Review
Copyright ©The Author(s) 2023.
World J Radiol. Sep 28, 2023; 15(9): 256-273
Published online Sep 28, 2023. doi: 10.4329/wjr.v15.i9.256
Table 1 Characteristics of included studies
Ref.
Study design
Patients (n)
Demographics
Aims
Methodology
Analysis
Results (95%CI)
Amundsen et al[31], 1997Prospective, qualitative77 patients with suspected PETo evaluate the feasibility of perfusion MRI for detection of perfusion defects distal to suspected pulmonary embolism compared to V/QRapid acquisition of two sets of dynamic images in coronal and trans axial planeQualitative analysis (MRI Vs V/Q)Perfusion MRI correctly identified 16/18 lung segments with perfusion defects
Amundsen et al[32], 2002Prospective, qualitative4220 suspected PE, 11 Pneumonias, 11 COPDTo compare perfusion MRI and V/Q for the perfusion defects detectionRapid acquisition of two sets of dynamic images in coronal and trans axial plane with an inversion recovery gradient MRI sequenceQualitative analysis (MRI Vs V/Q)For PE: Intra-modality kappa = 0.77, Inter-observer kappa = 0.92
Ohno et al[33], 2004Prospective, qualitative40Controls=15, (Mean age 42 yr), PH patients=25, (Mean age 61 yr)To assess regional differences in quantitative pulmonary perfusion parameters using MRIThree dimensional ultrafast DCE-MRI was performed and PBF, PBV & MTT measured by signal intensity time course curveMATLAB, For PBF, MTT, PBV, Mean, SD, ANOVA, Fisher’s PLSD testPBF, PBV & MTT showed significant differences between normal volunteers and patients with PH (P < 0.05)
Nikolaou et al[34], 2005Prospective, qualitative 2916 females (mean age 54 ± 17 yr), 13 males (Mean age 57 ± 15 yr) Pulmonary hypertension & CTEPH differentiation by perfusion MRI and pulmonary angiographyTurbo fast low angle shot gradient echo MRI sequence was performed by using generalized auto calibrating partially parallel technique or GRAPPAStudent t test for significance, ROC using SPSS softwareROC: MRA = 0.85, MRI = 0.82, MRA, MRI combined0.90
Kluge et al[35], 2005Prospective, qualitative 3115 females, 18 males, (Mean age 59.4 yr) with acute PETo compare the feasibility of perfusion MRI with CT for follow up examination in acute PEContrast enhanced 3-dimensional fast low angle shot or FLASH sequence was used for perfusion MRI and time to peak and peak enhancement was measuredT test for paired samples using SPSSFollow up examination using MRI were feasible compared to CT for all patients
Kluge et al[36], 2006Prospective, qualitative 4141 patients with suspected PE To assess the agreement of perfusion MRI with SPECT for identifying perfusion defectsContrast enhanced 3-dimensional fast low angle shot or FLASH sequence was used for perfusion MRINot givenMRI and SPECT agreement kappa Lobar = 0.98, Segmental = 0.98, Subsegmental = 0.69
Ohno et al[37], 2007Prospective, qualitative 28Controls=14, (Mean age 34 yr), PH patients=14, (Mean age 41 yr)To measure diagnostic potential of DCE-MRI for pulmonary hypertensionThree dimensional ultrafast DCE-MRI was performed and PBF, PBV & MTT measured by signal intensity time course curveMATLAB, For PBF, MTT, PBV, MathWorks, Mean, SD, T testDifference for study groups: PBF: P < 0.0001, PBV: P < 0.0001, MTT: P < 0.0001
Ley et al[38], 2007Prospective, qualitative 25Controls=5, PH patients=20To measure diagnostic potential of DCE-MRI for pulmonary hypertensionContrast enhanced 3-dimensional fast low angle shot or FLASH sequence was used for perfusion MRIQuantitative analysis of PBF, PBV and MTT, Mann-Whitney U-testPBF, PBV & MTT showed significant differences between normal volunteers and patients with PH (P < 0.05)
Ohno et al[39], 2008Prospective, qualitative 27Controls = 9, 18 gender and age matched CTD patientsTo measure diagnostic potential of DCE-MRI for PAH PBF, MTT and PBV measured by DCE-MRI and correlated by %DL(CO) measured by pulmonary function test and mPAP, sPAP measured by doppler echoMATLAB, MathWorks, Mean, SD, T test, Correlation testPBF, MTT, PBV correlated positively with %DL(CO) & sPAP (P < 0.05), PBF& PBV correlated positively with mPAP& moderately with PVR (P < 0.05)
Ohno et al[40], 2010Prospective, qualitative 5050 PE patients with acute pulmonary thromboembolism (APTE)To measure diagnostic potential of DCE-MRI for acute pulmonary thromboembolism (APTE)PBF, PBV, MTT & APTE index measured by DCE-MRI using 3-dimensional spoiled gradient sequence, MPAP, PVR measured by RHC. RV/LV diameter ratio, APTE index measured by CT & MRAROC curve, Logistic regressionPBF and MTT significantly lower for APTE segments to non-APTE segments (P < 0.05), APTE indexes from all modalities proved significant predictors for differentiating APTE patients
Stein et al[41], 2010Prospective, qualitative 371371 adults with diagnosed or excluded pulmonary embolism- (PIOPED III)To assess performance of MRA and venography for pulmonary embolism detection MRA was compared with CTPA, V/Q scan, venous ultrasonography, D-dimer assay, and clinical assessment, Qualitative assessment by expert reader only Chi-square test ANOVATechnically adequate images for MRA: SE: 78%, SP: 99%
Kang et al[42], 2011Prospective, qualitative 3535 PAH patients (Mean age 44 yr)To assess if Cardiac MRI based pulmonary artery distensibility index correlates with RHC estimates for PAH Pulmonary artery distensibility indices were derived from transverse view MRI and compared with PVR using RHC Correlation Non-invasive MRI based pulmonary artery distensibility index correlates with RHC based estimates P < 0.001
Ohno et al[43], 2012Prospective, qualitative 24Response group=13, Non-response group=11, 12 females & 12 males mean age 68 yr ± 8.6CTPA, MRA & DCE-MRI comparison for treatment response in inoperable CTEPH patientsPBF, PBV, MTT measured by DCE-MRI using 3-dimensional spoiled gradient sequence, RV/LV diameter ratio and embolic burden measured by CTPA & MRAMean of student T test, Correlation, ROC curve analysis, McNemar’s test DCE-MRI SP = 90%, AC = 95%, CTPA SP = 36%, AC = 70%, MRA SP = 54%, AC = 79%
Ley et al[44], 2013Prospective, qualitative 20 PAH or CTEPH patientsControls 10, Training group 10To evaluate if training improves pulmonary perfusion in PH as assessed by MR perfusion imagingTraining group received in hospital exercise training while control group received conventional rehabilitation. 6 min walk test, PBF, PBV, MTT & peak flow velocity measured by MR perfusion were assessed for both groups from baseline to 3 wkMann-Whitney-Wilcoxon test, Spearman correlation coefficient Training group had significantly improved 6-min walk test, MR flow and MR perfusion
Rajaram et al[45], 2013Prospective, qualitative 13278 CTEPH patientsTo compare the diagnostic accuracy of perfusion MRI for CTEPH Vs. CTPA and V/QPulmonary perfusion MRI using time resolved 3-Dimensional spoiled gradient and pulmonary MRA were compared with CTPA and V/QNot givenSE, SP in %, MRI: 97, 92, V/Q: 96, 90, CTPA: 94, 98
Revel et al[46], 2013Prospective, qualitative 274274 suspected PE patientsTo evaluate unenhanced, enhanced perfusion and MR angiography for PE detection Unenhanced steady state free precession or SSFP, fast spoiled gradient echo for perfusion MRI and MR angiography were compared with CTPAChi-squared Kappa statisticsKappa agreement MRA = 0.77, Perfusion MRI = 0.51, Unenhanced MRI = 0.62
Sugimoto et al[47], 2013 Prospective, qualitative 3434 congenital heart disease patientsTo assess if velocity encoded cine imaging can measure pulmonary artery pressure in children with congenital heart diseasePulmonary blood flow (QP), systemic blood flow (QS), acceleration time, ejection time, peak velocity, and maximal change in flow rate during ejection (MCFR) were measured by velocity encoded MRI and RHCVelocity encoded MRI correlated strongly with RHC for QS, right to left QP ratio and QP/QS. Suggesting usefulness of MRI for pulmonary artery pressure measurement
Schoenfeld et al[48], 2015Prospective, qualitative 6464 ruled out or confirmed PE patientsTo compare perfusion weighted Fourier decomposition or PW-FD to DCE-MRI for PE detection Time resolved angiography with stochastic trajectories or TWIST for DCE-MRI was used and compared with PW-FDQualitative only, Kappa statisticsFor PW-FD per patient basis, SE = 100%, SP = 95%, PPV = 98%, NPV = 98%, Intraobserver k = 0.96, Interobserver k = 0.96
Ingrisch et al[49], 2016Prospective, qualitative 188 acute PE, 10 controlsDCE-MRI evaluation for acute PE detection compared with CTPAQualitative assessment of presence and absence of perfusion defects using DCE-MRI using TWIST sequenceCohen’s kappa, Fisher’s exact testSE: 87-93%, SP: 90-95%, PPV: 87-93%, NPV: 90-95%, Inter-reader agreement: k = 0.77, Intra-modality agreement: P < 0.001
Johns et al[50], 2017Prospective, qualitative 7420 male, 26 female, Mean age 62 ± 14 yrDCE-MRI, SPECT & CTPA comparison for CTEPH diagnosisQualitative comparison of presence/absence of perfusion defects on DCE-MRI using fast spoiled gradient echo, perfusion, SPECT and CTPA2*2 predictive table, Kappa (k) for inter-observer agreementSE: 100%, SP: 81%, PPV: 90%, NPV: 100%, Inter-observer agreement for DCE-MRI: k = 0.88, SPECT: (k = 0.80)
Voskrebenzev et al[51], 2018Prospective, qualitative 52 controls, 1 CTEPH patient 1 CF patient, 1 obstructive pulmonary disease patientTo assess the feasibility of phase resolved functional lung MRI (PREFUL) for quantitative reginal ventilation and perfusionTime to peak, V/Q maps and fractional ventilation flow volume were calculated using PREFUL MRIFull Cardiac and respiratory cycle were sorted using PREFULPost endarterectomy, CTEPH patient showed increased perfusion time to peak in visual agreement with DCE-MRI
Agoston-Coldea et al[52], 2018Prospective, qualitative 3030 consecutive patients with COPD and suspected secondary pulmonary hypertensionTo evaluate ability of CMR right ventricular parameters and pulmonary artery stiffness to identify pulmonary hypertensionClinical examination. 6-min walk test, echocardiography, RHC and cardiac functions and late gadolinium CMR imaging with phase contrast flow imaging of pulmonary artery. Followed up for a mean period of 16 moROC curve analysis, Kolmogorov-Smirnov test, ANOVA test. Fischer’s exact testPulse wave velocity: SE = 93.5%, SP = 92.8%
Schoenfeld et al[53], 2019Prospective, qualitative 2920 CTEPH patientsCardiopulmonary evaluation of treatment response after BPA in CTEPH patientsPBF and first pass bolus kinetic parameters and biventricular mass and functions were evaluated using MRIPaired two sides Wilcoxon rank sum test, Spearman p correlation, Multiple linear regressionPost BPA, PBF changes in treated lobes were significantly higher than non-treated lobes P < 0.05, MRI derived pulmonary artery pressure ejection fraction, RV stroke volume, CO, ventricular mass index & PBF in non-treated lobes correlated with PBF changes in treated lobes P < 0.05
Ray et al[54], 2019Prospective, qualitative 5120 mild PH, 31 moderate to severe PAHUtility of pulmonary artery pulsatility by cardiac MRI as an early marker of pulmonary hypertension Standards steady state free precession or cine SSFP for pulmonary artery pulsatility and phased contrast MRI imaging for pulmonary flow assessmentWilcoxon rank sum test, Roc analysisPulmonary artery pulsatility declined from normal (53%), mild (22%) and moderate to severe PAH (17%)
Alsady et al[55], 2021Prospective, qualitative 2020 CTEPH patients To compare DCE-MRI and computed tomography for lung perfusion defects before and after pulmonary endarterectomyLobe based analysis of perfusion defects using DCE-MRI and PBF and PBV measurement, comparison with dual energy computed tomographyPearson product-moment correlation, Paired t test using MATLABCorrelation between CT and MRI based perfusion defects (r > 0.78; P < 0.001)
Torres et al[56], 2022 Prospective, qualitative4120 IPF patientsDCE-MRI for the evaluation of lung perfusion in IPFPBF CV, FVC% predicted %DL(CO) and LCI% were evaluated using DCE-MRIRegression analysis, Spearman rank correlation DCE-MRI identified regional perfusion defects between controls and IPF (P < 0.05). Correlation observed between PBF CV and %DL(CO) (r = 0.48, P < 0.001)