Pulmonary hypertension MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Richard Channick, M.D.; Assistant Editor(s)-in-Chief: Ralph Matar

Cardiac MR

Due to the important prognostic indicators of the function of the right ventricle in patients with PAH. Cardiac MR is performed in some patients to:

1-Accurately evaluate 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.

2-Detect shunts contributing to pulmonary hypertension.

3-Detect acute and chronic pulmonary thromboembolic disease.

4-Distinguish between the pulmonary vasculature and mediastinal adenopathy when used with contrast enhancement.

5-Also used for follow-up of right heart hemodynamics for follow-up purposes.

Poor right ventricular function is indicated by the following according to the ACCF/AHA 2009 Expert consensus document on pulmonary hypertension:

1. Stroke volume ≤25ml/m^2.
2. Right ventricular end-diastolic volume ≥84ml/m^2( Most appropriate marker of right ventricular failure in the follow-up.)
3. Left ventricvular end-diastolic volume ≤40ml/m^2

• MRI has similar abilities to those of echocardiography in the diagnosis and treatment of patients with pulmonary hypertension.

• Pulmonary artery stiffness measured by relative cross sectional area change ≤16% also has implications on mortality rate.

MRI Limitations include:

1- Inability to perform breath hold.

2-Claustrophobia.

3- Incompatible hardware such as neurostimulators, cochlear implants, aneurysm clips, cardiac pacemakers and defibrillators.

4- Limited availability and cost.

5- Difficulty in assessing PA pressures.

Cardiac MR images:

1-Short axis slices showing right ventricular volumes, mass and ejection fraction.

2-Short axis views of the ventricles showing a dilated and hypertrophied right ventricle.

References

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