Iodinated Contrast Allergy Research Articles

Zero-contrast intravascular ultrasound-guided percutaneous coronary intervention in a patient with high-risk iodinated contrast allergy: navigating in the dark through a brighter inner light.

Zero-contrast intravascular ultrasound-guided percutaneous coronary intervention in a patient with high-risk iodinated contrast allergy: navigating in the dark through a brighter inner light.

244 - Clinical Significance and Application Value of MRU in Patients with Iodine Contrast Allergy

244 - Clinical Significance and Application Value of MRU in Patients with Iodine Contrast Allergy

6808 Effect of Corticosteroid Premedication on Adrenal Vein Sampling in Patients with Primary Aldosteronism and Iodine Contrast Allergy

6808 Effect of Corticosteroid Premedication on Adrenal Vein Sampling in Patients with Primary Aldosteronism and Iodine Contrast Allergy

To PE or Not to PE: Perfusion SPECT/CT Avoids Overdiagnosis.

A 41-year-old woman with metastatic breast cancer presented with dyspnea, hypoxia, and elevated d -dimer. Perfusion planar imaging followed by SPECT/CT of the chest was performed due to the patient's iodinated contrast allergy. Planar images showed multiple pleural-based wedge-shaped defects concerning for bilateral pulmonary embolism (PE). Perfusion SPECT/CT of the chest confirmed multiple areas of perfusion defects but was considered negative for PE and attributed the perfusion defects to the compressing of pulmonary vasculature from metastatic lymph nodes and pulmonary masses. Given the high pretest probability of PE, a CT pulmonary angiogram was performed after premedication for contrast allergy confirming absence of PE.

Use of indocyanine green dye for sentinel lymph node mapping in patients with endometrial cancer and a history of iodinated contrast allergy

ObjectivesSentinel lymph node (SLN) mapping is a surgical technique with high accuracy in detecting metastases while limiting morbidity associated with full lymphadenectomy in endometrial cancer. Cervical injection of indocyanine green (ICG) dye is associated with very high SLN detection rates; however, iodinated contrast allergy has traditionally been viewed as a contraindication to ICG use. The objective of this study was to describe the use of ICG in a population of patients with iodinated contrast allergies undergoing surgical staging for endometrial cancer. MethodsIRB approval was obtained. All patients with clinically early-stage endometrial cancer who underwent minimally invasive surgical staging with SLN mapping with ICG at a single academic institution from 1/1/2017 to 12/31/2020 were identified retrospectively. Patients with reported iodinated contrast allergies prior to surgery were identified. Data were collected through electronic medical record review and compared using descriptive statistics. Results820 patients who underwent minimally invasive surgical staging with SLN mapping with ICG were identified, and 25 had documented iodinated contrast allergies. Documented reactions included rash/hives (n = 10, 40 %), anaphylaxis (n = 6, 24 %), shortness of breath (n = 5, 20 %), diarrhea (n = 1, 4 %), and not specified (n = 3, 12 %). A majority (24/25, 96 %) received 4 mg intravenous dexamethasone during induction of general anesthesia as per the institutional enhanced recovery after surgery (ERAS) protocol. No patients experienced allergic reactions or other adverse events after ICG injection. ConclusionsNo patients in this cohort demonstrated an adverse reaction after ICG injection for SLN mapping. This study supports the reasonable safety of ICG in patients with contrast allergies, particularly when routine ERAS protocols containing dexamethasone are utilized.

Gadolinium-Based Contrast Agents: Rationale for Use in Patients with Iodine Contrast or Shellfish Allergy?

Gadolinium-Based Contrast Agents: Rationale for Use in Patients with Iodine Contrast or Shellfish Allergy?

Use of indocyanine green dye for sentinel lymph node mapping in patients with endometrial cancer and a history of iodinated contrast allergy (176)

Use of indocyanine green dye for sentinel lymph node mapping in patients with endometrial cancer and a history of iodinated contrast allergy (176)

A Survey of Practicing Radiologists on the Use of Premedication Before Intravenous Iodinated Contrast Medium Administration

ObjectiveTo determine whether updated guidance by the ACR in 2017 advocating use of intravenous (IV) premedication in emergency department (ED) patients and inpatients with reported iodinated contrast allergy was associated with a change in clinical practice. MethodsAn anonymous survey was distributed via e-mail in October 2020 to practicing radiologist members of the ACR interrogating use of corticosteroid premedication for two clinical vignettes: an indicated routine (perform within 24 hours) inpatient contrast-enhanced CT (CE-CT) and an indicated urgent (perform within 6 hours) ED CE-CT. In both scenarios, the patient had a prior moderate hypersensitivity reaction to iodinated contrast media. Clinical management was evaluated. Data were compared to historical controls from 2009. ResultsThe response rate was 11% (724 of 6,616). For the inpatient scenario, 72% (518 of 724) would use corticosteroid premedication with CE-CT, and 28% (200 of 724) would perform noncontrast CT. For the ED scenario, 67% (487 of 724) would use corticosteroid premedication with CE-CT, and 30% (217 of 724) would perform noncontrast CT. Oral premedication (85%, 439 of 518) was preferred for routine inpatients, and rapid IV premedication (89%, 433 of 487) was preferred for urgent ED patients. Of those who provided rapid IV dosing data in the ED, two doses of corticosteroids were used by 53% (216 of 410) and one dose was used by 45% (185 of 410), with academic radiologists more likely than private or hybrid practice radiologists to administer two doses (74% [74 of 100] versus 48% [151 of 312], P < .001, odds ratio, 3.03; 95% confidence interval, 1.84-5.00). Rapid IV premedication was more commonly used in 2020 than in 2009 (60% [433 of 724] versus 29% [20 of 69], P < .001, odds ratio, 3.65; 95% confidence interval, 2.12-6.26). Antihistamine use was common in both inpatient (93%, 480 of 518) and ED settings (92%, 447 of 487). Only 32% (229 of 721) of radiologists practiced in accordance with ACR guidelines, suggesting no need for routine premedication before CE-CT in patients with prior severe hypersensitivity reaction to gadolinium-based contrast media. Nonetheless, most (93%, 670 of 724) said the ACR Manual on Contrast Media was a major determinant of their practice. ConclusionsUse of rapid IV premedication in urgent settings has increased since 2009, following updated ACR guidelines, but there is disagreement over whether one or two corticosteroid doses is required. Despite reported high reliance on ACR guidelines, deviations from those guidelines remain common. In general, when ACR guidelines were not followed, it was in a risk-averse direction.

PO-03-164 FEASIBILITY OF GADOLINIUM CONTRAST FLUOROSCOPY TO FACILITATE WATCHMAN FLX IMPLANTATION USING INTRACARDIAC ECHOCARDIOGRAPHY

In patients with non-valvular atrial fibrillation, left atrial appendage closure (LAAC) is an alternative to oral anticoagulation for stroke-risk reduction. The standard imaging used during LAAC procedures is transesophageal echocardiography with iodinated contrast media. The recent worldwide supply chain shortage in April 2022 resulted in a global shortage of these contrast agents, limiting the ability to perform LAAC. Alternatives to iodinated contrast agents are needed to combat the impact of the contrast shortage on patient care. Limited published experience has shown effective use of IV gadolinium contrast for coronary angiography. We sought to validate the use of gadolinium contrast for LAAC in lieu of iodinated contrast agents. Thirty consecutive patients referred for LAAC underwent Watchman FLX implant with intracardiac echo (ICE) using gadolinium (Gadovist) for intra-procedural LAA angiography and device assessment prior to device release. Ultrasound imaging was performed with an 8 Fr. ICE catheter (AcuNav). Light sedation was used. Patients were managed with antithrombotic therapy for 12-weeks post implant with CT imaging at 4 months. Of the total cohort of 32 patients, two were excluded for creatinine clearance < 30 mL/min. The 30 remaining patients had successful closure of the LAA with no peri-device leaks (PDL) using an average of 11 mL (10-15) gadolinium contrast and ICE imaging. The workflow consisted of a pigtail angiogram of the LAA using 5 mL gadolinium with the remainder used through the Watchman delivery sheath post-deployment to visualize the tug test and assess for PDL. ICE verified Watchman FLX position at multiple angles. Procedure time was 42 min (30-59) with an average of 1.5 deployments per case (1-3). At 4 months, 26 (87%) had complete closure (20 by CT, 6 by TEE). Four patients had a PDL of 1.5 mm (1-3 mm) by CT. No device-related thrombus was noted. There were no complications noted during the first 4 months post implant. Gadolinium contrast may be used as an alternative to iodinated contrast agents for LAA angiography to facilitate Watchman FLX implantation with ICE with both efficacy and safety. Operators should have sufficient experience with Watchman FLX LAAC to minimize the need for multiple angiographic views and use ultrasound imaging to assess for PDL. Gadolinium contrast can be a valuable option during efforts to conserve IV iodinated contrast, but also for patients with iodinated contrast allergy.

Expediting emergent MRI in acute ischemic stroke by extending CT scout image: a simple intervention to decrease time to treatment (P11-5.010)

<h3>Objective:</h3> We revised our acute stroke CT protocol to reduce time to MRI in acute ischemic stroke. <h3>Background:</h3> “Time is brain” in acute stroke. Patients requiring emergent MR imaging in the emergency department prior to thrombolytic treatment (e.g. wake-up strokes, iodinated contrast allergy, assessment of DWI/FLAIR mismatch) must undergo the MRI safety screen for implantable devices and foreign metallic bodies. Patient factors including neurologic deficits, language barrier, or lack of information on implantable devices make the screening process time-consuming. If patients cannot complete the safety checklist, radiographic clearance with chest and abdomen x-rays is pursued which delays time to treatment. <h3>Design/Methods:</h3> We revised our CT acute stroke radiology protocol to include scout images from the head to the femur to screen for foreign bodies, implantable devices or metallic objects. Standard CTA head and neck scout images previously only extended to the mid-chest. The new protocol obviates need for MRI screening checklist in emergent situations and allows to proceed directly from CT to MRI with the assistance of the radiologist interpreting the scout image. <h3>Results:</h3> Our multidisciplinary stroke team has implemented this change in our emergency department CT acute stroke protocol. The difference in additional radiation exposure is minimal to non-significant; the estimated total radiation dose of the topogram for the head, neck, chest, abdomen, and pelvic regions is approximately 0.24mSv (of which only the abdomen and pelvis are additional in this protocol). In comparison, the radiation dose of a standard abdomen/pelvis radiograph is 0.7mSv. Data collection is ongoing to measure impact on door to needle time. <h3>Conclusions:</h3> Revision of the CT stroke protocol to extend the CT scout from the head to the femur can expedite clearance for emergent MRI in patients who are candidates for thrombolysis or thrombectomy at no significant expense or radiation. This has potential to reduce time to acute stroke treatment. <b>Disclosure:</b> Dr. Aghajan has nothing to disclose. Dr. Gupta has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for •

The first experience of using carboxyangiography in renal denervation in a patient with resistant arterial hypertension, chronic kidney disease and iodine contrast allergy

The first experience of using carboxyangiography in renal denervation in a patient with resistant arterial hypertension, chronic kidney disease and iodine contrast allergy

Teaching Neuro Images : Hyperintense acute reperfusion marker in ischemic stroke with transient symptoms

A 67-year-old man with 45-minute onset left hemiparesis underwent 3.0T gadolinium-enhanced MRI (reported iodine contrast allergy) with right frontoparietal small infarcts on diffusion-weighted images without vascular obstruction. No reperfusion therapy was given due to complete spontaneous symptoms regression. Twenty-four hours later, a second MRI showed right parietal CSF space enhancement on fluid-attenuated inversion recovery. Neither MRI nor CT had sign of hemorrhage (figure).

JS-AHA: AHA SESSION CLINICAL CASE; CLINICAL-PATHOLOGICAL CONFERENCE (CPC) IN COOPERATION WITH HYPERTENSION, AN AMERICAN HEART ASSOCIATION JOURNAL

A 35-year-old woman, with a known history of right renal artery FMD, presented at the Hypertension Outpatient Clinic for evaluation of resistant hypertension. The patient was an active smoker and had a single kidney after left nephrectomy for kidney malformation during childhood. The diagnosis of FMD had been made on the occasion of a previous pregnancy at 23 years, complicated by preeclampsia and an angioplasty had been performed. Work-up disclosed a recurrence of right renal artery stenosis, and a new renal angioplasty was performed. Blood pressure normalized after the procedure. At 36 years, the patient had another pregnancy, also complicated by preeclampsia and preterm delivery. An Echo-Doppler performed during pregnancy and an Angio-CT after delivery, allowed ruling out recurrence of renal artery stenosis. At 43 years, she was admitted to the emergency room for thoracic pain. The coronarography was in favour of a coronary spasm. There was no coronary stenosis or image suggestive of a Spontaneous Coronary Artery Dissection. At 54 years, the patient was again admitted in emergency for malignant hypertension associated with severe acute renal failure. She also reported a history of lower limbs claudication since several months. An abdominal CT disclosed dissection complicated by occlusion of the right renal artery, dissection of both iliac arteries as well as a severe stenosis of the infra-renal aorta. An angioplasty with insertion of stents in the right renal artery and the aorta was performed. After the procedure, a partial normalization of renal function was observed, and blood pressure control was achieved on 3 medications. During the recovery, the patient presented a skin rash associated with a general feeling of discomfort, with spontaneous resolution after a few days. One year later, following a control Angio-CT of the abdomen, an anaphylaxis episode occurred, requiring Adrenaline administration. Iodine contrast allergy was suspected, but milder hypersensitivity symptoms occurred in the following months, without exposition to a clear trigger. An allergology work-up was performed with final diagnosis of secondary Mast Cell Activation Syndrome. B-Blockers and ACE-inhibitors were contra-indicated and cautious premedication before further exposure to iodine contrast was recommended.

Impact of iodinated contrast allergies on emergency department operations

ObjectivesAdverse reactions to intravenous (IV) iodinated contrast media are classified by the American College of Radiology (ACR) Manual on Contrast Media as either allergic-like (ALR) or physiologic (PR). Premedication may be beneficial for patients who have prior documented mild or moderate ALR. We sought to perform a retrospective analysis of patients who received computed tomography (CT) imaging in our emergency department (ED) to establish whether listing of an iodinated contrast media allergy results in a delay in care, increases the use of non-contrast studies, and to quantify the incidence of listing iodinated contrast allergies which do not necessitate premedication. MethodsWe performed a retrospective analysis of CT scans performed in our academic medical center ED during a 6-month period. There were 12,737 unique patients of whom 454 patients had a listed iodinated contrast allergy. Of these, 106 received IV contrast and were categorized as to whether premedication was necessary. Descriptive statistics were used to evaluate patient demographics, clinical characteristics, and operational outcomes. A multivariate linear regression model was used to predict time from order to start (OTS time) of CT imaging while controlling for co-variates. ResultsNon-allergic patients underwent contrast-enhanced CT imaging at a significantly higher rate than allergic patients (45.9% vs. 23.3%, p < 0.01). The OTS time for allergic patients who underwent contrast-enhanced CT imaging was 360 min and significantly longer than the OTS time for non-allergic patients who underwent contrast-enhanced CT imaging (118 min, p < 0.001). Of the 106 allergic patients who underwent contrast-enhanced CT imaging, 27 (25.5%) did not meet ACR criteria for necessitating premedication. The average OTS time for these 27 patients was 296 min, significantly longer than the OTS for non-allergic patients (118 min, p < 0.01) and did not differ from the OTS time for the 79 patients who did meet premedication criteria (382 min, p = 0.23). A multivariate linear regression showed that OTS time was significantly longer if a contrast allergy was present (p < 0.001). ConclusionA chart-documented iodinated contrast allergy resulted in a significant increase in time to obtain a contrast-enhanced CT study. This delay persisted among patients who did not meet ACR criteria for premedication. Appropriately deferring premedication could potentially reduce the ED length-of-stay by over 4 h for these patients.

The Role of Magnetic Resonance in Evaluating Abdominopelvic Trauma - Part 2: Trauma in Pregnancy, Vascular, and Genitourinary Injuries.

Trauma is an important cause of mortality, particularly in the young. While computed tomography (CT) is the mainstay of body imaging in the setting of trauma, magnetic resonance (MR) imaging can be useful in stable patients. Although more commonly used in spinal and musculoskeletal trauma, MR also has a role in abdominopelvic trauma. Broadly, its uses include clarification of equivocal cases, monitoring complications of trauma, particularly with solid organ injury, or as a primary imaging modality for patients with low suspicion for injury for whom avoiding ionizing radiation is a priority-namely, in pediatric and pregnant patients. In this two-part review article, we will review clinical scenarios where this may be encountered, utilizing case examples. Our second installment will focus on the use of MR in pregnant patients and in the characterization of vascular and genitourinary trauma. Body MR can be useful in pregnant patients in characterizing injuries both specific for and not specific for pregnancy. Placental injuries and hematomas in particular may be better seen on MR relative to CT, owing to its superior contrast resolution. MR angiography can be performed either without or with contrast and can be useful to monitor low-grade traumatic aortic injuries. Renal and ureteral injuries can be followed with MR to help identify urine leaks, either in a delayed presentation or in patients who have an iodinated contrast allergy. Lastly, penile injuries are often imaged with ultrasound, but may benefit from additional imaging with MR when the tunica albuginea cannot be completely seen due to overlying hematoma.

MASSIVE HEMOPTYSIS POST COVID-19 INFECTION IN THE SETTING OF UNILATERAL PULMONARY ARTERY AGENESIS

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Unilateral pulmonary artery agenesis (UPAA) is a rare congenital condition with a prevalence of 1 in 200,000 adults3. It is often associated with other cardiovascular abnormalities, and occurs most frequently as an absence of the right branch. Hemoptysis has been reported in up to 10% of patients with UPAA1,2. Here we describe the case of a patient with UPAA and massive hemoptysis after SARS-CoV-2 infection. CASE PRESENTATION: A 27-year-old female with a past medical history significant for patent ductus arteriosus, atrial septal defect, hypoplastic right lung, agenesis of the right pulmonary artery, von Willebrand Disease, and iodinated contrast allergy who presented with complaint of persistent hemoptysis after COVID-19 infection. The patient had been diagnosed with COVID-19 two weeks prior, and was treated as an outpatient without significant symptoms. She subsequently developed acute onset of massive hemoptysis, and upon presentation was admitted to the intensive care unit and intubated for airway protection. The case was discussed with interventional radiology (IR). Given the patient's contrast allergy, bronchoscopy was pursued in an attempt to identify the location of bleeding. Flexible bronchoscopy showed extensive bilateral airway casting with clot as well as active bleeding from the right mainstem bronchus. Significant hypoxia was encountered due to the clot burden. Bronchial artery embolization (BAE) was discussed with IR, but there were concerns for lung necrosis due to embolization in the setting UPAA. Hematology evaluated the patient, and administered Factor VIII/von Willebrand Factor Complex. The patient was evaluated for ECMO in the setting of severe refractory hypoxia. Fortunately, the active bleeding resolved and a 14 cm clot was extracted using alligator forceps via a bronchoscope. The patient's severe hypoxia resolved and she was subsequently extubated. DISCUSSION: Massive hemoptysis is a life-threatening condition. Treatment is centered on identifying the location of the hemorrhage. BAE is often required if the bleeding cannot be managed endoscopically. Our patient presented a unique problem as her bleeding appeared to be coming from the right lung whose vascular supply subsisted from the bronchial artery system alone. There is a paucity of literature on this particular issue, and it is unclear if BAE increases the incidence of ischemia and tissue necrosis. Fortunately this patient avoided the need for BAE and ultimately had a favorable outcome. CONCLUSIONS: This case highlights not only massive hemoptysis in the setting of recent COVID-19 infection, but the difficulties that pulmonary artery agenesis can pose when attempting to provide treatment. REFERENCE #1: Lee EY, Boiselle PM, Cleveland RH. Multidetector CT evaluation of congenital lung anomalies. Radiology. 2008;247(3):632–48 REFERENCE #2: Zylak CJ, Eyler WR, Spizarny DL, Stone CH. Developmental lung anomalies in the adult: radiologic-pathologic correlation. Radiographics. 2002;22 Spec No:S25–43 REFERENCE #3: Reading DW, Oza U. Unilateral absence of a pulmonary artery: a rare disorder with variable presentation. Proc (Bayl Univ Med Cent). 2012;25(2):115-118. DISCLOSURES: No relevant relationships by Arjan Ahluwalia, source=Web Response No relevant relationships by Henry Lam, source=Web Response No relevant relationships by Theresa Maitz, source=Web Response No relevant relationships by Brian Miller, source=Web Response No relevant relationships by Kaitlyn Musco, source=Web Response

Patients have very limited knowledge of their contrast allergies

PurposeTo quantify patients' knowledge of their iodinated contrast allergies; and to compare this data to literature estimates of patient knowledge of other medication allergies. MethodsUsing a key word search of 15,715 patients undergoing a total of 19,043 CT studies over a six-month period, a cohort of 307 adult patients claiming prior allergic reaction to iodinated intravenous contrast was identified. A patient questionnaire with the CT studies inquired about the specifics of their contrast allergy, including the symptoms of their prior allergic reaction; when and where the reaction occurred; and if patients could name the contrast agent to which they claim to be allergic. ResultsIn the cohort of 307 patients claiming a prior allergic reaction to iodinated contrast, 86.6% could describe their prior allergic reaction symptoms. Only 36.8% could provide an approximate year of the reaction, with an additional 6.5% claiming that their reactions were remote, for a total of 43.3% providing some information when their reaction occurred. 56.7% provided no information on the year of their reaction. 40.7% named either the facility or the city where the reaction occurred, while 59.3% could not. Only 5 of 307 (1.6%, p < 0.00001) could name the contrast agent to which they believed they were allergic. ConclusionOther studies have reported inconsistencies, limited documentation, and limited ability to confirm patients' pharmacologic allergies, estimating that patients prior to pharmacist consultation are approximately 60-70% accurate in listing their drug allergies by name. Nevertheless, patients' knowledge of their iodinated contrast allergies is markedly more limited when compared to expected patient knowledge of medication allergies in general.

Sentinel lymph node biopsy in patients with endometrial cancer and an indocyanine green or iodinated contrast reaction - A proposed management algorithm

ObjectiveTo describe the incidence of adverse reactions to indocyanine green (ICG) administered during sentinel lymph node (SLN) biopsy for endometrial cancer, and to propose an ICG management algorithm for these patients. MethodsAll patients who underwent surgery for endometrial cancer with SLN biopsy using ICG from 1/2017 to 8/2020 were identified using a single-institution prospective database. Surgical adverse events (SAEs) related to the procedure were identified. A review of the literature was performed. ResultsIn all, 1414 patients met inclusion criteria and were evaluated. Sixty-seven (4.7%) patients had a history of either an iodine or contrast allergy. No patients had a history of documented ICG allergy. Among patients with an iodine or contrast allergy, 65 (97%) received a corticosteroid with or without diphenhydramine prior to ICG administration. One hundred five patients (7.4%) experienced 116 SAEs. Among these patients, 3 experienced potentially allergic SAEs possibly related to ICG administration. After thorough chart review, however, the likelihood these SAEs were due to ICG appeared low. No patients experienced an anaphylactic response after ICG admission. ConclusionThere were no anaphylactic reactions to ICG intracervical administration during 1414 consecutive SLN biopsies, including in patients with a documented iodine or contrast allergy. Intracervical injection of ICG is safe, and premedication using corticosteroids with or without diphenhydramine prior to SLN biopsy is a reasonable strategy in patients with iodinated contrast allergy.

Primary diagnosis of pulmonary embolism with unenhanced MRI for patients not eligible for CTPA: Clinical outcome

PurposeTo follow up the clinical outcome of patients with suspected pulmonary embolism (PE), in those only imaged using unenhanced, free-breathing magnetic resonance imaging (MRI). Methods and materialsFifty-seven patients aged 29–99 years (mean 70, SD 18) that could not undergo Computed Tomography Pulmonary Angiography (CTPA) were offered alternative imaging diagnostics in parallel with ongoing methodological studies validating MRI vs CTPA. Contraindications included renal failure (n = 44), severe iodine contrast allergy (n = 10), pregnancy (n = 2) and radioactive iodine therapy (n = 1). The unenhanced MRI protocol was based on free-breathing, steady-state free precession with no cardiac or respiratory gating. Retrospective review of the electronic medical record (EMR) was made of 0–12 months post-imaging and was collected during 2012–2018. ResultsAll 57 MRIs were of diagnostic quality and 12 pulmonary embolisms were diagnosed. Of the 57 patients, 44 were already on, or had started anticoagulation therapy due to clinical suspicion of PE. Four of the patients were put on anticoagulation after the positive MRI and 13 were taken off anticoagulation after a negative MRI report. Other diagnoses reported (considering dyspnea) were pleural effusion (n = 24), consolidation (n = 12) and pericardial effusion (n = 2). One patient had a deep vein thrombosis (DVT) within three months of our negative MRI result and then had a stroke within one year. Another patient suffered a stroke within three months of being diagnosed (by MRI) with PE and given anticoagulation as treatment. ConclusionsOur method supported or altered clinical decision-making and treatment in this cohort. A diagnostic tool for PE without intravenous contrast agent or radiation is of great benefit for certain patients.

Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging.

Pulmonary contrast enhanced magnetic resonance angiography (CE-MRA) is useful for the primary diagnosis of pulmonary embolism (PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography (CTA). In this review, we discuss the strengths and weaknesses of CE-MRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multi-institutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women (< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness (patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.