ORIGINAL ARTICLE

Magnetic Resonance Imaging for Pulmonary Hypertension Methods, Applications, and Outcomes Ignacio Lopez-Costa, MD, Sanjeev Bhalla, MD, and Constantine Raptis, MD

Abstract: Pulmonary hypertension (PH) is a potentially life-threatening disease. Clinical classification of PH has undergone multiple modifications and was last updated in 2008. Initial detection and classification rely on a combination of invasive and noninvasive tests, among which the most important are echocardiography, right-sided heart catheterization, and computed tomography. Treatment response assessment and monitoring are focused on the functional evaluation of the right ventricle, and magnetic resonance imaging is the noninvasive test of choice as its accuracy and reproducibility are superior to echocardiography. In this article, we discuss our PH evaluation magnetic resonance imaging protocol, which has been customized to provide clinicians with the information needed to assess right-sided heart functional status and determine response to treatment or disease progression. Key Words: pulmonary hypertension, cardiac MRI, heart catheterization (Top Magn Reson Imaging 2014;23: 43Y50)

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ulmonary hypertension (PH) is a potentially life-threatening disease that can be difficult to diagnose as it usually manifests with nonspecific and insidious symptoms, often confused with other cardiopulmonary diseases. Pulmonary hypertension is defined as a resting mean pulmonary arterial pressure of greater than or equal to 25 mm Hg at right-sided heart catheterization. During exercise, the normal mean pulmonary artery pressure should be less than 30 mm Hg.1 If left undiagnosed and untreated, PH progresses to right ventricular dilatation and hypertrophy with subsequent heart failure, followed by death. Clinical workup and management are based on 4 pillars: suspicion, detection, classification, and functional evaluation. Traditionally, detection relies on a combination of chest radiography, electrocardiography, and Doppler echocardiography. The ability of Doppler echocardiography to noninvasively estimate pulmonary arterial pressure with good sensitivity and specificity renders it the screening test of choice. However, this modality has several limitations, which will be addressed later in this article. The first attempt to classify PH took place in 1973. This classification has undergone a series of changes leading to the creation of a 5-category system, in which each category shares underlying pathophysiology. The core of this classification system was developed in the Evian and Venice symposia, held, respectively, in 1998 and 2003, and was last revised during the fourth World Symposium on PH at Dana Point, Calif, in 20082 (Table 1).

From the Mallinckrodt Institute of Radiology, St Louis, MO Reprints: Ignacio Lopez-Costa, MD, Mallinckrodt Institute of Radiology, 510 S. Kingshighway, St. Louis, MO 63110 (e

Magnetic resonance imaging for pulmonary hypertension: methods, applications, and outcomes.

Pulmonary hypertension (PH) is a potentially life-threatening disease. Clinical classification of PH has undergone multiple modifications and was last...
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