Why Can't Magnetic Resonance Imaging Reliably Diagnose Pulmonary Embolism?
Authors: Bruce L. Davidson
Journal: Annals of Internal Medicine (2010)

Editorials6 April 2010Why Can't Magnetic Resonance Imaging Reliably Diagnose Pulmonary Embolism?Bruce L. Davidson, MD, MPH and Marc J. Lacrampe, MDBruce L. Davidson, MD, MPHFrom University of Washington School of Medicine, Seattle, Washington 98119; and Virginia Mason Medical Center, Seattle, Washington 98101. and Marc J. Lacrampe, MDFrom University of Washington School of Medicine, Seattle, Washington 98119; and Virginia Mason Medical Center, Seattle, Washington 98101.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-7-201004060-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, the PIOPED III (Prospective Investigation of Pulmonary Embolism Diagnosis III) investigators report the results of their diagnostic accuracy study of magnetic resonance pulmonary angiography (MRA) and thigh-vein magnetic resonance venography (MRV) for identifying suspected pulmonary embolism (1). They conclude that combined MRA and MRV ought to be considered only at centers that perform it well and only in patients who have contraindications to other standard tests. We agree with their conclusions and the methods they used to reach them.Not a management study, PIOPED III subjected patients with suspected pulmonary embolism to the clinical site's usual diagnostic ...References1. Stein PD, Chenevert TL, Fowler SE, Goodman LR, Gottschalk A, Hales CA, et al. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism. A multicenter prospective study (PIOPED III). Ann Intern Med. 2010;152:434-43. LinkGoogle Scholar2. Stein PD, Gottschalk A, Sostman HD, Chenevert TL, Fowler SE, Goodman LR, et al. Methods of Prospective Investigation of Pulmonary Embolism Diagnosis III (PIOPED III). Semin Nucl Med. 2008;38:462-70. [PMID: 19331840] CrossrefMedlineGoogle Scholar3. Koreishi AF, Nazarian RM, Saenz AJ, Klepeis VE, McDonald AG, Farris AB, et al. Nephrogenic systemic fibrosis: a pathologic study of autopsy cases. Arch Pathol Lab Med. 2009;133:1943-8. [PMID: 19961249] CrossrefMedlineGoogle Scholar4. Gutte H, Mortensen J, Jensen CV, Johnbeck CB, von der Recke P, Petersen CL, et al. Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT: head-to-head comparison with multidetector CT angiography. J Nucl Med. 2009;50:1987-92. [PMID: 19910421] CrossrefMedlineGoogle Scholar5. Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ; American College of Chest Physicians. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133:454S-545S. [PMID: 18574272] CrossrefMedlineGoogle Scholar6. Huisman MV, Klok FA. Diagnostic management of clinically suspected acute pulmonary embolism. J Thromb Haemost. 2009;7 Suppl 1 312-7. [PMID: 19630824] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Bruce L. Davidson, MD, MPH; Marc J. Lacrampe, MDAffiliations: From University of Washington School of Medicine, Seattle, Washington 98119; and Virginia Mason Medical Center, Seattle, Washington 98101.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0344.Corresponding Author: Bruce L. Davidson, MD, MPH, 1952 Tenth Avenue West, Seattle, WA 98119; e-mail, brucedavidson@pobox.com.Current Author Addresses: Dr. Davidson: 1952 Tenth Avenue West, Seattle, WA 98119.Dr. Lacrampe: Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoGadolinium-Enhanced Magnetic Resonance Angiography for Pulmonary Embolism Paul D. Stein , Thomas L. Chenevert , Sarah E. Fowler , Lawrence R. Goodman , Alexander Gottschalk , Charles A. Hales , Russell D. Hull , Kathleen A. Jablonski , Kenneth V. Leeper Jr. , David P. Naidich , Daniel J. Sak , H. Dirk Sostman , Victor F. Tapson , John G. Weg , and Pamela K. Woodard , for the PIOPED III (Prospective Investigation of Pulmonary Embolism Diagnosis III) Investigators* Metrics Cited byPrimary diagnosis of pulmonary embolism with unenhanced MRI for patients not eligible for CTPA: Clinical outcomeContrast-enhanced pulmonary MRA for the primary diagnosis of pulmonary embolism: current state of the art and future directionsDetection of pulmonary embolism using repeated MRI acquisitions without respiratory gating: a preliminary studyDiagnostic performance of magnetic resonance imaging for acute pulmonary embolism: a systematic review and meta‐analysisDiagnostic accuracy of unenhanced, contrast-enhanced perfusion and angiographic MRI sequences for pulmonary embolism diagnosis: results of independent sequence readingsDiagnostic accuracy of magnetic resonance imaging for an acute pulmonary embolism: results of the 'IRM‐EP' studyCurrent Approach to the Diagnosis of Acute Nonmassive Pulmonary EmbolismDetection of Pulmonary Embolism 6 April 2010Volume 152, Issue 7 Page: 467-468 Keywords Angiography Computed axial tomography Lungs Magnetic resonance imaging Pulmonary embolism Renal failure Thorax Veins ePublished: 6 April 2010 Issue Published: 6 April 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. 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