3D contrast-enhanced lung perfusion MRI is an effective screening tool for chronic thromboembolic pulmonary hypertension: results from the ASPIRE Registry
- Smitha Rajaram1,
- Andrew J Swift1,
- Adam Telfer1,
- Judith Hurdman,
- Helen Marshall2,1,
- Eleanor Lorenz3,
- David Capener1,
- Christine Davies4,
- Catherine Hill4,
- Charlie Elliot2,
- Robin Condliffe2,
- Jim M Wild1,
- David G Kiely2
- 1Academic Unit of Radiology, University of Sheffield, Sheffield, UK
- 2Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- 3Department of Nuclear Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- 4Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Correspondence to Dr David G Kiely, Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK;
- Received 19 November 2012
- Revised 11 December 2012
- Accepted 12 December 2012
- Published Online First 24 January 2013
Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism potentially curable by surgery. Perfusion scintigraphy is currently advocated as the imaging modality of choice to exclude CTEPH due to its high sensitivity. We have evaluated the diagnostic utility of lung perfusion MRI.
Methods Consecutive patients attending a pulmonary hypertension referral centre undergoing lung perfusion MRI, perfusion scintigraphy, CT pulmonary angiography (CTPA) and right heart catheterisation within 14 days were identified.
Results Of 132 patients, 78 were diagnosed as having CTEPH. Lung perfusion MRI correctly identified 76 patients as having CTEPH with an overall sensitivity of 97%, specificity 92%, positive predictive value 95% and negative predictive value 96% compared with perfusion scintigraphy (sensitivity 96%, specificity 90%) and CTPA (sensitivity 94%, specificity 98%). No cases of surgically accessible CTEPH were missed with either modality.
Conclusions Lung perfusion MRI has high sensitivity equivalent to perfusion scintigraphy in diagnosing CTEPH but does not require ionising radiation, making it an attractive initial imaging modality to assess patients with suspected CTEPH.