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Objectives <p>To conduct a meta-analysis of the diagnostic performance of non-contrast magnetic resonance pulmonary angiography (NC-MRPA) and ventilation–perfusion (V/Q) scintigraphy for the detection of acute pulmonary embolism (PE).</p> Materials and methods <p>Systematic searches of electronic databases were conducted from 2000 to 2024. Primary outcomes were per-patient sensitivity and specificity of NC-MRPA and V/Q scintigraphy. The pooled sensitivities, specificities, and 95% confidence intervals (95% CI) were calculated using a random-effect analysis. Summary receiver-operating characteristic (SROC) curves and the area under the curve (AUC) were obtained.</p> Results <p>A total of 3709 studies (1941 NC-MRPA studies) were identified through systematic searches, with eight published MRI and nine published V/Q investigations meeting inclusion criteria. The results showed that NC-MRPA had a pooled sensitivity of 0.88 (95% CI: 0.83–0.91) and specificity of 0.97 (95% CI: 0.93–0.98), yielding an AUC of 0.92 (95% CI: 0.85–0.96). V/Q scanning had a pooled sensitivity of 0.81 (95% CI: 0.76–0.85) and specificity of 0.84 (95% CI: 0.74–0.91), yielding an AUC of 0.87 (95% CI: 0.75–0.91). The pooled proportion of non-diagnostic tests for V/Q scans (34.7%, 95% CI: 30.8–38.7) was greater than that of NC-MRPA studies (3.31%, 95% CI: 1.65–4.97).</p> Conclusion <p>This meta-analysis suggests that NC-MRPA is more specific than V/Q scintigraphy for the detection of PE, with comparable accuracy and sensitivity. NC-MRPA yielded fewer non-diagnostic scans than V/Q scintigraphy and is a feasible alternative imaging modality for diagnosing PE in patients for whom intravenous contrast administration poses a substantive risk.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>V/Q lung scintigraphy has been used as a reserve, alternative modality for patients who cannot undergo CT pulmonary angiography</i>.</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Non-contrast MR angiography (MRA) is a feasible alternative for diagnosing PE in patients for whom intravenous iodinated contrast administration poses a substantial risk.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>Non-contrast MRA provides similar sensitivity and superior specificity to V/Q scintigraphy for diagnosing PE, without ionizing radiation exposure</i>.</p>

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Comparison of the diagnostic performance of non-contrast MR angiography and planar V/Q scintigraphy for pulmonary embolism: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年1月26日

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  • Ricardo F. Silva,
  • Matheus Zanon,
  • Jeanne B. Ackman,
  • Gabriele C. Forte,
  • Stephan Altmayer,
  • Jürgen Biederer,
  • Liisa L. Bergmann,
  • Rubens Gabriel Feijó Andrade,
  • Bruno Hochhegger

摘要

Objectives

To conduct a meta-analysis of the diagnostic performance of non-contrast magnetic resonance pulmonary angiography (NC-MRPA) and ventilation–perfusion (V/Q) scintigraphy for the detection of acute pulmonary embolism (PE).

Materials and methods

Systematic searches of electronic databases were conducted from 2000 to 2024. Primary outcomes were per-patient sensitivity and specificity of NC-MRPA and V/Q scintigraphy. The pooled sensitivities, specificities, and 95% confidence intervals (95% CI) were calculated using a random-effect analysis. Summary receiver-operating characteristic (SROC) curves and the area under the curve (AUC) were obtained.

Results

A total of 3709 studies (1941 NC-MRPA studies) were identified through systematic searches, with eight published MRI and nine published V/Q investigations meeting inclusion criteria. The results showed that NC-MRPA had a pooled sensitivity of 0.88 (95% CI: 0.83–0.91) and specificity of 0.97 (95% CI: 0.93–0.98), yielding an AUC of 0.92 (95% CI: 0.85–0.96). V/Q scanning had a pooled sensitivity of 0.81 (95% CI: 0.76–0.85) and specificity of 0.84 (95% CI: 0.74–0.91), yielding an AUC of 0.87 (95% CI: 0.75–0.91). The pooled proportion of non-diagnostic tests for V/Q scans (34.7%, 95% CI: 30.8–38.7) was greater than that of NC-MRPA studies (3.31%, 95% CI: 1.65–4.97).

Conclusion

This meta-analysis suggests that NC-MRPA is more specific than V/Q scintigraphy for the detection of PE, with comparable accuracy and sensitivity. NC-MRPA yielded fewer non-diagnostic scans than V/Q scintigraphy and is a feasible alternative imaging modality for diagnosing PE in patients for whom intravenous contrast administration poses a substantive risk.

Key Points

Question V/Q lung scintigraphy has been used as a reserve, alternative modality for patients who cannot undergo CT pulmonary angiography.

Findings Non-contrast MR angiography (MRA) is a feasible alternative for diagnosing PE in patients for whom intravenous iodinated contrast administration poses a substantial risk.

Clinical relevance Non-contrast MRA provides similar sensitivity and superior specificity to V/Q scintigraphy for diagnosing PE, without ionizing radiation exposure.