Lung

pp 1–7 | Cite as

Multiparametric Magnetic Resonance Imaging in the Assessment of Pulmonary Hypertension: Initial Experience of a One-Stop Study

  • Gisela M. B. Meyer
  • Fernanda B. Spilimbergo
  • Stephan Atmayer
  • Gabriel S. Pacini
  • Matheus Zanon
  • Guilherme Watte
  • Edson Marchiori
  • Bruno Hochhegger
Pulmonary Hypertension

Abstract

Introduction

Our goal was to assess the diagnostic performance of magnetic resonance imaging (MRI) as a single method to diagnose pulmonary hypertension (PH) compared to right heart catheterization (RHC), computed tomography (CT), and ventilation/perfusion (V/Q) scintigraphy.

Methods

We identified 35 patients diagnosed with PH by RHC in our institution who have also undergone a CT, a scintigraphy, and an MRI within a month. All cases were discussed in multidisciplinary meetings. We performed correlations between the MRI-derived hemodynamic parameters and those from RHC. The sensitivity and specificity of MRI were determined to identify its diagnostic performance to identify chronic thromboembolic pulmonary hypertension (CTEPH) and interstitial lung disease PH. The gold standard reference for the diagnosis of CTEPH and ILD was based on a review of multimodality imaging (V/Q scintigraphy and CT scan) and clinical findings.

Results

Our results showed a good correlation between the hemodynamic parameters of cardiac MRI and RHC. Pulmonary vascular resistance had the best correlation between both methods (r = 0.923). The sensitivity and specificity of MRI to diagnose CTEPH was 100 and 96.8%, respectively. For the ILD-related PH, the MRI yielded a sensitivity of 60.0% and a specificity of 100%. Additionally, cardiac MRI was able to confirm all cases of PAH due to congenital heart disease initially detected by echocardiography.

Conclusions

MRI represents a promising imaging modality as an initial, single-shot study, for patients with suspected PH with the advantages of being non-invasive and having no radiation exposure.

Keywords

Pulmonary hypertension Magnetic resonance imaging Right heath catheterization Computed tomography Lung scintigraphy 

Notes

Acknowledgements

The authors thank Dr. Yuchi Han for her scientific contribution to improve this manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Galiè N, Humbert M, Vachiery JL et al (2016) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 37:67–119CrossRefPubMedGoogle Scholar
  2. 2.
    Kovacs MJ, Rodger M, Anderson DR et al (2003) Comparison of 10-mg and 5-mg Warfarin initiation nomograms together with low-molecular-weight heparin for outpatient treatment of acute venous thromboembolism: a randomized, double-blind, controlled trial. Ann Intern Med 138:714–719CrossRefPubMedGoogle Scholar
  3. 3.
    Bane O, Shah SJ, Cuttica MJ et al (2015) A non-invasive assessment of cardiopulmonary hemodynamics with MRI in pulmonary hypertension. Magn Reson Imaging 33:1224–1235CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Rajaram S, Swift AJ, Capener D et al (2012) Comparison of the diagnostic utility of cardiac magnetic resonance imaging, computed tomography, and echocardiography in assessment of suspected pulmonary arterial hypertension in patients with connective tissue disease. J Rheumatol 39:1265–1274CrossRefPubMedGoogle Scholar
  5. 5.
    Grünig E, Peacock AJ (2015) Imaging the heart in pulmonary hypertension: an update. Eur Respir Rev 24:653–664CrossRefPubMedGoogle Scholar
  6. 6.
    Swift AJ, Wild JM, Nagle SK et al (2014) Quantitative magnetic resonance imaging of pulmonary hypertension. J Thorac Imaging 29:68–79CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    D’Alonzo GE, Barst RJ, Ayres SM et al (1991) Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med 115:343–349CrossRefPubMedGoogle Scholar
  8. 8.
    Bradlow WM, Gibbs R, Mohiaddin JS RH (2012) Cardiovascular magnetic resonance in pulmonary hypertension. J Cardiovasc Magn Reson 14:6CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hoeper MM, Lee SH, Voswinckel R et al (2006) Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol 48:2546–2552CrossRefPubMedGoogle Scholar
  10. 10.
    Swift AJ, Rajaram S, Hurdman J et al (2013) Noninvasive estimation of PA pressure, flow, and resistance with CMR imaging. JACC Cardiovasc Imaging 6:1036–1047CrossRefPubMedGoogle Scholar
  11. 11.
    Johns CS, Swift AJ, Rajaram S et al (2017) Lung perfusion: MRI vs. SPECT for screening in suspected chronic thromboembolic pulmonary hypertension. J Magn Reson Imaging 46:1693–1697CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hochhegger B, Marchiori E, Irion K et al (2012) Magnetic resonance of the lung: a step forward in the study of lung disease. J Bras Pneumol 38:105–115CrossRefPubMedGoogle Scholar
  13. 13.
    The Criteria Committee of the New York Heart Association (1994) Nomenclature and criteria for diagnosis of diseases of the heart and great vessels, 9th edn. Little, Brown & Co; Boston, pp 253–256Google Scholar
  14. 14.
    Condliffe R, Kiely DG, Peacock AJ et al (2009) Connective tissue disease-associated pulmonary arterial hypertension in the modern treatment era. Am J Respir Crit Care Med 179:151–157CrossRefPubMedGoogle Scholar
  15. 15.
    Launay D (2007) Prevalence and characteristics of moderate to severe pulmonary hypertension in systemic sclerosis with and without interstitial lung disease. J Rheumatol 34:1005–1011PubMedGoogle Scholar
  16. 16.
    Travis WD, Costabel U, Hansell DM et al (2013) An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 188:733–748CrossRefPubMedGoogle Scholar
  17. 17.
    Hochhegger B, Ley-Zaporozhan J, Marchiori E et al (2011) Magnetic resonance imaging findings in acute pulmonary embolism. Br J Radiol 84:282–287CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Swift AJ, Wild JM, Nagle SK et al (2014) Quantitative magnetic resonance imaging of pulmonary hypertension: a practical approach to the current state of the art. J Thorac Imaging 29:68–79CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Hurdman J, Condliffe R, Elliot CA et al (2012) ASPIRE registry: assessing the spectrum of pulmonary hypertension identified at a referral centre. Eur Respir J 39:945–955CrossRefPubMedGoogle Scholar
  20. 20.
    Peacock AJ, Vonk Noordegraaf A (2013) Cardiac magnetic resonance imaging in pulmonary arterial hypertension. Eur Respir Rev 22:526–534CrossRefPubMedGoogle Scholar
  21. 21.
    Guo X, Liu M, Ma Z et al (2015) Assessing right ventricular function in patients with pulmonary hypertension based on noninvasive measurements: correlation between cardiac MRI, ultrasonic cardiogram, multidetector CT and right heart catheterization. J Cardiovasc Magn Reson 17:185CrossRefGoogle Scholar
  22. 22.
    Jardim C, Rochitte CE, Humbert M et al (2007) Pulmonary artery distensibility in pulmonary arterial hypertension: an MRI pilot study. Eur Respir J 29:476–481CrossRefPubMedGoogle Scholar
  23. 23.
    Ameli-Renani S, Rahman F, Nair A et al (2014) Dual-energy CT for imaging of pulmonary hypertension: challenges and opportunities. RadioGraphics 34:1769–1790CrossRefPubMedGoogle Scholar
  24. 24.
    Kovacs G, Reiter G, Reiter U et al (2008) The emerging role of magnetic resonance imaging in the diagnosis and management of pulmonary hypertension. Respiration 76:458–470CrossRefPubMedGoogle Scholar
  25. 25.
    McLure LE, Peacock AJ (2009) Cardiac magnetic resonance imaging for the assessment of the heart and pulmonary circulation in pulmonary hypertension. Eur Respir J 33:1454–1466CrossRefPubMedGoogle Scholar
  26. 26.
    Contijoch F, Witschey WRT, Rogers K et al (2015) User-initialized active contour segmentation and golden-angle real-time cardiovascular magnetic resonance enable accurate assessment of LV function in patients with sinus rhythm and arrhythmias. J Cardiovasc Magn Reson 17:37CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Contijoch F, Iyer SK, Pilla JJ et al (2017) Self-gated MRI of multiple beat morphologies in the presence of arrhythmias. Magn Reson Med 78:678–688CrossRefPubMedGoogle Scholar
  28. 28.
    Usman M, Atkinson D, Odille F et al (2013) Motion corrected compressed sensing for free-breathing dynamic cardiac MRI. Magn Reson Med 70:504–516CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Gisela M. B. Meyer
    • 1
  • Fernanda B. Spilimbergo
    • 1
  • Stephan Atmayer
    • 2
    • 3
    • 6
  • Gabriel S. Pacini
    • 2
    • 3
    • 6
  • Matheus Zanon
    • 2
    • 3
    • 6
  • Guilherme Watte
    • 4
    • 6
  • Edson Marchiori
    • 5
  • Bruno Hochhegger
    • 2
    • 3
    • 6
  1. 1.Pulmonary Hypertension GroupSanta Casa de Porto AlegrePorto AlegreBrazil
  2. 2.Federal University of Health Sciences of Porto AlegrePorto AlegreBrazil
  3. 3.Medical Imaging Research LaboratoryFederal University of Health Sciences of Porto AlegrePorto AlegreBrazil
  4. 4.Department of Respiratory Medicine and Thoracic SurgeryIrmandade da Santa Casa de Misericordia de Porto AlegrePorto AlegreBrazil
  5. 5.Federal University of Rio de JaneiroRio De JaneiroBrazil
  6. 6.LABIMED – Medical Imaging Research Lab, Department of Radiology, Pavilhão Pereira Filho HospitalIrmandade Santa Casa de Misericórdia de Porto AlegrePorto AlegreBrazil

Personalised recommendations