Pulmonary Arterial Hypertension: Diagnosis with Fast Perfusion MR Imaging and High-Spatial-Resolution MR Angiography—Preliminary Experience

Nikolaou, Konstantin; Schoenberg, Stefan O.; Attenberger, Ulrike; Scheidler, J.; Dietrich, Olaf; Kuehn, Bernd; Rosa, Frank; Huber, Armin; Leuchte, Hanno; Baumgärtner, R; Behr, J.; Reiser, Maximilian

doi:10.1148/radiol.2361040502

Cited by 123 publications

(68 citation statements)

References 28 publications

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“…A very high PVR signifies secondary arteriopathy, which is inoperable. Further refinement in pulmonary waveform analysis, pulmonary flow systolic notch analysis, pulmonary angiography, CT imaging and magnetic resonance imaging may be helpful in recognizing patients with severe pulmonary hypertension and minimal clot burden who will not benefit from surgical therapy (14)(15)(16)(17) . The goal of PTE is to remove sufficient material from the pulmonary arteries to substantially lower PVR and improve the cardiac output.…”

Section: Ptementioning

confidence: 99%

The Pulmonary Thromboendarterectomy Increases Gradually All Over the World; Review

Yanartaş¹,

Acar²,

Yıldızeli³

2016

Kosuyolu Heart Journal

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Pulmonary endarterectomy (PTE) is a complex surgical procedure that provides functional and haemodynamic improvement in patients with chronic thromboembolic pulmonary hypertension. The use of PTE procedures is increasing all over the world and by getting a high level of surgical expertise; therefore, mortality rates are gradually decreasing day by day. Initially, operative mortality rates were high with a range of approximately 4%-24%. These rates have substantially decreased all over the world. PTE is a surgical technique that aims to remove unresolved thromboembolic material that obstructs the pulmonary arteries. Significant and persistent decreases in pulmonary artery pressures and pulmonary vascular resistance are observed in patients with chronic thromboembolic pulmonary hypertension after the surgery. Nowadays, this operation is offered to those patients who were considered to be inoperable in the past. Key Words: Pulmonary thromboendarterectomy; chronic thromboembolic pulmonary hypertensionPulmoner Tromboendarterektomi Tüm Dünyada Giderek Yaygınlaşmaktadır; Derleme ÖZET Pulmoner tromboendarterektomi (PTE) kronik tromboembolik pulmoner hipertansiyonda hemodinamik ve fonksiyonel iyileşmeyi sağlayan karmaşık bir cerrahi işlemdir. PTE işlemi uygulaması tüm dünyada giderek yaygınlaşmakta ve cerrahi deneyim arttıkça ölüm oranları her geçen gün giderek azalmaktadır. Başlangıçta %4 -24 gibi yüksek değerlerde olan cerrahi ölüm oranları tüm dünyada önemli oranda düşmüştür. PTE pulmoner arterleri tıkayan ve erimemiş olan trombotik tıkacı çıkarmayı amaçlayan cerrahi bir tekniktir. Kronik tromboemboliye bağlı pulmoner hipertansiyon olgularında PTE işlemi sonrası pulmoner arter basıncı ve pulmoner vasküler dirençte önemli ve sürekli değişiklikler gözlenmektedir. Son günlerde, daha önceden cerrahi işlem için uygun olmadığı düşünülen bazı olgulara bile artık PTE önerilmektedir.

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Section: Ptementioning

confidence: 99%

The Pulmonary Thromboendarterectomy Increases Gradually All Over the World; Review

Yanartaş¹,

Acar²,

Yıldızeli³

2016

Kosuyolu Heart Journal

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“…However, it remains to be determined whether a negative ECGgated MD-CTPA scan precludes a surgically assessable form of CTEPH in all cases [17,28,29] and to what extent MD-CTPA and ce-MRA can distinguish between different forms of pulmonary hypertension [19 -30]. Nikolaou et al in their study on 29 patients with either CTEPH or pulmonary arterial hypertension (PAH) found that based on occluding vascular findings alone, ce-MRA enabled correct differentiation between PAH and CTEPH in 24 of 29 patients (83 %) [31]. MD-CTPA and ce-MRA enable the detection of dilated systemic, especially bronchial arteries: flow through these vessels increases in patients with CTEPH because of the obstructions in the pulmonary arteries ( • " Fig.…”

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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“…(22,23) In addition, MRA allows for an in-depth evaluation of the location of the thromboembolic material, and, for surgical planning, MRA is equally as useful as are digital subtraction angiography and CT angiography. (24,25) In MRI, perfusion sequences can be quantitatively evaluated, allowing the severity of small-vessel disease to be assessed.…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

Ressonância magnética de pulmão: um novo passo no estudo das doenças pulmonares

et al. 2012

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Magnetic resonance imaging (MRI) of the lung has progressed tremendously in recent years. Because of improvements in speed and image quality, MRI is now ready for routine clinical use. The main advantage of MRI of the lung is its unique combination of structural and functional assessment in a single imaging session. We review the three major clinical indications for MRI of the lung: staging of lung tumors; evaluation of pulmonary vascular disease; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.Keywords: Magnetic resonance imaging; Lung; Lung diseases; Carcinoma, non-small-cell lung; Lung diseases, interstitial; Pneumonia. ResumoA ressonância magnética (RM) de pulmão progrediu tremendamente nos últimos anos. Devido a melhorias na velocidade e na qualidade de imagens, a RM de pulmão hoje está pronta para a utilização clínica de rotina. A principal vantagem da RM de pulmão é a sua combinação exclusiva de avaliação estrutural e funcional em uma única sessão de imagens. Revisamos aqui as três principais indicações clínicas da RM de pulmão: o estadiamento de tumores pulmonares, a avaliação de doença vascular pulmonar e a investigação de anormalidades pulmonares em pacientes que não podem ser expostos à radiação.Descritores: Imagem por ressonância magnética; Pulmão; Pneumopatias; Carcinoma pulmonar de células não pequenas; Doenças pulmonares intersticiais; Pneumonia.

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Pulmonary Arterial Hypertension: Diagnosis with Fast Perfusion MR Imaging and High-Spatial-Resolution MR Angiography—Preliminary Experience

Abstract: The combination of fast MR perfusion imaging and high-spatial-resolution MR angiography with parallel acquisition techniques enables the differentiation of PPH from CTEPH with high accuracy.

Cited by 123 publications

References 28 publications

The Pulmonary Thromboendarterectomy Increases Gradually All Over the World; Review

The Pulmonary Thromboendarterectomy Increases Gradually All Over the World; Review

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

Ressonância magnética de pulmão: um novo passo no estudo das doenças pulmonares

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