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

Rajaram, Smitha; Swift, Andrew J.; Capener, David; Telfer, Adam; Davies, Christine; Hill, Catherine; Condliffe, Robin; Elliot, Charles; Hurdman, Judith; Kiely, David G.; Wild, Jim M.

doi:10.1007/s00330-011-2252-x

Cited by 66 publications

(57 citation statements)

References 25 publications

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“…6 For assessment of operability, many criteria have to be considered, one of which is evidence of surgically accessible thrombi that are best depicted by a state-of-the-art ECG-gated multidetector computed tomography angiography. 7,8 However, pulmonary hemodynamics (mPAP and PVR) still have to be determined in the preoperative work-up, requiring invasive right heart catheterization (RHC). An accurate noninvasive method for measurement of mPAP and PVR would be desirable to eliminate the discomfort, the radiation exposure, and a small but real risk of morbidity and mortality associated with RHC.…”

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confidence: 99%

Noninvasive Assessment of Pulmonary Hemodynamics in Patients With Chronic Thromboembolic Pulmonary Hypertension by High Temporal Resolution Phase-Contrast MRI

Kreitner

Wirth

Krummenauer

et al. 2013

Circ: Cardiovascular Imaging

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Noninvasive imaging modalities, such as echocardiography and MRI, have been used to predict pulmonary hypertension Background-Right heart catheterization is the gold standard for assessment of pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension. To date, MRI has not been able to produce precise measurements of mean pulmonary arterial pressure (mPAP). The purpose of the study was to create a model for estimating mPAP and pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension by high temporal resolution phase-contrast MRI (PC-MRI) and to correlate the results with simultaneously acquired, invasive catheterbased measurements (simultaneously measured mPAP) and with right heart catheterization measurements. Methods and Results-A total of 19 patients with chronic thromboembolic pulmonary hypertension underwent right heart catheterization and-after digital subtraction angiography of the pulmonary arteries-subsequent PC-MRI at 1.5 T with simultaneous recording of mPAP. Velocity-and flow-time curves of PC-MRI were used to calculate absolute acceleration time (

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mentioning

confidence: 99%

Noninvasive Assessment of Pulmonary Hemodynamics in Patients With Chronic Thromboembolic Pulmonary Hypertension by High Temporal Resolution Phase-Contrast MRI

Kreitner

Wirth

Krummenauer

et al. 2013

Circ: Cardiovascular Imaging

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“…However, 64-slice and beyond MD-CT angiography of the pulmonary arteries (MD-CTPA) offer advantages over contrast-en- hanced MRA (ce-MRA) because they enable imaging with improved spatial and temporal resolution, shorter scanning times and breath-holds [18 -20]. This was confirmed in a retrospective study on 53 patients with CTEPH patients and 36 controls, where ce-MRA had an overall sensitivity of 98 % and a specificity of 94 % for diagnosing the disease with MD-CTPA as the reference standard [23]. In a recent study on 24 patients with suspected CTEPH, it could be shown that retrospectively ECG-gated MD-CTPA was superior to ce-MRA especially for the assessment of the segmental and subsegmental arteries [24].…”

Section: Macrocirculationmentioning

confidence: 99%

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

Wirth

Brüggemann

Bostel

et al. 2014

Fortschr Röntgenstr

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Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as pulmonary hypertension (resting mean pulmonary arterial pressure of 25?mm Hg or more determined at right heart catheterization) with persistent pulmonary perfusion defects. It is a rare, but underdiagnosed disease with estimated incidences ranging from 0.5?% to 3.8?% of patients after an acute pulmonary embolism (PE), and in up to 10?% of those with a history of recurrent PE. CTEPH is the only form of pulmonary hypertension that can be surgically treated leading to normalization of pulmonary hemodynamics and exercise capacity in the vast majority of patients. The challenges for imaging in patients with suspected CTEPH are fourfold: the imaging modality should have a high diagnostic accuracy with regard to the presence of CTEPH and allow for differential diagnosis. It should enable detection of patients suitable for PEA with great certainty, and allow for quantification of PH by measuring pulmonary hemodynamics (mPAP and PVR), and finally, it can be used for therapy monitoring. This overview tries to elucidate the potential role of ECG-gated multidetector CT pulmonary angiography (MD-CTPA) and MR imaging, and summarizes the most important results that have been achieved so far. Generally speaking, ECG-gated MD-CTPA is superior to MR in the assessment of parenchymal and vascular pathologies of the lung, and allows for the assessment of cardiac structures. The implementation of iodine maps as a surrogate for lung perfusion enables functional assessment of lung perfusion by CT. MR imaging is the reference standard for the assessment of right heart function and lung perfusion, the latter delineating typical wedge-shaped perfusion defects in patients with CTEPH. New developments show that with MR techniques, an estimation of hemodynamic parameters like mean pulmonary arterial pressure and pulmonary vascular resistance will be possible. CT and MR imaging should be considered as complementary investigations providing comprehensive information in patients with CTEPH. Citation Format: ??Wirth G, Br?ggemann K, Bostel T et?al. 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. Fortschr R?ntgenstr 2014; 186: 751???761

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“…SSFP is particularly useful in imaging the blood, which has long T2 when compared to the surrounding tissues (3) and has short acquisition times allowing for short breath-holds (19). The high contrast between pulmonary blood pool and lumen make bSSFP an effective tool for assessment of thrombus when MRA and CTPA are inconclusive (20) and a fast 3D bSSFP acquisition provides a quick and contrast free means of generating a pulmonary angiogram (21).…”

Section: Non-contrast Enhanced Mra and Perfusion Imagingmentioning

confidence: 99%

Pulmonary MR angiography and perfusion imaging—A review of methods and applications

Johns

Swift

Hughes

et al. 2017

European Journal of Radiology

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

Abstract: CE-MRA has high sensitivity and specificity for diagnosing CTE. The sensitivity of CE-MRA for visualisation of adherent central and lobar thrombus significantly improves with the addition of unenhanced proton MRA which delineates the vessel wall.

Cited by 66 publications

References 25 publications

Noninvasive Assessment of Pulmonary Hemodynamics in Patients With Chronic Thromboembolic Pulmonary Hypertension by High Temporal Resolution Phase-Contrast MRI

Noninvasive Assessment of Pulmonary Hemodynamics in Patients With Chronic Thromboembolic Pulmonary Hypertension by High Temporal Resolution Phase-Contrast MRI

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

Pulmonary MR angiography and perfusion imaging—A review of methods and applications

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