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By Martin R. Prince MD, PhD, Thomas M. Grist M.D., Jörg F. Debatin M.D., MBA (auth.)

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Since there is significant cost and some morbidity associated with pul- 46 CHAPTER 2 Pulmonary MRA monary arteriography, physicians are reluctant to use this test. As a result, treatment for pulmonary embolism is often undertaken without the benefit of a definitive diagnosis. A major impetus for using a cross-sectional imaging technique for the diagnostic workup of patients suspected of PE is based on the des ire to image the pulmonary arteries directly, without incurring high cost, and, of course, patient morbidity.

Evidence of enlargement of right-sided cardiac chambers and right heart failure can also be documented by 3D contrast MRA. 4). Mapping out the anatomy prior to embolization helps to facilitate procedural planning, induding coil or embolization balloon sizing. It also reduces procedure times. Following coil embolization, however, the metal artifact makes it difficult to visualize the region of the AVM by MRI. LungTumors Although the accuracy of 3D contrast MRA for staging lung tumors remains undetermined, our experience suggests this technique may be useful for staging tumor patients who cannot tolerate iodinated contrast.

Prior to finalizing the imaging parameters, a test breath-hold may be performed outside the gantry in order to determine the appropriate scan duration. If the patient is intubated, pharmacological muscular relax- 44 CHAPTER 2 Pulmonary MRA ation may be useful to prevent spontaneous breathing during suspension of ventilation. After acquiring a pulmonary arterial phase volume of image data, equilibrium phase data should be collected during another breath-hold. It may be useful to acquire several sets of equilibrium phase data to ensure that at least one of them is obtained during complete suspension of respiration.

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