Lung perfusion: MRI vs. SPECT for screening in suspected chronic thromboembolic pulmonary hypertension

Johns, Chris; Swift, Andrew J.; Rajaram, Smitha; Hughes, Paul; Capener, David; Kiely, David G.; Wild, Jim M.

doi:10.1002/jmri.25714

Cited by 76 publications

(57 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The diagnostic accuracy of dynamic contrast-enhanced perfusion MRI in the diagnosis of CTEPH was shown to be comparable to computed tomography pulmonary angiography (CTPA) and perfusion single-photon emission tomography (SPECT) [ 73 ]. Perfusion MRI identified all cases of CTEPH and had comparable sensitivity and specificity to the other modalities.…”

Section: Pulmonary Mr Angiography and Perfusionmentioning

confidence: 99%

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Alabed

Garg

Johns

et al. 2020

Curr Cardiovasc Imaging Rep

Self Cite

View full text Add to dashboard Cite

Purpose of Review This article reviews advances over the past 3 years in cardiac magnetic resonance (CMR) imaging in pulmonary hypertension (PH). We aim to bring the reader up-to-date with CMR applications in diagnosis, prognosis, 4D flow, strain analysis, T1 mapping, machine learning and ongoing research. Recent Findings CMR volumetric and functional metrics are now established as valuable prognostic markers in PH. This imaging modality is increasingly used to assess treatment response and improves risk stratification when incorporated into PH risk scores. Emerging techniques such as myocardial T1 mapping may play a role in the follow-up of selected patients. Myocardial strain may be used as an early marker for right and left ventricular dysfunction and a predictor for mortality. Machine learning has offered a glimpse into future possibilities. Ongoing research of new PH therapies is increasingly using CMR as a clinical endpoint. Summary The last 3 years have seen several large studies establishing CMR as a valuable diagnostic and prognostic tool in patients with PH, with CMR increasingly considered as an endpoint in clinical trials of PH therapies. Machine learning approaches to improve automation and accuracy of CMR metrics and identify imaging features of PH is an area of active research interest with promising clinical utility.

show abstract

Section: Pulmonary Mr Angiography and Perfusionmentioning

confidence: 99%

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Alabed

Garg

Johns

et al. 2020

Curr Cardiovasc Imaging Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…Regarding the metric and results of the present work, it needs to be noted that quantitative volumetric data of both ventilation and perfusion scans were not evaluated in any of the referenced studies [10][11][12][13][14][15][16][17]. The main image analysis method is a qualitative assessment of the perfusion SPECT and segmental or subsegmental defects, as defined in the clinical guidelines of the EANM [3].…”

Section: Discussionmentioning

confidence: 99%

“…The main image analysis method is a qualitative assessment of the perfusion SPECT and segmental or subsegmental defects, as defined in the clinical guidelines of the EANM [3]. For example, Johns et al [10] determined a positive or negative diagnosis for CTEPH based on visual interpretation of perfusion SPECT images. Wang et al [15] also classified the images visually as positive or negative for PE, as the clinical guidelines do not differentiate between acute PE and CTEPH.…”

Section: Discussionmentioning

confidence: 99%

“…The ventilation and perfusion of the lungs on SPECT V/Q images for the diagnosis and evaluation of treatment response of CTEPH is usually based on a qualitative analysis of the image data. SPECT V/Q is also used as a reference in the evaluation of other diagnostic techniques [10][11][12][13][14][15][16]. The quantitative analysis of lung perfusion on SPECT images by volumetric data has previously been proposed [17].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Automatic Diagnosis of Chronic Thromboembolic Pulmonary Hypertension Based on Volumetric Data from SPECT Ventilation and Perfusion Images

et al. 2020

View full text Add to dashboard Cite

Chronic thromboembolic pulmonary hypertension (CTEPH) is confirmed by visual analysis of single-photon emission computer tomography (SPECT) ventilation and perfusion (V/Q) images. Defects in the perfusion image discordant with the ventilation image indicate obstructed segments and the positive diagnosis of CTEPH. A quantitative metric and classification algorithm are proposed based on volumetric data from SPECT V/Q images. The difference in ventilation and perfusion volumes (VV-P) is defined as a quantitative metric to identify discordant defects in the SPECT images. The algorithm was validated with 22 patients grouped according to their diagnosis: (1) CTEPH and (2) respiratory pathology. Volumetric data from SPECT perfusion images was also compared before and after treatment for CTEPH. CTEPH was detected with a sensitivity of 0.67 and specificity of 0.80. The performance of volumetric data from SPECT perfusion images for the evaluation of treatment response was studied for two cases and improvement of pulmonary perfusion was observed in one case. This study uses volumetric data from SPECT V/Q images for the diagnosis of CTEPH and its differentiation from respiratory pathologies. The results indicate that the defined metric is a viable option for a quantitative analysis of SPECT V/Q images.

show abstract

“…) . Similarly, dynamic contrast enhanced (DCE) lung perfusion magnetic resonance (MR) has shown at least equivalent sensitivity when compared with SPECT perfusion scintigraphy in screening for CTEPH . Still, VQ scan is the recommended screening test for CTEPH.…”

Section: Diagnosis Of Ctephmentioning

confidence: 99%

Chronic thromboembolic pulmonary hypertension from the perspective of patients with pulmonary embolism

Klok

Delcroix

Bogaard

2018

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but feared long-term complication of acute pulmonary embolism (PE), although CTEPH may occur in patients with no history of symptomatic venous thromboembolism. It represents the most severe presentation of the so-called 'post-PE syndrome', a phenomenon of permanent functional limitations after PE caused by deconditioning after PE or ventilatory or circulatory impairment as a result of unresolved pulmonary artery thrombi. Because the post-PE syndrome may occur in up to 50% of PE survivors, and CTEPH tends to have an insidious and non-specific clinical presentation, CTEPH is often not diagnosed or diagnosed after a very long delay. Once the diagnosis is confirmed, the treatment of choice is pulmonary endarterectomy which effectively lowers the pulmonary vascular resistance and normalizes resting pulmonary artery pressures, leading to recovery of the right ventricle. When pulmonary endarterectomy is not technically feasible, balloon pulmonary angioplasty may be a potential acceptable alternative. Also, medical treatment may help to improve patient's symptoms and hemodynamics. Current studies are focusing on strategies for earlier CTEPH diagnosis after acute PE, as well as the most optimal treatment of inoperable patients. This review will focus on the epidemiology, risk factors, diagnosis and treatment of CTEPH from the perspective of the PE patient.

show abstract

Lung perfusion: MRI vs. SPECT for screening in suspected chronic thromboembolic pulmonary hypertension

Cited by 76 publications

References 24 publications

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Automatic Diagnosis of Chronic Thromboembolic Pulmonary Hypertension Based on Volumetric Data from SPECT Ventilation and Perfusion Images

Chronic thromboembolic pulmonary hypertension from the perspective of patients with pulmonary embolism

Contact Info

Product

Resources

About