Abstract
PurposeTo assess the diagnostic accuracy of magnetic resonance imaging (MRI) perfusion against perfusion single photon emission tomography (SPECT) screening for chronic thromboembolic pulmonary hypertension (CTEPH). Ventilation/perfusion (V/Q) scintigraphy is recommended to screen for suspected CTEPH. It has previously been shown that 3D dynamic contrast‐enhanced (DCE) lung perfusion MRI has a similar sensitivity for diagnosing CTEPH in comparison to planar perfusion scintigraphy; however, planar scintigraphy has now been largely replaced by SPECT, due to higher spatial resolution and sensitivity.Materials and MethodsConsecutive patients with suspected CTEPH or unexplained pulmonary hypertension attending a referral center, who underwent lung DCE perfusion MRI at 1.5T, perfusion SPECT, and computed tomography pulmonary angiography (CTPA) within 14 days of right heart catheterization, from April 2013 to April 2014, were included. DCE‐MR, SPECT, and CTPA were independently analyzed by two blinded radiologists. Disagreements were corrected by consensus. The gold standard reference for the diagnosis of chronic thromboemboli was based on a review of multimodality imaging and clinical findings.ResultsIn all, 74 patients with suspected CTEPH underwent all three modalities. Forty‐six were diagnosed with CTEPH (36) or chronic thromboembolic disease (CTED) (10). 3D DCE perfusion MRI correctly identified all patients (sensitivity of 100%), compared with a 97% sensitivity for SPECT.ConclusionDCE lung perfusion MRI has increased sensitivity when compared with perfusion scintigraphy in screening for CTEPH. As MRI does not use ionizing radiation, it should be considered as a first‐line imaging modality in suspected CTEPH. Level of Evidence: 3 Technical Efficacy: Stage 3J. Magn. Reson. Imaging 2017;46:1693–1697.
Highlights
Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable form of pulmonary hypertension (PH).[1]
Patients with CTEPH usually have a history of either pulmonary embolism or deep venous thrombosis, a significant proportion may present with unexplained breathlessness or pulmonary hypertension of unknown cause.[6,7]
The patient not identified by single photon emission computed tomography (SPECT) had mild, inoperable CTEPH, and was correctly identified on computed tomography pulmonary angiography (CTPA) and perfusion magnetic resonance imaging (MRI)
Summary
Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable form of pulmonary hypertension (PH).[1]. Patients with CTEPH usually have a history of either pulmonary embolism or deep venous thrombosis, a significant proportion may present with unexplained breathlessness or pulmonary hypertension of unknown cause.[6,7] It is important that the diagnosis of CTEPH is made, as pulmonary. VC 2017 The Authors Journal of Magnetic Resonance Imaging published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine 1693
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