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(Chest. 1994;106:1333-1338.)
© 1994 American College of Chest Physicians

Magnetic Resonance Imaging Evaluation of Pulmonary Vascular Malformations

Jeffrey M. Silverman M.D., F.C.C.P.1; Peter J. Julien M.D.1; Robert J. Herfkens M.D.2; and Norbert J. Pelc Sc.D.2

1 From the Department of Radiology, Cedars-Sinai Medical Center, Los Angeles
2 From Stanford University School of Medicine, Stanford Calif.

Objective: The purpose of our study was to establish magnetic resonance imaging (MRI) criteria for the diagnosis of pulmonary vascular malformations (PVMs).

Materials and methods: Since 1987, 11 patients have been referred for chest MRI at our institution because of findings suggestive of a PVM. They were evaluated with a 1.5-T MRI system, incorporating a combination of spin-echo, gradient-recalled echo (GRE) cine, and 2-D phase contrast (PC) cine sequences. We used the following MRI criteria to diagnose PVM: (1) flow void or intermediate gray signal on spin-echo sequences; (2) bright signal on GRE cine sequences; and (3) bright signal consistent with flow detected on PC cine sequences using relatively low velocity ranges. Twelve patients not suspected of having a PVM served as controls; all had both MRI and pulmonary angiography to evaluate for central pulmonary embolus.

Results: Eight patients in the study group had PVM as determined with MRI using these criteria. In four of these patients, a PVM was confirmed by subsequent pulmonary angiography. Three patients did not have PVM utilizing these criteria; two had neoplasms and one had presumed mucus plugging and/or atelectasis that resolved spontaneously. The smallest vascular malformation detected by MRI was 1 cm. None of the control patients had PVM by MRI or pulmonary angiography.

Conclusion: Utilizing these criteria, we believe that MRI is potentially an excellent noninvasive modality to evaluate PVM, and we stress that some form of PC cine sequence must be performed to determine if indeed there is blood flow within a suspicious lesion.

Key Words: lung MR studies • malformations, arteriovenous • MR, utilization • MR, vascular studies • pulmonary arteries, MR

Submitted on September 9, 1993
Accepted on April 18, 1994




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