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Dara A, Arvanitaki A, Theodorakopoulou M, Athanasiou C, Pagkopoulou E, Boutou A. Non-Invasive Assessment of Endothelial Dysfunction in Pulmonary Arterial Hypertension. Mediterr J Rheumatol 2021; 32:6-14. [PMID: 34386697 PMCID: PMC8314877 DOI: 10.31138/mjr.32.1.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterised by an increased pressure in the pulmonary arterial circulation, resulting in the elevation of pulmonary vascular resistance. Pulmonary endothelial dysfunction and inflammation, triggered by shear stress and hypoxia, constitute the hallmarks of pulmonary vasculopathy by promoting endothelial and smooth muscle cells proliferation, vasoconstriction, and thrombosis. While research was predominantly focused on pulmonary vasculature, the investigation of peripheral endothelial damage in different vascular beds has attracted the interest over the last years. As a result, effective non-invasive methods that can assess the endothelial function and the architectural integrity have been utilized for the evaluation of pulmonary and peripheral vasculature. Non-invasive plethysmography, pulmonary flow reserve, nailfold videocapillaroscopy, near-infrared spectroscopy, and imaging techniques such as magnetic resonance angiography and perfusion imaging coupled by a number of biomarkers can be used for the assessment of peripheral vascular function in PAH individuals. In this review, we summarise and critically approach the current evidence of more systemic derangement of vascular function in PAH defined by novel, non-invasive methods employed for functional and morphological assessment of endothelium and microcirculation.
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Affiliation(s)
- Athanasia Dara
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Arvanitaki
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Adult Congenital Heart Centre and National Centre for Pulmonary Arterial Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Imperial College, London, UK
| | | | - Christos Athanasiou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Pagkopoulou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
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Leitman EM, McDermott S. Pulmonary arteries: imaging of pulmonary embolism and beyond. Cardiovasc Diagn Ther 2019; 9:S37-S58. [PMID: 31559153 DOI: 10.21037/cdt.2018.08.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The pulmonary arteries are not just affected by thrombus. Various acquired and congenital conditions can also affect the pulmonary arteries. In this review we discuss cross sectional imaging modalities utilized for the imaging of the pulmonary arteries. Acquired pulmonary artery entities, including pulmonary artery sarcoma (PAS), vasculitis, aneurysm, and arteriovenous malformations, and congenital anomalies in adults, including proximal interruption of the pulmonary artery, pulmonary sling, pulmonary artery stenosis, and idiopathic dilatation of the pulmonary trunk, are also discussed. An awareness of these entities and their imaging findings is important for radiologists interpreting chest imaging.
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Affiliation(s)
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
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3
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Abstract
Magnetic resonance (MR) angiography of the pulmonary arteries is a rapidly evolving technique with proven clinical usefulness. Multiple-step protocols, such as MR perfusion followed by high-spatial resolution MR angiography, seem to be a good approach for the assessment of different vascular diseases affecting the pulmonary arteries. In combination with other imaging sequences, MR imaging is one of the most comprehensive potential noninvasive imaging techniques available.
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Affiliation(s)
- Sebastian Ley
- Diagnostic and Interventional Radiology, Chirurgische Klinik Dr Rinecker, Am Isarkanal 30, Munich 81379, Germany; Department of Clinical Radiology, Ludwig Maximilians University, Marchioninistrasse 15, Munich 81377, Germany.
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Blankholm AD, Ringgaard S. Non-contrast-enhanced magnetic resonance angiography: techniques and applications. Expert Rev Cardiovasc Ther 2014; 10:75-88. [DOI: 10.1586/erc.11.176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hochhegger B, Marchiori E, Irion K, Souza AS, Volkart J, Rubin AS. Magnetic resonance of the lung: a step forward in the study of lung disease. J Bras Pneumol 2012; 38:105-15. [PMID: 22407047 DOI: 10.1590/s1806-37132012000100015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 11/03/2011] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance imaging (MRI) of the lung has progressed tremendously in recent years. Because of improvements in speed and image quality, MRI is now ready for routine clinical use. The main advantage of MRI of the lung is its unique combination of structural and functional assessment in a single imaging session. We review the three major clinical indications for MRI of the lung: staging of lung tumors; evaluation of pulmonary vascular disease; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.
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Affiliation(s)
- Bruno Hochhegger
- Departamento de Pneumologia, Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brasil
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Shah DJ, Lim TH. Evaluation of meglumine gadoterate-enhanced MR angiography (MRA) compared with time-of-flight MRA in the diagnosis of clinically significant non-coronary arterial disease: a pooled analysis of data from two clinical trials. Br J Radiol 2011; 85:596-605. [PMID: 22167518 DOI: 10.1259/bjr/16406056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We analysed pooled data from two clinical trials to assess the diagnostic accuracy and safety of meglumine gadoterate (Gd-DOTA)-enhanced MR angiography (MRA) relative to those of non-enhanced time-of-flight (TOF) MRA for non-coronary arterial disease. Both techniques were compared with X-ray angiography as the gold standard. METHODS Patients were of both sexes, were aged at least 18 years and had suspected non-coronary arterial disease. Each patient was his/her own control and underwent TOF MRA followed by Gd-DOTA-enhanced MRA, and then X-ray angiography. MRA was performed at 1.5 T (USA study) or 3 T (Republic of Korea study). The primary criterion used to evaluate efficacy was the degree to which the MRA examination agreed with X-ray angiography in assessing non-coronary arterial lesions. The performance of Gd-DOTA over TOF was assessed using a one-sided paired t-test. We also evaluated the specificity, sensitivity, image quality, examination duration and clinical safety of both MRA procedures. RESULTS In total, 192 patients were enrolled and received Gd-DOTA. In the intent-to-treat population (n=162), within-patient accuracy was significantly greater for Gd-DOTA than for TOF (85.8 ± 19.8% agreement between Gd-DOTA and X-ray angiography compared with 78.3 ± 24.9% agreement between TOF and X-ray angiography; p=0.0001). The sensitivity, specificity, image quality and examination duration were also better for Gd-DOTA than for TOF. There were no serious drug-related adverse events. CONCLUSION We conclude that Gd-DOTA-enhanced MRA is a safe and accurate procedure for detecting arterial stenosis at both 1.5 T and 3 T.
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Affiliation(s)
- D J Shah
- Cardiac Magnetic Resonance Imaging, Weill Cornell Medical College, The Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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Guillerman RP. Newer CT applications and their alternatives: what is appropriate in children? Pediatr Radiol 2011; 41 Suppl 2:534-48. [PMID: 21847736 DOI: 10.1007/s00247-011-2163-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 05/18/2011] [Accepted: 05/25/2011] [Indexed: 12/20/2022]
Abstract
Innovations in image acquisition and reconstruction technologies have greatly expanded the range of CT applications available in the routine clinical setting. CT images of sub-millimeter resolution can now be acquired of entire body regions in a few seconds or even sub-second time, allowing depiction of fine anatomical detail uncompromised by motion artifact. With sophisticated visualization software, image data can be processed into multiplanar, volume-rendered, cine and other formats to better display anatomical abnormalities and facilitate newer applications such as CT angiography, enterography, urography, tracheobronchography and cardiac CT. Newer applications including dual-energy material decomposition CT are furthering the transition of CT from a purely morphological to a combined anatomical, functional and metabolic imaging technique. These newer applications have largely been pioneered in adult populations, and heightened concern of the risk of carcinogenesis from ionizing radiation tempers dissemination of their use in children. Similar information can often be gleaned from alternative imaging modalities without ionizing radiation exposure, such as MRI and US, and what is most appropriate in children will depend on relative diagnostic efficacy, cost, availability and local expertise.
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Affiliation(s)
- R Paul Guillerman
- Department of Pediatric Radiology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030, USA.
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Urgent findings on portable chest radiography: what the radiologist should know--review. AJR Am J Roentgenol 2011; 196:S45-61. [PMID: 21606235 DOI: 10.2214/ajr.09.7170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Jeong HJ, Vakil P, Sheehan JJ, Shah SJ, Cuttica M, Carr JC, Carroll TJ, Davarpanah A. Time-resolved magnetic resonance angiography: evaluation of intrapulmonary circulation parameters in pulmonary arterial hypertension. J Magn Reson Imaging 2011; 33:225-31. [PMID: 21182144 DOI: 10.1002/jmri.22428] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To determine whether pulmonary arterial and venous transit times measured by time-resolved magnetic resonance angiography (MRA) can be used as a diagnostic tool for pulmonary arterial hypertension (PAH). MATERIALS AND METHODS Twelve patients with confirmed PAH and 10 healthy volunteers were scanned with Institutional Review Board (IRB) approval. Time-resolved MRA and 2D phase contrast flow images of the pulmonary vasculature were acquired. Pulmonary arterial and venous transit times (PaTT and PvTT) and pulmonary valve flow (PVF) were obtained. Pulmonary arterial and pulmonary venous blood volumes (PaBV and PvBV) were calculated as the product of flow and transit time. RESULTS Patients with PAH showed statistically significant increases in PaTT and PvTT (P < 0.0004, P < 0.05, respectively) compared to controls. PaBV (165.2 ± 92.0 mL) was significantly higher in PAH subjects than controls (97.0 ± 47.1 mL) (P < 0.04), whereas PvBV (127.9 ± 148.9 mL) of PAH subjects had no significant increase from those of healthy controls (142.5 ± 104.1 mL) (P < 0.38). CONCLUSION Pulmonary arterial transit times measured using time-resolved MRA can be used as a simple, noninvasive metric for detection of altered hemodynamics in PAH.
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Affiliation(s)
- Hyun J Jeong
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
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van Langevelde K, Tan M, Srámek A, Huisman MV, de Roos A. Magnetic resonance imaging and computed tomography developments in imaging of venous thromboembolism. J Magn Reson Imaging 2011; 32:1302-12. [PMID: 21105136 DOI: 10.1002/jmri.22379] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Venous thromboembolism (VTE) is a disease that causes high morbidity and mortality in the population. At present the first-line imaging test for a suspected pulmonary embolism (PE) is computed tomography (CT) pulmonary angiography, and ultrasonography is widely used for the diagnosis of deep-vein thrombosis (DVT). Although these modalities are proven to be safe and accurate, unresolved issues remain, such as whether CT scanning in patients with a suspected PE should be extended to the legs. Another issue is the diagnosis of recurrent DVT. Magnetic resonance imaging (MRI) offers a number of advantages in the imaging of VTE. Recent developments of scanning protocols with shorter acquisition times, sometimes complemented by navigator gating or making use of endogenous contrast, offer new perspectives for the use of MRI. This review provides an overview of state of the art MRI techniques for the diagnosis of PE and DVT. Furthermore, the use of new contrast agents such as fibrin labeling to detect thrombi are addressed.
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Affiliation(s)
- Kirsten van Langevelde
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
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Ley S, Grünig E, Kiely DG, van Beek E, Wild J. Computed tomography and magnetic resonance imaging of pulmonary hypertension: Pulmonary vessels and right ventricle. J Magn Reson Imaging 2011; 32:1313-24. [PMID: 21105137 DOI: 10.1002/jmri.22373] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pulmonary hypertension (PH) is very heterogeneous and the classification identifies five major groups including many associated disease processes. The treatment of PH depends on the underlying cause and accurate classification is paramount. A comprehensive assessment to identify the cause and severity of PH is therefore needed. Furthermore, follow-up assessments are required to monitor changes in disease status and response to therapy. Traditionally, the diagnostic imaging work-up of PH comprised mainly echocardiography, invasive right heart catheterization, and ventilation/perfusion scintigraphy. Due to technical advances, multidetector row computed tomography (CT) and magnetic resonance imaging (MRI) have become important and complementary investigations in the evaluation of patients with suspected PH. Both modalities are reviewed and recommendations for clinical use are given.
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Affiliation(s)
- Sebastian Ley
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
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Imaging in Pulmonary Hypertension. JACC Cardiovasc Imaging 2010; 3:1287-95. [DOI: 10.1016/j.jcmg.2010.09.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 08/26/2010] [Accepted: 09/17/2010] [Indexed: 11/21/2022]
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Chen SC, Liu WC, Lee CH, Chang JM, Chen HC. Nephrotic syndrome complicated by life-threatening pulmonary embolism in an adult patient. Kaohsiung J Med Sci 2010; 26:89-95. [PMID: 20123597 DOI: 10.1016/s1607-551x(10)70013-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We report a 23-year-old male presenting with edema. He was originally admitted for an elective renal biopsy for diagnosis of renal pathology. Unfortunately, because of acute abdominal pain an exploratory laparotomy was done. Progressive azotemia and oliguria then developed, and he required temporary hemodialysis. However, he suffered from sudden-onset severe respiratory distress, and blood gas analysis showed profound hypoxemia with a marked arterial-alveolar oxygen difference. Assessment of a pulmonary embolism by radioisotope imaging was not possible because of his dependence on mechanical ventilation. Subcutaneous low molecular weight heparin and intravenous methylprednisolone were given to treat the presumed pulmonary embolism and the underlying nephrotic syndrome. His partial oxygen level gradually increased after continuous heparin and steroid administration. Complete obliteration of one major pulmonary artery and partial obliteration of other smaller arteries were revealed by magnetic resonance angiography. He was discharged and followed-up as an outpatient, and was given oral warfarin and prednisolone. Follow-up magnetic resonance angiography 5 months later showed a normal pulmonary tree with no residual lesions.
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Affiliation(s)
- Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
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15
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New insights for the diagnosis and management of right ventricular failure, from molecular imaging to targeted right ventricular therapy. Curr Opin Cardiol 2010; 25:131-40. [DOI: 10.1097/hco.0b013e328335febd] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Ge RL, Ru-yan M, Hai-hua B, Xi-peng Z, Hai-ning Q. Changes of Cardiac Structure and Function in Pediatric Patients with High Altitude Pulmonary Hypertension in Tibet. High Alt Med Biol 2009; 10:247-52. [PMID: 19775214 DOI: 10.1089/ham.2009.0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ri-Li Ge
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, P.R. China
| | - Ma Ru-yan
- Department of Cardiology, Qinghai Provincial Women's and Children's Hospital, Xining, Qinghai, P.R. China
| | - Bao Hai-hua
- Department of MRI, Affiliated Hospital of Qinghai University, Xining, 810000, Qinghai, P.R. China
| | - Zhao Xi-peng
- Department of MRI, Affiliated Hospital of Qinghai University, Xining, 810000, Qinghai, P.R. China
| | - Qi Hai-ning
- Department of Cardiology, Qinghai Provincial Women's and Children's Hospital, Xining, Qinghai, P.R. China
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