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Pulmonary MRA: Differentiation of pulmonary embolism from truncation artefact

  • Magnetic Resonance
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Abstract

Purpose

Truncation artefact (Gibbs ringing) causes central signal drop within vessels in pulmonary magnetic resonance angiography (MRA) that can be mistaken for emboli, reducing diagnostic accuracy for pulmonary embolism (PE). We propose a quantitative approach to differentiate truncation artefact from PE.

Methods

Twenty-eight patients who underwent pulmonary computed tomography angiography (CTA) for suspected PE were recruited for pulmonary MRA. Signal intensity drops within pulmonary arteries that persisted on both arterial-phase and delayed-phase MRA were identified. The percent signal loss between the vessel lumen and central drop was measured. CTA served as the reference standard for presence of pulmonary emboli.

Results

A total of 65 signal intensity drops were identified on MRA. Of these, 48 (74 %) were artefacts and 17 (26 %) were PE, as confirmed by CTA. Truncation artefacts had a significantly lower median signal drop than PE on both arterial-phase (26 % [range 12–58 %] vs. 85 % [range 53–91 %]) and delayed-phase MRA (26 % [range 11–55 %] vs. 77 % [range 47–89 %]), p < 0.0001 for both. Receiver operating characteristic (ROC) analyses revealed a threshold value of 51 % (arterial phase) and 47 % signal drop (delayed phase) to differentiate between truncation artefact and PE with 100 % sensitivity and greater than 90 % specificity.

Conclusion

Quantitative signal drop is an objective tool to help differentiate truncation artefact and pulmonary embolism in pulmonary MRA.

Key points

• Inexperienced readers may mistake truncation artefacts for emboli on pulmonary MRA

• Pulmonary emboli have non-uniform signal drop

• 51 % (arterial phase) and 47 % (delayed phase) cut-off differentiates truncation artefact from PE

• Quantitative signal drop measurement enables more accurate pulmonary embolism diagnosis with MRA

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Acknowledgments

The authors wish to thank Alejandro Munoz del Rio, PhD for his statistical advice at all stages of this project. The authors also wish to thank Bracco Diagnostic for their support through an unrestricted research grant. The scientific guarantor of this publication is Scott K Nagle. The authors of this manuscript declare relationships with the following companies: Bracco and GE. This study has received funding by the Department of Radiology Research and Development Committee. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, cross-sectional study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Room E1/372, Madison, WI, 53792-3252, USA

    Peter Bannas, Mark L. Schiebler, Utaroh Motosugi, Christopher J. François, Scott B. Reeder & Scott K. Nagle

  2. Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA

    Scott B. Reeder

  3. Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA

    Scott B. Reeder & Scott K. Nagle

  4. Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Peter Bannas

  5. Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA

    Scott B. Reeder

  6. Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA

    Scott K. Nagle

Authors
  1. Peter Bannas
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  2. Mark L. Schiebler
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  3. Utaroh Motosugi
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  4. Christopher J. François
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  5. Scott B. Reeder
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  6. Scott K. Nagle
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Corresponding author

Correspondence to Peter Bannas.

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Bannas, P., Schiebler, M.L., Motosugi, U. et al. Pulmonary MRA: Differentiation of pulmonary embolism from truncation artefact. Eur Radiol 24, 1942–1949 (2014). https://doi.org/10.1007/s00330-014-3219-5

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  • DOI: https://doi.org/10.1007/s00330-014-3219-5

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