Computed tomography and magnetic resonance imaging of pulmonary hypertension: Pulmonary vessels and right ventricle

Abstract

Pulmonary hypertension (PH) is very heterogeneous and the classification identifies five major groups including many associated disease processes. The treatment of PH depends on the underlying cause and accurate classification is paramount. A comprehensive assessment to identify the cause and severity of PH is therefore needed. Furthermore, follow‐up assessments are required to monitor changes in disease status and response to therapy. Traditionally, the diagnostic imaging work‐up of PH comprised mainly echocardiography, invasive right heart catheterization, and ventilation/perfusion scintigraphy. Due to technical advances, multidetector row computed tomography (CT) and magnetic resonance imaging (MRI) have become important and complementary investigations in the evaluation of patients with suspected PH. Both modalities are reviewed and recommendations for clinical use are given. J. Magn. Reson. Imaging 2010;32:1313–1324. © 2010 Wiley‐Liss, Inc.

Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension

“…Patients with CTEPH will often require repeated studies to confirm the diagnosis, to assess the course of the disease and to monitor outcome and hence an alternative radiation-free imaging technique would be ideal. Contrast-enhanced MRA is increasingly recognised as a valuable technique for imaging the pulmonary vasculature in patients with suspected CTEPH [19,26]. With the application of faster gradients and parallel imaging techniques, the duration of the breath-holding for the MRA sequences are significantly reduced and can rapidly characterise the pulmonary vasculature even in a symptomatic patient (breath-hold <20 s).…”

Black blood MRI has diagnostic and prognostic value in the assessment of patients with pulmonary hypertension

“…The morphology of the pulmonary vasculature can be assessed using high resolution MR pulmonary angiography, this is particularly of value in the identification of surgically accessible disease in patients with chronic thromboembolism [16]. Furthermore, time-resolved 3D MR pulmonary perfusion can be used to track the passage of a contrast bolus through the pulmonary vascular system in 3D, previous studies assessing 3D MR perfusion data derived Fig.…”

“…MRI may therefore be of value as a second line investigation for patients with suboptimal echocardiography or for patients in whom echocardiographic findings are equivocal. Cardiac MRI has high accuracy and reproducibility in measurements of cardiac morphology and function [16,27,28], and may in the future play a more central role in the diagnosis of patients with pulmonary hypertension and in the assessment of response following treatment. This is, to our knowledge, the largest study assessing PA size in patients with PH, our work has shown relatively weak correlations with PA size and invasive haemodynamics and modest diagnostic accuracy.…”

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) – Potential Role of Multidetector-Row CT (MD-CT) and MR Imaging in the Diagnosis and Differential Diagnosis of the Disease

“…However, MR perfusion techniques allow for the assessment of lung tissue perfusion. Contrast-based perfusion MR is usually performed in combination with ultra-fast 3 D MRA: with the use of parallel imaging techniques, acquisition of time-resolved ce-MRA with reduced spatial resolution is possible with a temporal resolution of 1 s covering the whole lung volume [34]. Thus, MR perfusion techniques provide insights into regional pulmonary perfusion by tracking the dynamic passage of a contrast bolus: they allow for the differentiation of patients with CTEPH from patients with PAH: vascular obstructions in CTEPH lead to typical wedge- Fig.…”