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
Overview
Cardiac MRI provides important prognostic indicators regarding the function of right ventricle in patients with pulmonary hypertension.
MRI
Role of MRI
- Accurate evaluation of the size, morphology and function of the right ventricle.
- MRI has similar abilities to those of 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 with 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 ventricvular 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