• Christian Schönfeld, Serghei Cebotari, Andreas Voskrebenzev, Marcel Gutberlet, Jan Hinrichs, Julius Renne, Marius M Hoeper, Karen M Olsson, Tobias Welte, Frank Wacker, and Jens Vogel-Claussen.
• Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
• J Magn Reson Imaging. 2015 Jul 1; 42 (1): 72-9.

PurposeTo evaluate the test performance of perfusion-weighted Fourier-decomposition (pw-FD) magnetic resonance imaging (MRI) in comparison to dynamic contrast-enhanced (DCE)-MRI as a reference standard in patients with known or suspected chronic pulmonary embolism (PE).Materials And MethodsIn 64 patients, chronic PE was ruled out or confirmed by DCE-MRI using a time-resolved angiography with stochastic trajectories (TWIST) sequence in one breath-hold. Pw-FD-MRI was performed using a 2D fast low-angle shot (FLASH) sequence in free-breathing. After a nonrigid image registration, FD was applied to generate pw-images. Lungs were scored by two radiologists (2 and 12 years of lung MRI experience) visually for each lobe and segment for hypoperfused areas. For intra- and interobserver variability, the MR images were analyzed 2 months after the first analysis, blinded to the results of the first reader.ResultsPE was diagnosed by DCE-MRI in 39 patients. For the pw-FD MRI sensitivity, specificity, accuracy, and positive and negative predictive value for diagnosis of PE were 100%, 95%, 98%, 98%, and 100% on a per-patient basis, 94%, 94%, 94%, 95%, 94% on a per-lobe basis, and 82%, 92%, 88%, 88%, 88% on a segmental basis, respectively. Detection of subsegmental and segmental hypoperfusion using pw-FD MRI showed a moderate agreement with DCE-MRI (kappa of 0.68; 95% confidence interval: 0.64; 0.72).ConclusionPw-FD of the lung is a feasible test to diagnose chronic PE on a per-patient level during free-breathing without the use of ionizing radiation or contrast agents.© 2014 Wiley Periodicals, Inc.

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