Bronchopulmonary Shunts in Patients with Chronic Thromboembolic Pulmonary  Hypertension: Evaluation with Helical CT and MR Imaging

Ley, Sebastian; Kreitner, Karl‐Friedrich; Morgenstern, Iris; Thelen, M.; Kauczor, Hans‐Ulrich

doi:10.2214/ajr.179.5.1791209

Cited by 102 publications

(62 citation statements)

References 29 publications

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“…The severity of collateral development has only been assessed by angiographic visualization at cardiac catheterization, which is not a quantitative method. PCMR has been used to measure systemic collateral arterial flow to the lungs noninvasively by calculating the difference between ascending aorta flow and pulmonary artery flow (18). However, this method is not applicable in patients with bidirectional cavopulmonary anastomosis or when there is an intracardiac shunt.…”

Section: Clinical Applications Of Mr Quantification Of Pulmonary Venomentioning

confidence: 99%

“…In fact, systemic collateral arterial flow volume can easily be calculated by subtracting the pulmonary arterial flow volume from the pulmonary venous flow volume (Qspa ϭ Qpv Ϫ Qpa). Accurate measurement of systemic collateral flow to the lungs is also useful in differentiating secondary from primary pulmonary hypertension (16,18,19).…”

Section: Clinical Applications Of Mr Quantification Of Pulmonary Venomentioning

confidence: 99%

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Phase‐contrast magnetic resonance quantification of normal pulmonary venous return

Goo

Alotay

Grosse-Wortmann

et al. 2009

Magnetic Resonance Imaging

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Purpose:To assess the feasibility of phase-contrast magnetic resonance (PCMR) in quantifying the pulmonary venous return in normal subjects. Materials and Methods:PCMR was performed in 12 healthy adult volunteers (mean age 38 years, range 27-60 years; 9 men; body surface area 1.81 Ϯ 0.15 m 2 ) for the ascending and descending aorta, caval veins, main and branch pulmonary arteries, and pulmonary veins. Two readers independently quantified blood flow in all subjects.Results: Intraobserver differences were Ϫ2.0% (95% confidence interval [CI]: Ϫ9.9% to 5.9%), Ϫ4.5% (95% CI: Ϫ15.6% to 6.5%), and Ϫ0.7% (95% CI: Ϫ4.5% to 3.0%) for all vessels, pulmonary veins, and other great vessels, respectively. Interobserver differences were Ϫ2.0% (95% CI: Ϫ10.6% to 6.6%), Ϫ3.1% (95% CI: Ϫ16.0% to 9.9%), and Ϫ1.4% (95% CI: Ϫ6.4% to 3.5%) for all vessels, pulmonary veins, and other great vessels, respectively. Pulmonary venous flow volume showed high correlations with the volumes of the pulmonary arterial flow, systemic arterial flow, and systemic venous flow (r ϭ 0.76 -0.92, P Ͻ 0.005). Conclusion:Flow quantification of normal pulmonary venous return using PCMR is feasible with high reproducibility and accuracy. FLOW QUANTIFICATION using the phase-contrast (or velocity-encoded) technique is a central part of comprehensive cardiac magnetic resonance (MR) imaging for congenital heart disease in children and adults. Phasecontrast MR imaging (PCMR) has been validated as accurate in evaluating velocity, volume, and pattern of pulsatile blood flow (1-5). Flow measurements using PCMR have been used at various great vessels, including the aorta, the pulmonary artery, and the superior and inferior vena cavae, in various clinical settings (6 -10). In contrast, feasibility of flow quantification of the pulmonary veins using PCMR has not been evaluated. As in systemic circulation, information on pulmonary venous flow in addition to pulmonary arterial flow is crucial for the full understanding of pulmonary circulation.Measurement of pulmonary venous flow is important in the following clinical scenarios: direct measurement of systemic collateral arterial flow to the lung; shunting involving the pulmonary vein; and alternative measurement of pulmonary arterial flow when it is not available for any reason. Attention with regard to evaluation of pulmonary vein abnormalities after radiofrequency ablation has also increased recently. However, it is very difficult to provide accurate quantification of pulmonary venous flow when using echocardiography and the catheter technique. This fact motivated our study because noninvasive PCMR has great potential in offering such pulmonary venous flow data. A few clinical studies have demonstrated the usefulness of quantification of pulmonary venous flow volume with PCMR in patients with anomalous pulmonary venous connection, stenotic pulmonary artery with or without a stent, and systemic collateral arteries supplying the lungs (11-13). The amount of systemic collateral arterial supply to the lungs can be calcula...

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Section: Clinical Applications Of Mr Quantification Of Pulmonary Venomentioning

confidence: 99%

Section: Clinical Applications Of Mr Quantification Of Pulmonary Venomentioning

confidence: 99%

Phase‐contrast magnetic resonance quantification of normal pulmonary venous return

Goo

Alotay

Grosse-Wortmann

et al. 2009

Magnetic Resonance Imaging

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“…2,3 As the finding of dilated BAs is rarely seen in patients with idiopathic pulmonary arterial hypertension (PAH) or acute pulmonary embolism, it has been suggested that this feature could help distinguish patients with CTEPH from those with other diseases causing pulmonary hypertension. 1,3,4 The presence of dilated BAs represents increased systemic collateral blood supply 1,2 and it plays a important role in maintaining the viability of ischemic lung parenchyma after pulmonary artery occlusion. 5 However, the mechanisms of bronchial arterial development are not well understood.…”

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confidence: 99%

Dilatation of Bronchial Arteries Correlates With Extent of Central Disease in Patients With Chronic Thromboembolic Pulmonary Hypertension

Shimizu

Tanabe

Terada

et al. 2008

Circ J

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Background Dilatation of the bronchial arteries is a well-recognized feature in patients with chronic thromboembolic pulmonary hypertension (CTEPH). The purpose of the current study was to use computed tomography (CT) to assess the relationship between dilated bronchial arteries and the extent of thrombi, and to evaluate the predictive value of the former for surgical outcome. Methods and ResultsFifty-nine patients with CTEPH and 16 with pulmonary arterial hypertension (PAH) were retrospectively evaluated. The total cross-sectional area of bronchial arteries was measured by CT and its relationship with the central extent of thrombi or surgical outcome was assessed. The total area of the bronchial arteries in CTEPH patients was significantly larger than that in PAH patients (median [range], 6.9 [1.7-29.5] mm 2 vs 3.2 [0.8-9.4] mm 2 ), with the total area of bronchial arteries correlating with the central extent of thrombi. In patients who had undergone pulmonary thromboendarterectomy (PTE) (n=22), the change in PaO2 after surgery had a tendency to correlate with the total area of the bronchial arteries. Conclusion The total cross-sectional area of the bronchial arteries correlated with the extent of central disease in patients with CTEPH, and it might predict gas exchange improvement after PTE. (Circ J 2008; 72: 1136 -1141

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“…1 d). There may be significant systemic to pulmonary shunting, as systemic artery circulation in these cases not only supports the lung parenchyma, but also participates in blood oxygenation [32,33]. However, the detection of dilated systemic arteries is not a specific sign in patients with CTEPH as it may also be present in other forms of PH.…”

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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Bronchopulmonary Shunts in Patients with Chronic Thromboembolic Pulmonary Hypertension: Evaluation with Helical CT and MR Imaging

Cited by 102 publications

References 29 publications

Phase‐contrast magnetic resonance quantification of normal pulmonary venous return

Phase‐contrast magnetic resonance quantification of normal pulmonary venous return

Dilatation of Bronchial Arteries Correlates With Extent of Central Disease in Patients With Chronic Thromboembolic Pulmonary Hypertension

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

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