Imaging of Pulmonary Hypertension in Adults: A Position Paper from                    the Fleischner Society

Rémy‐Jardin, Martine; Ryerson, Christopher J.; Schiebler, Mark L.; Leung, Ann N.; Wild, JM; Hoeper, Marius M.; Alderson, Philip O.; Goodman, Lawrence R.; Mayo, John R.; Haramati, Linda B.; Ohno, Yoshiharu; Thistlethwaite, Patricia A.; Beek, Edwin Jacques Rudolph van; Knight, Shandra L; Lynch, David A.; Rubin, Geoffrey D.; Humbert, Marc

doi:10.1148/radiol.2020203108

Cited by 56 publications

(53 citation statements)

References 137 publications

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“…Serial magnetic resonance imaging machines have the advantage of demonstrating longitudinal and circumferential RV strain, PA stiffness, and reduced RV and PA coupling. 38 Echocardiography: The 2015 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines for the diagnosis and treatment of PH recommend screening patients with suspicion for PH using a transthoracic echocardiogram. These guidelines recommend yearly echocardiographic screening for all patients with SSc.…”

Section: Imagingmentioning

confidence: 99%

Connective Tissue Disease, Interstitial Lung Disease, and Pulmonary Hypertension (CTD PH-ILD): A Distinct Entity and Potential Opportunity

Sese

Highland

2021

Advances in Pulmonary Hypertension

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Connective tissue diseases are a multisystem disorder that can cause impairments in quality of life, shorten life expectancy, and increase the risk of mortality at a younger age. These patients have an increased risk for the development of pulmonary hypertension through several mechanisms including pulmonary arterial hypertension and pulmonary hypertension associated with interstitial lung disease. This review aims to discuss the various presentations of connective tissue disease associated with pulmonary hypertension associated with interstitial lung disease, demographics, and survival. It gives an overview of accepted mechanisms of disease pathogenesis, discusses advances in diagnostics, and treatment options. Despite a deeper understanding of disease pathogenesis, treatment for this remains limited to prevention of disease progression. The identification of the primary disease driver requires careful evaluation of the disease phenotype and is a potential target for treatment and prevention of death.

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Section: Imagingmentioning

confidence: 99%

Connective Tissue Disease, Interstitial Lung Disease, and Pulmonary Hypertension (CTD PH-ILD): A Distinct Entity and Potential Opportunity

Sese

Highland

2021

Advances in Pulmonary Hypertension

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“…Computed tomography (CT) has excellent spatial and temporal resolution, enabling a comprehensive evaluation of cardiopulmonary structures within a single breath hold [ 12 , 13 , 14 ]. Contrast-enhanced CT pulmonary angiography (CTPA) allows for the non-invasive assessment of chronic thromboembolic changes in the pulmonary arteries [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Dual-Energy CT Pulmonary Angiography for the Assessment of Surgical Accessibility in Patients with Chronic Thromboembolic Pulmonary Hypertension

et al. 2022

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We assessed the value of dual-energy CT pulmonary angiography (CTPA) for classification of the level of disease in chronic thromboembolic pulmonary hypertension (CTEPH) patients compared to the surgical Jamieson classification and prediction of hemodynamic changes after pulmonary endarterectomy. Forty-three CTEPH patients (mean age, 57 ± 16 years; 18 females) undergoing CTPA prior to surgery were retrospectively included. “Proximal” and “distal disease” were defined as L1 and 2a (main and lobar pulmonary artery [PA]) and L2b-4 (lower lobe basal trunk to subsegmental PA), respectively. Three radiologists had a moderate interobserver agreement for the radiological classification of disease (k = 0.55). Sensitivity was 92–100% and specificity was 24–53% to predict proximal disease according to the Jamieson classification. A median of 9 segments/patient had CTPA perfusion defects (range, 2–18 segments). L1 disease had a greater decrease in the mean pulmonary artery pressure (p = 0.029) and pulmonary vascular resistance (p = 0.011) after surgery compared to patients with L2a to L3 disease. The extent of perfusion defects was not associated with the level of disease or hemodynamic changes after surgery (p > 0.05 for all). CTPA is highly sensitive for predicting the level of disease in CTEPH patients with a moderate interobserver agreement. The radiological level of disease is associated with hemodynamic improvement after surgery.

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“…Diagnosis of pulmonary arterial thrombosis requires contrast-enhanced CT angiography, which implies the intravenous administration of iodinated contrast agents [35]. However, alterations of pulmonary vascular metrics also detectable with unenhanced CT, such as the enlargement of the PA and an increased ratio between diameters of the PA and of the ascending aorta (AA), are known indirect signs of pulmonary hypertension caused by fibrotic or thromboembolic processes [36][37][38][39][40][41][42]. Notably, these pulmonary vascular metrics have been demonstrated to be altered also in COVID-19 patients-when compared to previous values measured on CT scans acquired before the SARS-CoV-2 pandemic-and to carry prognostic implications [25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Machine Learning to Predict In-Hospital Mortality in COVID-19 Patients Using Computed Tomography-Derived Pulmonary and Vascular Features

Schiaffino

Codari

Cozzi

et al. 2021

JPM

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Pulmonary parenchymal and vascular damage are frequently reported in COVID-19 patients and can be assessed with unenhanced chest computed tomography (CT), widely used as a triaging exam. Integrating clinical data, chest CT features, and CT-derived vascular metrics, we aimed to build a predictive model of in-hospital mortality using univariate analysis (Mann–Whitney U test) and machine learning models (support vectors machines (SVM) and multilayer perceptrons (MLP)). Patients with RT-PCR-confirmed SARS-CoV-2 infection and unenhanced chest CT performed on emergency department admission were included after retrieving their outcome (discharge or death), with an 85/15% training/test dataset split. Out of 897 patients, the 229 (26%) patients who died during hospitalization had higher median pulmonary artery diameter (29.0 mm) than patients who survived (27.0 mm, p < 0.001) and higher median ascending aortic diameter (36.6 mm versus 34.0 mm, p < 0.001). SVM and MLP best models considered the same ten input features, yielding a 0.747 (precision 0.522, recall 0.800) and 0.844 (precision 0.680, recall 0.567) area under the curve, respectively. In this model integrating clinical and radiological data, pulmonary artery diameter was the third most important predictor after age and parenchymal involvement extent, contributing to reliable in-hospital mortality prediction, highlighting the value of vascular metrics in improving patient stratification.

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Imaging of Pulmonary Hypertension in Adults: A Position Paper from the Fleischner Society

Cited by 56 publications

References 137 publications

Connective Tissue Disease, Interstitial Lung Disease, and Pulmonary Hypertension (CTD PH-ILD): A Distinct Entity and Potential Opportunity

Connective Tissue Disease, Interstitial Lung Disease, and Pulmonary Hypertension (CTD PH-ILD): A Distinct Entity and Potential Opportunity

Dual-Energy CT Pulmonary Angiography for the Assessment of Surgical Accessibility in Patients with Chronic Thromboembolic Pulmonary Hypertension

Machine Learning to Predict In-Hospital Mortality in COVID-19 Patients Using Computed Tomography-Derived Pulmonary and Vascular Features

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