• magnetic resonance imaging;
  • perfusion imaging;
  • pulmonary embolism

Summary.  Background:  Magnetic resonance imaging (MRI) has not been validated as an alternative diagnostic test to computed tomography angiography (CTA) in patients with suspicion of a pulmonary embolism (PE).

Objectives:  To evaluate performance of current MRI technology in diagnosing PE, in reference to a 64-detector CTA.

Patients/methods:  Prospective investigation including 300 patients with a suspected PE, referred for CTA after assessment of clinical probability and D-dimer testing. MRI protocol included unenhanced, perfusion and angiographic sequences. MRI results were interpreted by two independent readers, to evaluate inter-reader agreement. Sensitivity and specificity were evaluated globally and according to PE location and to clinical probability category.

Results:  Of 300 enrolled patients, 274 were analyzed and 103 (37.5%) had a PE diagnosed by CTA. For patients with conclusive MRI results (72% for reader 1, 70% for reader 2), sensitivity and specificity were 84.5% (95% confidence interval [CI], 74.9–91.4%) and 99.1% (95% CI, 95.1–100.0%), respectively, for reader 1, and 78.7% (95% CI, 68.2–87.1%) and 100% (95% CI, 96.7–100.0%) for reader 2. After exclusion of inconclusive MRI results for both readers, inter-reader agreement was excellent (kappa value: 0.93, 95% CI: 0.88–0.99). Sensitivity was better for proximal (97.7–100%) than for segmental (68.0–91.7%) and sub-segmental (21.4–33.3%) PE (P < 0.0001). Sensitivity was similar for both readers within each clinical probability category.

Conclusions:  Current MRI technology demonstrates high specificity and high sensitivity for proximal PE, but still limited sensitivity for distal PE and 30% of inconclusive results. Although a positive result can aid in clinical decision making, MRI cannot be used as a stand-alone test to exclude PE.