Format

Send to

Choose Destination
Emerg Radiol. 2018 Oct;25(5):469-477. doi: 10.1007/s10140-018-1609-8. Epub 2018 May 10.

Clinical outcomes after magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) for pulmonary embolism evaluation.

Author information

1
BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, 800 University Bay Drive, Suite 310, Mail Code 9123, Madison, WI, 53705, USA. mdrepplinger@wisc.edu.
2
Department of Radiology, University of Wisconsin, Madison, WI, USA. mdrepplinger@wisc.edu.
3
Department of Radiology, University of Wisconsin, Madison, WI, USA.
4
Department of Medical Physics, University of Wisconsin, Madison, WI, USA.
5
Department of Pediatrics, University of Wisconsin, Madison, WI, USA.
6
BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, 800 University Bay Drive, Suite 310, Mail Code 9123, Madison, WI, 53705, USA.
7
School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
8
Department of Biostatistics, University of Wisconsin, Madison, WI, USA.
9
Department of Medicine, Dartmouth University, Geisel School of Medicine, Hanover, NH, USA.
10
Department of Medicine, University of Wisconsin, Madison, WI, USA.
11
Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA.

Abstract

PURPOSE:

To compare patient outcomes following magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) ordered for suspected pulmonary embolism (PE).

METHODS:

In this IRB-approved, single-center, retrospective, case-control study, we reviewed the medical records of all patients evaluated for PE with MRA during a 5-year period along with age- and sex-matched controls evaluated with CTA. Only the first instance of PE evaluation during the study period was included. After application of our exclusion criteria to both study arms, the analysis included 1173 subjects. The primary endpoint was major adverse PE-related event (MAPE), which we defined as major bleeding, venous thromboembolism, or death during the 6 months following the index imaging test (MRA or CTA), obtained through medical record review. Logistic regression, chi-square test for independence, and Fisher's exact test were used with a p < 0.05 threshold.

RESULTS:

The overall 6-month MAPE rate following MRA (5.4%) was lower than following CTA (13.6%, p < 0.01). Amongst outpatients, the MAPE rate was lower for MRA (3.7%) than for CTA (8.0%, p = 0.01). Accounting for age, sex, referral source, BMI, and Wells' score, patients were less likely to suffer MAPE than those who underwent CTA, with an odds ratio of 0.44 [0.24, 0.80]. Technical success rate did not differ significantly between MRA (92.6%) and CTA (90.5%) groups (p = 0.41).

CONCLUSION:

Within the inherent limitations of a retrospective case-controlled analysis, we observed that the rate of MAPE was lower (more favorable) for patients following pulmonary MRA for the primary evaluation of suspected PE than following CTA.

KEYWORDS:

Clinical effectiveness; Computed tomographic angiography; Magnetic resonance angiography; Patient-oriented outcomes; Pulmonary embolism

PMID:
29749576
PMCID:
PMC6119517
[Available on 2019-10-01]
DOI:
10.1007/s10140-018-1609-8
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center