Usefulness of Cardiovascular Magnetic Resonance Indices to Rule In or Rule Out Precapillary Pulmonary Hypertension

Imaging of Pulmonary Hypertension in Adults: A Position Paper from the Fleischner Society

“…At MRI, dynamic PA size measurements (PA diameter, PA ratio, PA area, and PA relative area change) show comparable performance to CT-based measurements in diagnosis of PH with AUCs ranging from 0.71-0.93 (15)(16)(17)(18)32). Overall, diagnostic performance of MRI is superior to that of non-electrocardiogram-gated CT due to its ability to assess and quantify additional structural and functional cardiovascular metrics indicative of increased PAP and pulmonary vascular resistance.…”

“…In patients with PH, increased PAP results in structural, functional, and hemodynamic changes assessable with imaging. Numerous CT (10)(11)(12)(13)(14) and MRI studies (15)(16)(17)(18) have shown that absolute or relative size of the PA can be directly correlated with PAP as measured with right heart catheterization. However, the diagnostic performance of static PA dimensions on routine chest CT studies to identify PH has yielded inconsistent results, with areas under the receiver operating characteristic curve, or AUCs, ranging from 0.55-0.93 for PA diameter and 0.73-0.95 for PA Truong et al (31) derived and validated a CT-based four-tier severity classification system of PA diameter and PA ratio (each measurement subdivided as normal, mild, moderate, and severe) for the diagnosis of PH, designed to maximize test sensitivity and specificity at low and high cutoff values, respectively.…”

Lung Magnetic Resonance Imaging

“…[191][192][193] Dynamic pulmonary artery (PA) size measurements on MR images obtained with various sequences have been determined to be comparable to CT-based measurements for diagnosis of PH, with area under the curves reportedly ranging from 0.71 to 0.93. [194][195][196][197] Moreover, the diagnostic performance of MRI for differentiating patients with PH from those without is rated higher than that of non-cardiac-gated CT due to its ability to assess and quantify additional structural and functional cardiovascular metrics. [198][199][200][201][202][203] Quantitatively or qualitatively assessed time-resolved or 4-dimensional (4D) CE-MR angiography is also useful for the severity assessment and the long-term assessment of the effect of therapy in PH.…”

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

“…In patients with PH, increased PAP results in structural, functional, and haemodynamic changes assessable with imaging. Numerous CT [10][11][12][13][14] and MRI studies [15][16][17][18] have shown that absolute or relative size of the pulmonary artery (PA) can be directly correlated with PAP as measured with right heart catheterisation. However, the diagnostic performance of static PA dimensions on routine chest CT studies to identify PH has yielded inconsistent results, with areas under the receiver operating characteristic curve, or AUCs, ranging from 0.55 to 0.93 for PA diameter and 0.73-0.95 for PA diameter-to-aorta ratio (hereafter, PA ratio), respectively [10][11][12][13][19][20][21][22].…”

“…Diagnostic accuracy of these PA size measurements at chest CT to diagnose PH in practice settings where the prevalence and severity of disease is likely to be lower would benefit from further validation in prospective studies. [15][16][17][18]32]. Overall, diagnostic performance of MRI is superior to that of non-electrocardiogram-gated CT due to its ability to assess and quantify additional structural and functional cardiovascular metrics indicative of increased PAP and pulmonary vascular resistance.…”