Magnetic Resonance Pulmonary Angiography in Detection of Pulmonary Emblism: A Meta-analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHANG Youzhi , XIA Jingwen , YANG Haihua , LONG Feng , CHEN Xiaodong

Department of Respiratory Medicine, Huashan Hospital Affiliated to Fudan University. Shanghai, 200040, ChinaCorresponding Author: CHEN Xiao-dong, E-mail: xiaodongch1963@ yahoo. cn;

Corresponding author：

Keywords：

Magnetic resonance angiography; Pulmonary embolism; Meta-analysis

DOI：

DOI: 10 . 7507 /1671 -6205 . 20130120

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Objective To assess the overall diagnostic value of magnetic resonance angiography ( MRA) in patients with suspected pulmonary embolism.
Methods A search in Cochrane Library,Medline,Embase,Wanfang and China Biology Medicine disc ( CBMdisc) was performed to identify relevant English and Chinese language publications from1990 to 2012. Criteria for inclusion was established based on validity criteria for diagnostic research published by the Cochrane Methods Group on Screening and Diagnostic Tests. Subsequently, the characteristics of the included articles were appraised and extracted. Statistical analysis was performed byMeta-disc version1. 4. Heterogeneity of the included articles was tested, which was used to select proper effect model to calculate pooled weighted sensitivity, specificity, positive likelihood ratio and negative likelihood ratio. Summary receiver opertating characteristic ( SROC) curve was performed and the area under the curve ( AUC) was calculated.
Results 6 literatures in English were finally collected, with a total of 534 cases recruited into the study. Heterogeneity was found because of threshold effect. A Metaanalysis was performed using the randomeffect model. The value of the positive likelihood ratio and negative likelihood ratio of MRA with 95% confidence interval ( 95% CI) were 32. 392( 15. 951-65. 778) and 0. 217( 0. 160-0. 294) , respectively. The pooled weighted sensitivity and specificity were 0. 800 ( 0. 728-0. 860)and 0. 984( 0. 966-0. 994) , respectively. The AUC of SROC was 0. 9783.
Conclusions MRA has certain diagnosis value for pulmonary embolismwith high sensitivity and specificity. MRA may be the best choice for some patients with renal mysfunction and allergy to radiographic contrast material. Otherwise, patients who are detected by MRA avoid exposure to ionizeing radiation.

Citation： ZHANG Youzhi,XIA Jingwen,YANG Haihua,LONG Feng,CHEN Xiaodong. Magnetic Resonance Pulmonary Angiography in Detection of Pulmonary Emblism: A Meta-analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2013, 12(5): 499-504. doi: DOI: 10 . 7507 /1671 -6205 . 20130120 Copy

1.	Furlan A, Aghayev A, Chang CC, et al. Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiology, 2012, 265 :283 -293.
2.	Stein PD, Athanasoulis C, Alavi A, et al. Complications and validity of pulmonary angiography in acute pulmonary embolism.Circulation, 1992, 85: 462-468.
3.	den Exter PL, Klok FA, Huisman MV. Diagnosis of pulmonary embolism: Advances and pitfalls. Best Pract Res Clin Haematol,2012, 25: 295-302.
4.	Battaglia M, Bucher H, Egger M, et al. The Bayes Library of Diagnostic Studies and Reviews. 2nd edition. 2002.5 Sackett DL, Straus SE, Rithardson WS. Evidence-based medicine:How to practice and teach EBM. 2nd edition. London: Chrchill Livingstone. 2000, 169-182 .
5.	Stein PD, Chenevert TL, Fowler SE, et al. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study ( PIOPED III ) . Ann Intern Med,2010, 152 : 434-443.
6.	Pleszewski B, Chartrand-Lefebvre C, Qanadli SD, et al.Gadolinium-enhanced pulmonary magnetic resonance angiography in the diagnosis of acute pulmonary embolism: a prospective study on.
7.	Oudkerk M, van BEJ, Wielopolski P, et al. Comparison of contrastenhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: aprospective study. Lancet, 2002 , 359: 1643 -1647 .
8.	Gupta A, Frazer CK, Ferguson JM, et al. Acute pulmonary embolism: diagnosis with MR angiography. Radiology, 1999 , 210 :353-359.
9.	Meaney JF, Weg JG, Chenevert TL, et al. Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med,1997, 336: 1422-1427.
10.	Loubeyre P, Revel D, Douek P, et al. Dynamic contrast-enhanced MR angiography of pulmonary embolism: comparison with pulmonary angiography. AJR Am J Roentgenol, 1994, 162 : 1035 -.
11.	Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med, 2006 ,354: 2317-2327.
12.	Blum A, Bellou A, Guillemin F, et al. Performance of magnetic resonance angiography in suspected acute pulmonary embolism.Hrombosis & Haemostasis, 2005, 93: 503-511 .
13.	Stein PD, Woodard PK, Hull RD, et al. Gadolinium-enhanced magnetic resonance angiography for detection of acute pulmonary embolism: an in-depth review. Chest, 2003, 124: 2324-2328.
14.	Jacschke R, Guyart GH, Sackett DL, et al. Users’guides to the medical literature. III. How to use an artical about a diagnostic test.B. What are the results and will they help me in caring for mypatients? The Evidence-Based Medicine Working Group. JAMA,1994, 271: 703-707.
15.	Salaun PY, Couturaud F, Le DA, et al. Noninvasive diagnosis of pulmonary embolism. Chest, 2011 , 139: 1294 -1298 .
16.	Safriel Y, Zinn H. CT pulmonary angiography in the detection of pulmonary emboli: a meta-analysis of sensitivities and specificities.Clin Imaging, 2002, 26: 101-105.
17.	郭佑民, 张少娟, 杨健, 等. CT 动脉造影对肺动脉栓塞诊断价值的Meta 分析. 中华放射学杂志, 2004 , 38: 706-710.
18.	Moses LE, Shapiro D, Littenberg B. Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med, 1993, 12 :1293-1316.
19.	patients. Clin Imaging, 2006, 30 : 166-172.
20.	.

1. Furlan A, Aghayev A, Chang CC, et al. Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiology, 2012, 265 :283 -293.
2. Stein PD, Athanasoulis C, Alavi A, et al. Complications and validity of pulmonary angiography in acute pulmonary embolism.Circulation, 1992, 85: 462-468.
3. den Exter PL, Klok FA, Huisman MV. Diagnosis of pulmonary embolism: Advances and pitfalls. Best Pract Res Clin Haematol,2012, 25: 295-302.
4. Battaglia M, Bucher H, Egger M, et al. The Bayes Library of Diagnostic Studies and Reviews. 2nd edition. 2002.5 Sackett DL, Straus SE, Rithardson WS. Evidence-based medicine:How to practice and teach EBM. 2nd edition. London: Chrchill Livingstone. 2000, 169-182 .
5. Stein PD, Chenevert TL, Fowler SE, et al. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study ( PIOPED III ) . Ann Intern Med,2010, 152 : 434-443.
6. Pleszewski B, Chartrand-Lefebvre C, Qanadli SD, et al.Gadolinium-enhanced pulmonary magnetic resonance angiography in the diagnosis of acute pulmonary embolism: a prospective study on.
7. Oudkerk M, van BEJ, Wielopolski P, et al. Comparison of contrastenhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: aprospective study. Lancet, 2002 , 359: 1643 -1647 .
8. Gupta A, Frazer CK, Ferguson JM, et al. Acute pulmonary embolism: diagnosis with MR angiography. Radiology, 1999 , 210 :353-359.
9. Meaney JF, Weg JG, Chenevert TL, et al. Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med,1997, 336: 1422-1427.
10. Loubeyre P, Revel D, Douek P, et al. Dynamic contrast-enhanced MR angiography of pulmonary embolism: comparison with pulmonary angiography. AJR Am J Roentgenol, 1994, 162 : 1035 -.
11. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med, 2006 ,354: 2317-2327.
12. Blum A, Bellou A, Guillemin F, et al. Performance of magnetic resonance angiography in suspected acute pulmonary embolism.Hrombosis & Haemostasis, 2005, 93: 503-511 .
13. Stein PD, Woodard PK, Hull RD, et al. Gadolinium-enhanced magnetic resonance angiography for detection of acute pulmonary embolism: an in-depth review. Chest, 2003, 124: 2324-2328.
14. Jacschke R, Guyart GH, Sackett DL, et al. Users’guides to the medical literature. III. How to use an artical about a diagnostic test.B. What are the results and will they help me in caring for mypatients? The Evidence-Based Medicine Working Group. JAMA,1994, 271: 703-707.
15. Salaun PY, Couturaud F, Le DA, et al. Noninvasive diagnosis of pulmonary embolism. Chest, 2011 , 139: 1294 -1298 .
16. Safriel Y, Zinn H. CT pulmonary angiography in the detection of pulmonary emboli: a meta-analysis of sensitivities and specificities.Clin Imaging, 2002, 26: 101-105.
17. 郭佑民, 张少娟, 杨健, 等. CT 动脉造影对肺动脉栓塞诊断价值的Meta 分析. 中华放射学杂志, 2004 , 38: 706-710.
18. Moses LE, Shapiro D, Littenberg B. Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med, 1993, 12 :1293-1316.
19. patients. Clin Imaging, 2006, 30 : 166-172.
20. .

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Magnetic Resonance Pulmonary Angiography in Detection of Pulmonary Emblism: A Meta-analysis

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