near perfect sensitivity for the detection of pulmonary embolism in the subsegmental size range that is provided by CTA-PE exams. There are two major groups fighting for clinical dominance of the treatment paradigm. There is one camp that stresses the need for long term anti-coagulation for any documented venous thromboembolic event (VTE). The second camp is less stringent in its dogmatic approach to mandatory treatment for all documented VTE, and suggests not treating those subsegmental PE in patients that have no other risk factors for thromboembolic disease. Outcomes data from our group support the second group’s framework for the treatment of this disease. With careful attention to the injection rate, contrast concentration, breathing instructions, and the use of parallel imaging, single breath-hold near isotropic whole lung MRA-PE exams can be routinely obtained of very high quality. The important artifacts of Gibbs ringing, cardiac and respiratory motion, Maki, need to be understood. While MRA-PE does not have the efficacy (lower sensitivity) of CTA for the detection of all PE, it has been shown to be an effective (high NPV) alternative for the diagnosis of this condition without the use of medical radiation.  

Schiebler, M, Optimizing Pulmonary MRA.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000782.html