Imaging of pulmonary hypertension in adults: a position paper from the Fleischner Society

Rémy‐Jardin, Martine; Ryerson, Christopher J.; Schiebler, Mark L.; Leung, Ann N.; Wild, Jim M.; Hoeper, Marius M.; Alderson, Philip O.; Goodman, Lawrence R.; Mayo, John R.; Haramati, Linda B.; Ohno, Yoshiharu; Thistlethwaite, Patricia A.; Beek, Edwin Jacques Rudolph van; Knight, Shandra L; Lynch, David A.; Rubin, Geoffrey D.; Humbert, Marc

doi:10.1183/13993003.04455-2020

Cited by 65 publications

(63 citation statements)

References 139 publications

(174 reference statements)

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“…The Fleishner society published this year a position paper on imaging of PH in adults [ 76 ]. David Kiely gave an overview of the novelties included in this statement paper in the session Clinical challenges beyond guidelines , with a focus on magnetic resonance imaging (MRI) in PH.…”

Section: Imaging Of Pulmonary Hypertension In Adults: a Position Pape...mentioning

confidence: 99%

ERS International Congress 2021: highlights from the Pulmonary Vascular Diseases Assembly

et al. 2022

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This article aims to summarise the latest research presented at the virtual 2021 European Respiratory Society (ERS) International Congress in the field of pulmonary vascular disease. In light of the current guidelines and proceedings, knowledge gaps are addressed and the newest findings of the various forms of pulmonary hypertension as well as key points on pulmonary embolism are discussed.Despite the comprehensive coverage of the guidelines for pulmonary embolism at previous conferences, discussions about controversies in the diagnosis and treatment of this condition in specific cases were debated and are addressed in the first section of this article.We then report on an interesting pro–con debate about the current classification of pulmonary hypertension.We further report on presentations on Group 3 pulmonary hypertension, with research exploring pathogenesis, phenotyping, diagnosis and treatment; important contributions on the diagnosis of post-capillary pulmonary hypertension are also included.Finally, we summarise the latest evidence presented on pulmonary vascular disease and COVID-19 and a statement on the new imaging guidelines for pulmonary vascular disease from the Fleischner Society.

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Section: Imaging Of Pulmonary Hypertension In Adults: a Position Pape...mentioning

confidence: 99%

ERS International Congress 2021: highlights from the Pulmonary Vascular Diseases Assembly

et al. 2022

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“…22 Advanced imaging may also provide markers of more severe disease and potential poor response to therapy. 35 Cardiac magnetic resonance imaging may be useful in this regard for earlier detection and therefore an opportunity for treatment stratification. Pulmonary arterial pulsatility is a surrogate that has been used to assess the presence and severity of PAH.…”

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confidence: 99%

Topic-Based, Recent Literature Review on Pulmonary Hypertension

Burger

DuBrock

Cartin‐Ceba

et al. 2021

Mayo Clinic Proceedings

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Pulmonary hypertension is a complex condition but a relatively common manifestation of severe cardiopulmonary disease. By contrast, pulmonary arterial hypertension is uncommon and is more prevalent in young women. To better categorize patients and to guide clinical decision-making, 5 diagnostic groups and associated subgroups characterize the spectrum of disease. A multidisciplinary approach to evaluation and treatment is recommended by published guidelines and often entails referral to a designated pulmonary hypertension center. Several key publications during the last couple of years merit review. The PubMed database was searched for English-language studies and guidelines relating to pulmonary hypertension. The following terms were searched, alone and in combination: pulmonary hypertension, pulmonary arterial hypertension, portopulmonary hypertension, and chronic thromboembolic pulmonary hypertension. The focus was on those publications with new information on evaluation and management of pulmonary hypertension between January 1, 2019, and January 31, 2021. Of the subgroups, 2 were of particular interest for this review: portopulmonary hypertension and chronic thromboembolic pulmonary hypertension. Last, available data on the impact of the coronavirus disease 2019 pandemic and newer treatment agents in early trials were selectively reviewed. The review is therefore intended to serve as a practical, focused review of important topics germane to those clinicians caring for patients with pulmonary hypertension.pulmonary hypertension, pulmonary arterial hypertension, right ventricular failure

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“…Pulmonary vascular disease encompasses a range of conditions that are linked with a large disease burden worldwide and are associated with high mortality and morbidity (1)(2)(3)(4). Computed tomography pulmonary angiography (CTPA) is a crucial imaging investigation performed in patients with suspected pulmonary embolism (PE) and in the work up of patients with suspected pulmonary hypertension (PH) (1).…”

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confidence: 99%

Fully automatic cardiac four chamber and great vessel segmentation on CT pulmonary angiography using deep learning

Sharkey

Taylor

Alabed

et al. 2022

Front. Cardiovasc. Med.

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IntroductionComputed tomography pulmonary angiography (CTPA) is an essential test in the work-up of suspected pulmonary vascular disease including pulmonary hypertension and pulmonary embolism. Cardiac and great vessel assessments on CTPA are based on visual assessment and manual measurements which are known to have poor reproducibility. The primary aim of this study was to develop an automated whole heart segmentation (four chamber and great vessels) model for CTPA.MethodsA nine structure semantic segmentation model of the heart and great vessels was developed using 200 patients (80/20/100 training/validation/internal testing) with testing in 20 external patients. Ground truth segmentations were performed by consultant cardiothoracic radiologists. Failure analysis was conducted in 1,333 patients with mixed pulmonary vascular disease. Segmentation was achieved using deep learning via a convolutional neural network. Volumetric imaging biomarkers were correlated with invasive haemodynamics in the test cohort.ResultsDice similarity coefficients (DSC) for segmented structures were in the range 0.58–0.93 for both the internal and external test cohorts. The left and right ventricle myocardium segmentations had lower DSC of 0.83 and 0.58 respectively while all other structures had DSC >0.89 in the internal test cohort and >0.87 in the external test cohort. Interobserver comparison found that the left and right ventricle myocardium segmentations showed the most variation between observers: mean DSC (range) of 0.795 (0.785–0.801) and 0.520 (0.482–0.542) respectively. Right ventricle myocardial volume had strong correlation with mean pulmonary artery pressure (Spearman's correlation coefficient = 0.7). The volume of segmented cardiac structures by deep learning had higher or equivalent correlation with invasive haemodynamics than by manual segmentations. The model demonstrated good generalisability to different vendors and hospitals with similar performance in the external test cohort. The failure rates in mixed pulmonary vascular disease were low (<3.9%) indicating good generalisability of the model to different diseases.ConclusionFully automated segmentation of the four cardiac chambers and great vessels has been achieved in CTPA with high accuracy and low rates of failure. DL volumetric biomarkers can potentially improve CTPA cardiac assessment and invasive haemodynamic prediction.

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Imaging of pulmonary hypertension in adults: a position paper from the Fleischner Society

Cited by 65 publications

References 139 publications

ERS International Congress 2021: highlights from the Pulmonary Vascular Diseases Assembly

ERS International Congress 2021: highlights from the Pulmonary Vascular Diseases Assembly

Topic-Based, Recent Literature Review on Pulmonary Hypertension

Fully automatic cardiac four chamber and great vessel segmentation on CT pulmonary angiography using deep learning

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