Pulmonary hypertension MRI
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Assistant Editor(s)-in-Chief: Ralph Matar; José Eduardo Riceto Loyola Junior, M.D.[2]
Overview
Thoracic MRI is helpful in the differential diagnosis of pulmonary hypertension as well as in the evaluation of the right ventricle function. It provides important prognostic indicators when assessing the right ventricle in patients with pulmonary hypertension. Findings that predict poor prognosis are: stroke volume ≤25ml/m^2, right ventricular end-diastolic volume ≥84ml/m^2 and left ventricvular end-diastolic volume ≤40ml/m^2.
Key MRI Findings in Pulmonary Hypertension
A MRI is useful for:[1][2][3][4][5]
- Accurate evaluation of the size, morphology and function of the right ventricle.
- A MRI has similar abilities to those of an echocardiography in the diagnosis and treatment of patients with pulmonary hypertension.
- Detection of shunts contributing to pulmonary hypertension.
- Detection of acute and chronic pulmonary thromboembolic disease.
- Differentiation between the pulmonary vasculature and mediastinal adenopathy when used for contrast enhancement.
- Follow-up for right heart hemodynamics.
- Poor right ventricular function is indicated by the following according to the ACCF/AHA 2009 expert consensus document on pulmonary hypertension:
- Stroke volume ≤25ml/m^2.
- Right ventricular end-diastolic volume ≥84ml/m^2( Most appropriate marker of right ventricular failure in the follow-up.)
- Left ventricular end-diastolic volume ≤40ml/m^2
- Poor right ventricular function is indicated by the following according to the ACCF/AHA 2009 expert consensus document on pulmonary hypertension:
- Pulmonary artery stiffness measured by relative cross sectional area change ≤16% also has implications on mortality rate.
MRI Limitations include
- Inability to perform breath hold
- Incompatible hardware such as neurostimulators, cochlear implants, aneurysm clips, cardiac pacemakers and defibrillators
- Limited availability and cost
- Difficulty in assessing PA pressures
References
- ↑ Alassas K, Mergo P, Ibrahim e, Burger C, Safford R, Parikh P, Shapiro B (January 2014). "Cardiac MRI as a diagnostic tool in pulmonary hypertension". Future Cardiol. 10 (1): 117–30. doi:10.2217/fca.13.97. PMID 24344668. Vancouver style error: initials (help)
- ↑ Lungu A, Wild JM, Capener D, Kiely DG, Swift AJ, Hose DR (September 2014). "MRI model-based non-invasive differential diagnosis in pulmonary hypertension". J Biomech. 47 (12): 2941–7. doi:10.1016/j.jbiomech.2014.07.024. PMID 25145313.
- ↑ Ohira H, Beanlands RS, Davies RA, Mielniczuk L (February 2015). "The role of nuclear imaging in pulmonary hypertension". J Nucl Cardiol. 22 (1): 141–57. doi:10.1007/s12350-014-9960-y. PMID 25161042.
- ↑ Kreitner KF, Wirth GM, Krummenauer F, Weber S, Pitton MB, Schneider J, Mayer E, Dueber C (September 2013). "Noninvasive assessment of pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension by high temporal resolution phase-contrast MRI: correlation with simultaneous invasive pressure recordings". Circ Cardiovasc Imaging. 6 (5): 722–9. doi:10.1161/CIRCIMAGING.112.000276. PMID 23863980.
- ↑ Wirth G, Brüggemann K, Bostel T, Mayer E, Düber C, Kreitner KF (August 2014). "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". Rofo. 186 (8): 751–61. doi:10.1055/s-0034-1366425. PMID 24756429.