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Black blood MRI has diagnostic and prognostic value in the assessment of patients with pulmonary hypertension

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Double inversion recovery (DIR) “black blood” MRI suppresses the signal from flowing blood, slow flowing blood causes incomplete suppression resulting in pulmonary blood flow artefact (PFA). This study examines the diagnostic utility and prognostic value of a PFA scoring system in a mixed cohort of patients with pulmonary hypertension (PH).

Methods

DIR-MRI images were reviewed for 233 patients referred with suspected PH who underwent right heart catheterisation (RHC) within 48 h of MR. The degree of PFA was visually scored in all patients from 0 to 5 (0 = absent, 1 = segmental, 2 = lobar, 3 = distal main, 4 = proximal main and 5 = trunk). Pulmonary artery (PA), aorta (Ao), and PA main branch diameters were measured from which PA/Ao ratios and mean PA branch diameters (MPAB) were calculated.

Results

PFA >1 demonstrated high sensitivity (86%) and specificity (85%) for the diagnosis PH in our mixed patient cohort. A good correlation was found with PFA and haemodynamic parameters, PVR (r = 0.70), mPAP (r = 0.65) and CI (r = −0.53). PFA predicted mortality (P = 0.005) during the mean follow-up for 19 months. PFA scoring demonstrated good inter-observer agreement (k = 0.83).

Conclusions

PFA scoring is of diagnostic and prognostic value in the assessment of patients with suspected PH. and is a predictor of mortality.

Key Points

• A simple magnetic resonance method of assessing pulmonary blood flow is presented

• This involves a qualitative scoring system of black blood pulmonary flow artefacts

• This is simple to perform and seems reproducible in pulmonary hypertension patients

• The degree of artefact correlates well with right heart catheter measurements

• Prominent pulmonary flow artefact predicts mortality in patients with pulmonary hypertension

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Acknowledgements

A.J.S., H.M., R.C., C.E., J.M.W. and D.G.K. received funding from the National Institute for Health Research (NIHR) via its Biomedical Research Units funding scheme. H.M. and J.M.W. are also funded by the Engineering and Physical Sciences Research Council (EPSRC). D.C. receives funding from Bayer Schering, S.R. from Pfizer and J.H. from Actelion Pharmaceuticals.

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Authors and Affiliations

  1. National Institute of Health Research, Cardiovascular Biomedical Research Unit, Sheffield, UK

    Andrew J. Swift, Helen Marshall, Robin Condliffe, Charlie A. Elliot, Jim M. Wild & David G. Kiely

  2. Academic Unit of Radiology, University of Sheffield, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2J, UK

    Andrew J. Swift, Smitha Rajaram, Helen Marshall, Dave Capener & Jim M. Wild

  3. Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    Robin Condliffe, Judith Hurdman, Charlie A. Elliot & David G. Kiely

  4. Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    Catherine Hill & Christine Davies

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  1. Andrew J. Swift
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Correspondence to Andrew J. Swift.

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Swift, A.J., Rajaram, S., Marshall, H. et al. Black blood MRI has diagnostic and prognostic value in the assessment of patients with pulmonary hypertension. Eur Radiol 22, 695–702 (2012). https://doi.org/10.1007/s00330-011-2306-0

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  • DOI: https://doi.org/10.1007/s00330-011-2306-0

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