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Acute Pulmonary Embolism to the Subsegmental Level: Diagnostic Accuracy of Three MRI Techniques Compared with 16-MDCT

Alexander Kluge1, Wolfgang Luboldt2 and Georg Bachmann1

1 Department of Diagnostic Radiology, Kerckhoff Heart Center, Benekestrasse 2-8, Bad Nauheim, Germany 61231.
2 Department of Angiology, University of Essen, Essen, Germany.


Figure 1
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  		Fig. 1A —59-year-old man with severe dyspnea. MR angiogram depicts large amounts of embolic material (arrowheads) in right pulmonary artery, in right upper and lower lobes, and in left lingual pulmonary artery. Nonenhancing masses (arrow) are present in liver.

 

Figure 2
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  		Fig. 1B —59-year-old man with severe dyspnea. CT angiogram depicts large central embolus (arrowhead) in right pulmonary artery.

 

Figure 3
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  		Fig. 1C —59-year-old man with severe dyspnea. Coronal real-time MR image shows pulmonary emboli (arrowheads) in central and right upper and lower lobes, left upper lobe, and lingula. Left polycystic kidney and polycystic liver (arrows) are evident.

 

Figure 4
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  		Fig. 1D —59-year-old man with severe dyspnea. MR perfusion image at phase of peak parenchymal enhancement shows near-total loss of perfusion in right middle lobe, marked perfusion reduction in segment 6 of lower lobe, and subsegmental perfusion defect (arrowhead) in segment 4 of lingula.

 

Figure 5
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  		Fig. 2A —63-year-old woman with elevated D-dimer values who had mild dyspnea 3 days previously. Oblique multiplanar reformatted MR angiogram. Although subsegmental arteries of right upper lobe are depicted, image quality suffers from motion artifacts and allows segmental analysis at best.

 

Figure 6
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  		Fig. 2B —63-year-old woman with elevated D-dimer values who had mild dyspnea 3 days previously. Double oblique maximum intensity projection (20-mm thickness) of CT angiogram shows peripheral saddle embolus (arrowhead) in segment 9 of right lower lobe.

 

Figure 7
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  		Fig. 2C —63-year-old woman with elevated D-dimer values who had mild dyspnea 3 days previously. Spatial resolution of transverse real-time MR image does not allow subsegmental analysis.

 

Figure 8
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  		Fig. 2D —63-year-old woman with elevated D-dimer values who had mild dyspnea 3 days previously. MR perfusion image depicts isolated peripheral perfusion defect (arrowhead) in segment 9 of right lower lobe.

 

Figure 9
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  		Fig. 3A —66-year-old woman with moderate dyspnea. Transverse real-time MR image shows coarse scar (arrowhead) in left lower lobe.

 

Figure 10
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  		Fig. 3B —66-year-old woman with moderate dyspnea. Sagittal paramedian real-time MR image shows basal scar (arrowhead) depicted in A.

 

Figure 11
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  		Fig. 3C —66-year-old woman with moderate dyspnea. MR perfusion image at same level as A. Perfusion defect (arrowhead) caused by basal parenchymal scarring (A and B) cannot be differentiated from small pulmonary embolism.

 

Figure 12
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  		Fig. 3D —66-year-old woman with moderate dyspnea. CT image (window, 1,400 H; center, 400 H) at same level as A and C shows basal coarse scarring (arrowheads, A and B).

 

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