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 CEMRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multiinstitutional 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.

Classification of Emphysema Subtypes: Comparative Assessment of Local Binary Patterns and Related Texture Features

The purpose of this study was to assess usefulness of local binary patterns (LBP) and related texture features, namely completed local binary patterns (CLBP) and local ternary patterns (LTP), for the classification of emphysema subtypes on low-dose CT images. Fifty patients (34 men and 16 women;age, 67.5 ± 10.1 years) who underwent low-dose CT (60 mAs) were included. They were comprised of 17 never smokers, 13 smokers without COPD, and 20 smokers with COPD. By consensus reading of low-dose CT images from these patients, two radiologists selected 3681 nonoverlapping regions of interest (ROIs) and annotated them as one of the following three classes: normal tissue, centrilobular emphysema, and paraseptal emphysema. From these ROIs, histogram of CT densities, LBP, CLBP, and LTP were calculated, and the 3 types of texture histograms were concatenated with the CT density histogram. These 3 types of histograms (referred to as combined LBP, combined CLBP, and combined LTP) were used to classify ROI using linear support vector machine. For each type of the combined histogram, the accuracy of classification was determined by patient-based 10-fold cross validation. The best accuracy of combined LBP, combined CLBP, and combined LTP were 81.36%, 82.99%, and 83.29%, respectively. Compared to the classification accuracies obtained with combined LBP, those with combined LTP or combined CLBP were consistently improved. In conclusion, the results of this study suggest that, on low-dose CT, LTP and CLBP were more useful for the classification of emphysema subtypes than LBP.