Update on MR imaging of the pulmonary vasculature

AbstractMagnetic resonance imaging (MRI) plays an increasingly important role in the non-invasive evaluation of the pulmonary vasculature. MR angiographic (MRA) techniques provide morphological information, while MR perfusion techniques provide functional information of the pulmonary vasculature. Contrast-enhanced MRA can be performed at high spatial resolution using 3D T1-weighted spoiled gradient echo sequence or at high temporal resolution using time-resolved techniques. Non-contrast MRA can be performed using 3D steady state free precession, double inversion fast spin echo, time of flight or phase contrast sequences. MR perfusion can be done using dynamic contrast-enhanced technique or using non-contrast techniques such as arterial spin labelling and time-resolved imaging of lungs during free breathing with Fourier decomposition analysis. MRI is used in the evaluation of acute and chronic pulmonary embolism, pulmonary hypertension and other vascular abnormalities, congenital anomalies and neoplasms. In this article, we review the different MR techniques used in the evaluation of pulmonary vasculature and its clinical applications.
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research

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AbstractPurpose of ReviewThe purpose of this article is to review the imaging findings and current imaging techniques of acute pulmonary embolism (PE) and chronic thromboembolic disease. Special considerations are also discussed, including pregnancy, congenital heart disease, lower extremity computed tomography (CT), and the isolated subsegmental PE.Recent FindingsCT pulmonary angiography and planar ventilation/perfusion (V/Q) lung scintigraphy are the primary means of evaluating pulmonary embolic disease. Magnetic resonance angiography avoids ionizing radiation and iodinated contrast in select patients. V/Q SPECT/CT provi...
Source: Current Respiratory Care Reports - Category: Respiratory Medicine Source Type: research
A 62-year-old woman with persistent chronic thromboembolic pulmonary hypertension (CTEPH) status after pulmonary thromboendarterectomy presented with worsening exercise capacity and continued dyspnea requiring 3 L O2 at home.  Ventilation perfusion scan (Fig 1) demonstrated A high probability of pulmonary embolism. Pulmonary angiography (Fig 2) revealed multifocal subsegmental arterial occlusions and stenoses consistent with CTEPH. Her medications included macitentan, riociguat, and selexipag for CTEPH.
Source: Journal of Vascular and Interventional Radiology : JVIR - Category: Radiology Authors: Tags: Images in IR Source Type: research
(CTEPH) is a complication of pulmonary embolism and a major cause of chronic PH leading to right heart failure and death. Lung ventilation/perfusion scintigraphy is the screening test of choice; a normal scan rules out CTEPH. In the case of an abnormal perfusion scan, a high-quality pulmonary angiogram is necessary to confirm and define the pulmonary vascular involvement and prior to making a treatment decision. PH is confirmed with right heart catheterisation, which is also necessary for treatment determination. In addition to chronic anticoagulation therapy, each patient with CTEPH should receive treatment assessment st...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: World Symposium on Pulmonary Hypertension Source Type: research
Pulmonary hypertension (PH) in adults with sickle cell disease (SCD) is associated with early mortality. Chronic thromboembolic PH (CTEPH) is an important complication and contributor to PH in SCD but is likely underappreciated. Guidelines recommend ventilation–perfusion (V/Q) scintigraphy as the imaging modality of choice to exclude CTEPH. Data on V/Q scanning are limited in SCD. Our objective was to compare the performance of V/Q scanning with that of CT pulmonary angiography (CTPA) and to report clinical outcomes associated with abnormal V/Q findings. Methods: Laboratory data, echocardiography, 6-min-walk testing,...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Clinical Source Type: research
Abstract BACKGROUND: Thrombolytic therapy is usually reserved for patients with clinically serious or massive pulmonary embolism (PE). Evidence suggests that thrombolytic agents may dissolve blood clots more rapidly than heparin and may reduce the death rate associated with PE. However, there are still concerns about the possible risk of adverse effects of thrombolytic therapy, such as major or minor haemorrhage. This is the third update of the Cochrane review first published in 2006. OBJECTIVES: To assess the effects of thrombolytic therapy for acute pulmonary embolism. SEARCH METHODS: The Cochrane Vasc...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Abstract Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially fatal disease, which may occur as a rare complication after acute pulmonary embolism, although the exact epidemiology of CTEPH is unknown. The mechanisms involved in nonresolution of thrombotic material and scarring of large and/or small pulmonary arteries are unknown; some risk factors have been identified. To date, CTEPH is still underdiagnosed and undertreated. The cardinal symptom of CTEPH is dyspnoea on exertion, but diagnosis is challenging owing to nonspecific symptoms. Right heart catheterisation is mandatory for the diagnosis ...
Source: Swiss Medical Weekly - Category: General Medicine Authors: Tags: Swiss Med Wkly Source Type: research
​BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; &AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and it...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Aims: Ventilation/perfusion (V/Q) scan is recommended to exclude chronic thromboembolic pulmonary hypertension (CTEPH) in the diagnostic algorithm of PH. Difference in value of planar V/Q and V/Q SPECT for CTEPH for diagnosing CTEPH is not clear. We aimed to prospectively compare the diagnostic performance of planar V/Q and V/Q SPECT combined with lose-dose CT (LDCT) using pulmonary angiography as gold standard.Methods: Consecutive patients with suspected PH were referred to perform V/Q scan. PH due to left heart diseases or lung diseases were excluded. 285 patients underwent planar V/Q and V/Q SPECT combined with LDCT. Pa...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Imaging Source Type: research
Authors: Minatsuki S, Hatano M, Kiyosue A, Saito A, Maki H, Takimoto E, Komuro I Abstract Riociguat, a soluble guanylate cyclase stimulator, induces pulmonary artery dilatation through blood flow and is effective in treating chronic thromboembolic pulmonary hypertension (CTEPH). There are two types of vasculopathies in CTEPH based upon its location, in other words, proximal or distal to the thrombus-medicated obstruction. Distal vasculopathy is characterized by intrapulmonary shunts due to diminished blood flow. While other therapeutic interventions for CTEPH including pulmonary endarterectomy and balloon pulmonary...
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research
Conclusion: CTEPH was uncommon in our institute, with an underuse of the standard test. Suboptimal diagnosis assessment and management remain critical problems. Developing a properly trained CTEPH care team would improve patient outcomes, but cost/resources may be prohibitive for such a relatively rare disease. Trial Registration: TCTR20180220008 registered February 19, 2018.
Source: Lung India - Category: Respiratory Medicine Authors: Source Type: research
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