Comparison of the diagnostic performance of non-contrast MR angiography and planar V/Q scintigraphy for pulmonary embolism: a systematic review and meta-analysis.
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| Title: | Comparison of the diagnostic performance of non-contrast MR angiography and planar V/Q scintigraphy for pulmonary embolism: a systematic review and meta-analysis. |
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| Authors: | Silva, Ricardo F.1 (AUTHOR), Zanon, Matheus1,2 (AUTHOR), Ackman, Jeanne B.3 (AUTHOR), Forte, Gabriele C.1 (AUTHOR), Altmayer, Stephan4 (AUTHOR), Biederer, Jürgen5 (AUTHOR), Bergmann, Liisa L.6 (AUTHOR), Andrade, Rubens Gabriel Feijó1 (AUTHOR) rubens.andrade@pucrs.br, Hochhegger, Bruno1,2,7 (AUTHOR) brunohochhegger@gmail.com |
| Source: | European Radiology. Aug2025, Vol. 35 Issue 8, p4814-4823. 10p. |
| Subjects: | Pulmonary embolism, Magnetic resonance angiography, Statistical accuracy, Sensitivity analysis, Perfusion imaging, Diagnostic imaging, Sensitivity & specificity (Statistics) |
| Abstract: | 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: QuestionV/Q lung scintigraphy has been used as a reserve, alternative modality for patients who cannot undergo CT pulmonary angiography. FindingsNon-contrast MR angiography (MRA) is a feasible alternative for diagnosing PE in patients for whom intravenous iodinated contrast administration poses a substantial risk. Clinical relevanceNon-contrast MRA provides similar sensitivity and superior specificity to V/Q scintigraphy for diagnosing PE, without ionizing radiation exposure. [ABSTRACT FROM AUTHOR] |
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| Database: | Engineering Source |
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| Abstract: | 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: QuestionV/Q lung scintigraphy has been used as a reserve, alternative modality for patients who cannot undergo CT pulmonary angiography. FindingsNon-contrast MR angiography (MRA) is a feasible alternative for diagnosing PE in patients for whom intravenous iodinated contrast administration poses a substantial risk. Clinical relevanceNon-contrast MRA provides similar sensitivity and superior specificity to V/Q scintigraphy for diagnosing PE, without ionizing radiation exposure. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 09387994 |
| DOI: | 10.1007/s00330-025-11366-x |
