Pulmonary Hypertension and Thromboembolic Disease

Ley, Sebastian; Kreitner, Karl‐Friedrich

doi:10.1007/978-3-540-34619-7_6

Cited by 3 publications

(8 citation statements)

References 81 publications

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“…Other signs include a partial filling defect surrounded by contrast material, the ''polo mint'' sign on images acquired perpendicular to the long axis of a vessel, the ''railway track'' sign on longitudinal images of the vessel, and a peripheral intraluminal filling defect that forms acute angles with the arterial wall [5,6]. All these …”

Section: Pulmonary Arterial Signsmentioning

confidence: 99%

“…Enlargement of the central pulmonary artery, when compared with ascending aorta, can be used indirectly to estimate the severity of the pressure, although this provides only a rough estimate, as individual pressure is heavily dependent on cardiac condition [5,6]. As the right ventricular systolic pressure approaches that of the left ventricle, a paradoxical systolic motion of the interventricular septum is observed ( Figure 7).…”

Section: Signs Of Pulmonary Hypertensionmentioning

confidence: 99%

“…An abrupt decrease in vessel diameter, and absence of contrast material in the vessel segment distal to the total obstruction, are definite signs of PE and are demonstrated in MR angiography [4,5] (Figures 1-5). Other signs include a partial filling defect surrounded by contrast material, the ''polo mint'' sign on images acquired perpendicular to the long axis of a vessel, the ''railway track'' sign on longitudinal images of the vessel, and a peripheral intraluminal filling defect that forms acute angles with the arterial wall [5,6].…”

Section: Pulmonary Arterial Signsmentioning

confidence: 99%

“…occlusion of the pulmonary arteries), flow through the bronchial arteries increases. With the improved spatial resolution of MR angiography, these can also be visualised with MRI [5].…”

Section: Signs Of Pulmonary Hypertensionmentioning

confidence: 99%

“…As the right ventricular systolic pressure approaches that of the left ventricle, a paradoxical systolic motion of the interventricular septum is observed ( Figure 7). Cine MRI is an accepted reference standard for assessing global and regional left and right ventricular function [5]. Collateral systemic supply…”

Section: Signs Of Pulmonary Hypertensionmentioning

confidence: 99%

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Magnetic resonance imaging findings in acute pulmonary embolism

Hochhegger¹,

Ley‐Zaporozhan²,

Marchiori³

et al. 2011

BJR

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ABSTRACT. Pulmonary embolism (PE) is the third most common acute cardiovascular disease after myocardial infarction and stroke, and results in thousands of deaths each year. Improvements in MRI accuracy are ongoing with the use of parallel imaging for angiography techniques and pulmonary perfusion. This, associated with other potential advantages of MRI (e.g. a radiation free method and better safety profile of MR contrast media), reinforces its use. The aim of this paper is to perform a pictorial review of the principal findings of MRI in acute PE. Acute PE can manifest itself as complete arterial occlusion and the affected artery may be enlarged. We report the main vascular and parenchymal signs, and an overview of current literature regarding accuracy, limitations and technical aspects is provided. Diagnostic strategies for pulmonary embolism (PE) have evolved over the last few decades with the development of new diagnostic methods. Initially, the time required for an MR examination and the lack of MR-compatible monitoring devices hindered the broad clinical acceptance of this method. Recently, significant technical developments in pulmonary MR angiography have occurred. Improvements include the use of parallel imaging, view-sharing, time-resolved echo-shared angiography [1, 2] and pulmonary perfusion. These techniques have shortened the acquisition time of MR angiography, improved spatial resolution and made it less susceptible to motion artefacts. In addition to classical MR angiography, other sequence types have been developed for more rapid acquisition of images and additional functional information.The increased use of multidetector CT (MDCT) scanning has raised concerns about overall radiation exposure to the population, and has emphasised the need in the radiology community for optimised scanning protocols [3]. MRI does not require ionising radiation, or iodated contrast media, and is associated with less renal impairment than MDCT. Thus, MRI appears to be the ideal imaging modality for use in ruling out PE.The aim of this paper is to provide a pictorial review of MRI in PE diagnosis, and assess its accuracy through a review of the literature. MRI techniqueThe proposed MRI protocol for PE diagnosis consists of real-time MR, MR perfusion imaging and MR angiography [3]. This basic evaluation protocol can be easily extended to match individual demands like the assessment of right and/or left ventricular function or the visualisation of the abdominal/pelvic and lower limb veins. The examination protocol first addresses fast overview sequences that ensure short examination times for use with patients in critical condition. Subsequently, the protocol presents a more comprehensive evaluation of the pulmonary arteries, for use with patients with less serious conditions ( Table 1). The total time of acquisition is therefore dependent on the depth of the evaluation and lasts anywhere between 3 and 20 min. The achieved diagnostic accuracy is, at each step, balanced against the patient's condition (30-50 s for tra...

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Section: Pulmonary Arterial Signsmentioning

confidence: 99%

Section: Signs Of Pulmonary Hypertensionmentioning

confidence: 99%

Section: Pulmonary Arterial Signsmentioning

confidence: 99%

“…occlusion of the pulmonary arteries), flow through the bronchial arteries increases. With the improved spatial resolution of MR angiography, these can also be visualised with MRI [5].…”

Section: Signs Of Pulmonary Hypertensionmentioning

confidence: 99%

Section: Signs Of Pulmonary Hypertensionmentioning

confidence: 99%

See 3 more Smart Citations

Magnetic resonance imaging findings in acute pulmonary embolism

Hochhegger¹,

Ley‐Zaporozhan²,

Marchiori³

et al. 2011

BJR

View full text Add to dashboard Cite

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Role of noncontrast magnetic resonance pulmonary imaging in diagnosis of pulmonary embolism

Elsaid

Mohammad

Okab

et al. 2022

The Egyptian Journal of Chest Diseases and Tuberculosis

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Background Pulmonary embolism (PE) is a serious condition and has a clinical dilemma in diagnosis. Computed tomography pulmonary angiography (CTPA) is a gold standard in its diagnosis, but MRI has proven a good role in PE diagnosis. Aim The aim of this work was to evaluate the role of noncontrast magnetic resonance pulmonary angiography (MRPA) imaging in diagnosis of acute PE using CTPA as a gold standard. Patients and methods In total, 25 patients with PE confirmed by CTPA were included in this study. All patients underwent computed tomography angiography and noncontrast MRPA on the same day or within three consecutive days. The results were compared and statistically analyzed. Results The mean age of the study group was 46.4 ± 13.5 years. Females represent 60% (15/25) and males represent 40% (10/25). The per-vessel sensitivity of noncontrast MRPA reached to about 100% with specificity 100% at the level of the main trunk, right and left main pulmonary arteries down to segmental arteries. The sensitivity for right subsegmental branches was 25% and left subsegmental branches was 33.3%. Conclusion The noncontrast MRPA has a reasonable sensitivity and specificity in the diagnosis of PE, especially in major branches. So, it can be used as an alternative to the computed tomography angiography, especially when the computed tomography angiography and the use of gadolinium are contraindicated.

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Pulmonary Vein Sign on Unenhanced-MRI as a Sign of Severe Pulmonary Embolism

et al. 2019

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Background: Increased right ventricle-to-left ventricle (RV/LV) ratio on computed tomography pulmonary angiography (CTPA) has been reported as a poor prognostic indicator in patients with acute pulmonary embolism (PE). It has also been reported that pulmonary vein sign (PVS) on CTPA is a rare finding of PE. Objectives: To evaluate PVS on CTPA and unenhanced magnetic resonance imaging (MRI) in patients with PE suspicion. We also aimed to investigate the relationship between the severity of PE and presence of PVS, RV/LV ratio and combination of these two on unenhanced MRI. Patients and Methods: One-hundred-twelve patients with PE suspicion who underwent CTPA and unenhanced-MRI [steady state free precession (SSFP)] within the first 48-hours constituted the study group. All CTPA images were evaluated for the presence, location and severity of PE by observer-1. Two observers (observer-2 and 3), independently evaluated unenhanced-MR images for the presence of PVS without knowing the results of CTPA. Then, these 2 observers reviewed the CTPA and MRI images together with observer-4 to reach the final consensus for the presence of PVS and measurement of RV/LV ratio. Cohen's Kappa analysis was used to assess the agreement between observers. Relationship between the mean PE index and imaging findings (PVS, RV/LV) were calculated.Results: Presence of PVS on CT or MRI is significantly correlated with PE index and patients with PVS had more severe PE than those without. Presence of both PVS and RV/LV ratio > 1 on MRI indicates more severe pulmonary embolism than absence of PVS or RV/LV ratio > 1. There was a very good agreement for the detection of PVS between two observers on unenhanced MRI. Conclusion: PVS on CTPA or unenhanced MRI can be used as a sign of severe PE and it may also be an indicator of right heart dysfunction.

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Pulmonary Hypertension and Thromboembolic Disease

Cited by 3 publications

References 81 publications

Magnetic resonance imaging findings in acute pulmonary embolism

Magnetic resonance imaging findings in acute pulmonary embolism

Role of noncontrast magnetic resonance pulmonary imaging in diagnosis of pulmonary embolism

Pulmonary Vein Sign on Unenhanced-MRI as a Sign of Severe Pulmonary Embolism

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