Combined Pulmonary Fibrosis and Emphysema: 3D Time-resolved MR Angiographic Evaluation of Pulmonary Arterial Mean Transit Time and Time to Peak Enhancement

Abstract

Purpose:To correlate conventional invasive pressure indexes of pulmonary circulation with pulmonary fi rst-order arterial mean transit time (MTT) and time to peak enhancement (TTP) measured by means of three-dimensional timeresolved magnetic resonance (MR) angiography in patients with combined pulmonary fi brosis and emphysema (CPFE). Materials and Methods:The study was institutional review board approved. All subjects involved in the study provided written informed consent. Eighteen patients with CPFE were enrolled in this study. Thirteen healthy individuals matched for age and sex served as control subjects. Three-dimensional timeresolved MR angiography was performed by using a 3.0-T MR imager. Regions of interest (ROIs) were drawn manually on fi rst-order pulmonary arteries. Within the ROIs, signal intensity-versus-time curves refl ecting the fi rst pass of the contrast agent bolus in the pulmonary vessels were obtained. MTT and TTP were calculated. Pulmonary arterial pressure and pulmonary capillary wedge pressure were measured with a double-lumen, balloon-tipped catheter that was positioned in the pulmonary artery. The mean pulmonary arterial pressure (mPAP) and the pulmonary vascular resistance (PVR) were determined. Results:MTT and TTP values were prolonged signifi cantly in patients with CPFE compared with those in the control subjects ( P , .001). Mean TTP and mean MTT correlated directly with mPAP and PVR index ( P , .005). At multiple linear regression analysis, MTT was the only factor independently associated with PVR index and mPAP. Conclusion:Three-dimensional time-resolved MR angiography enables determination of pulmonary hemodynamic parameters that correlate signifi cantly with the pulmonary hemodynamic parameters obtained with invasive methods and may represent a complementary tool for evaluating pulmonary hypertension in patients with CPFE.

Predicting survival in newly diagnosed idiopathic pulmonary fibrosis: a 3-year prospective study

“…Studies from COTTIN and co-workers [44,45] and SERGIACOMI et al [46] identified combined pulmonary fibrosis and emphysema (CPFE) as a relevant clinical entity, as mean survival is shorter than in other forms of IIP, the incidence of pulmonary hypertension is higher and PFTs are potentially confounding. Although CE was not an independent prognostic factor, our study showed that, in the long term, patients with CE have a worse prognosis than those without CE.…”

Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension

“…MRI perfusion imaging can provide information about the presence of perfusion defects at higher spatial resolution than perfusion scintigraphy. These functional haemodynamic-sensitive MR techniques have the potential to quantify the pulmonary blood flow and regional pulmonary vascular resistance and predict the surgical outcome [20,21]. The presence of dilated bronchial arteries has been shown to correlate with a lower mortality rate after pulmonary thrombo-endarterectomy and CE-MRA has been shown to accurately estimate the flow in the bronchial arteries in patients with CTEPH [22].…”

Pulmonary MR angiography and perfusion imaging—A review of methods and applications

“…PBF has been shown to improve in CTEPH patients who have had pulmonary endarterectomy (40). There is also an increase in MTT in patients with pulmonary arterial hypertension (PAH), which shows a modest correlation with mPAP (41,42) and in patients with combined emphysema and fibrosis MTT correlates with mean pulmonary artery pressure and pulmonary vascular resistance (43). In addition, in patients with PAH, pulmonary transit times have been shown to correlate with markers of disease severity, mean right atrial pressure and pulmonary vascular resistance (44) and are predictive of mortality at univariate analysis and have equivalent prognostic value to invasive measures taken at right heart catheterisation (45).…”