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Moore J, Altschul E, Remy-Jardin M, Raoof S. Chronic Thromboembolic Pulmonary Hypertension: Clinical and Imaging Evaluation. Clin Chest Med 2024; 45:405-418. [PMID: 38816096 DOI: 10.1016/j.ccm.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism and is an important cause of pulmonary hypertension. As a clinical entity, it is frequently underdiagnosed with prolonged diagnostic delays. This study reviews the clinical and radiographic findings associated with CTEPH to improve awareness and recognition. Strengths and limitations of multiple imaging modalities are reviewed. Accompanying images are provided to supplement the text and provide examples of important findings for the reader.
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Affiliation(s)
- Jonathan Moore
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY, USA
| | - Erica Altschul
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY, USA
| | - Martine Remy-Jardin
- Department of Thoracic Imaging, Univ.Lille, CHU Lille, LILLE F-59000, France; Univ.Lille, CHU Lille, ULR 2694 METRICS Evaluation des Technologies de Santé et des Pratiques Médicales, LILLE F-59000, France
| | - Suhail Raoof
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY, USA.
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2
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Oknińska M, Zajda K, Zambrowska Z, Grzanka M, Paterek A, Mackiewicz U, Szczylik C, Kurzyna M, Piekiełko-Witkowska A, Torbicki A, Kieda C, Mączewski M. Role of Oxygen Starvation in Right Ventricular Decompensation and Failure in Pulmonary Arterial Hypertension. JACC. HEART FAILURE 2024; 12:235-247. [PMID: 37140511 DOI: 10.1016/j.jchf.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 02/22/2023] [Accepted: 03/16/2023] [Indexed: 05/05/2023]
Abstract
Right ventricular (RV) function and eventually failure determine outcome in patients with pulmonary arterial hypertension (PAH). Initially, RV responds to an increased load caused by PAH with adaptive hypertrophy; however, eventually RV failure ensues. Unfortunately, it is unclear what causes the transition from compensated RV hypertrophy to decompensated RV failure. Moreover, at present, there are no therapies for RV failure; those for left ventricular (LV) failure are ineffective, and no therapies specifically targeting RV are available. Thus there is a clear need for understanding the biology of RV failure and differences in physiology and pathophysiology between RV and LV that can ultimately lead to development of such therapies. In this paper, we discuss RV adaptation and maladaptation in PAH, with a particular focus of oxygen delivery and hypoxia as the principal drivers of RV hypertrophy and failure, and attempt to pinpoint potential sites for therapy.
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Affiliation(s)
- Marta Oknińska
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Karolina Zajda
- Laboratory of Molecular Oncology and Innovative Therapies, Military Medical Institute, Warsaw, Poland
| | - Zuzanna Zambrowska
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Małgorzata Grzanka
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Aleksandra Paterek
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Urszula Mackiewicz
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Cezary Szczylik
- Department of Oncology at ECZ-Otwock, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at ECZ-Otwock, ERN-LUNG Member, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at ECZ-Otwock, ERN-LUNG Member, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Claudine Kieda
- Laboratory of Molecular Oncology and Innovative Therapies, Military Medical Institute, Warsaw, Poland; Centre for Molecular Biophysics, UPR, CNRS 4301, Orléans CEDEX 2, France; Department of Molecular and Translational Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Mączewski
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Warsaw, Poland.
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Bartnik A, Pepke-Zaba J, Bunclark K, Ruggiero A, Jenkins D, Taghavi J, Tsui S, Screaton N, D'Errico L, Weir-McCall J. Cardiac MRI in the assessment of chronic thromboembolic pulmonary hypertension and response to treatment. Thorax 2023; 79:90-97. [PMID: 38050117 DOI: 10.1136/thorax-2022-219716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/31/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Aleksandra Bartnik
- Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
- Radiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
- Radiology, University of Cambridge, Cambridge, UK
| | | | | | | | - D Jenkins
- Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - J Taghavi
- Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Steven Tsui
- Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | | | - L D'Errico
- Radiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Jonathan Weir-McCall
- Radiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
- Radiology, University of Cambridge, Cambridge, UK
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4
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Lacharie M, Villa A, Milidonis X, Hasaneen H, Chiribiri A, Benedetti G. Role of pulmonary perfusion magnetic resonance imaging for the diagnosis of pulmonary hypertension: A review. World J Radiol 2023; 15:256-273. [PMID: 37823020 PMCID: PMC10563854 DOI: 10.4329/wjr.v15.i9.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023] Open
Abstract
Among five types of pulmonary hypertension, chronic thromboembolic pulmonary hypertension (CTEPH) is the only curable form, but prompt and accurate diagnosis can be challenging. Computed tomography and nuclear medicine-based techniques are standard imaging modalities to non-invasively diagnose CTEPH, however these are limited by radiation exposure, subjective qualitative bias, and lack of cardiac functional assessment. This review aims to assess the methodology, diagnostic accuracy of pulmonary perfusion imaging in the current literature and discuss its advantages, limitations and future research scope.
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Affiliation(s)
- Miriam Lacharie
- Oxford Centre of Magnetic Resonance Imaging, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Adriana Villa
- Department of Diagnostic and Interventional Radiology, German Oncology Centre, Limassol 4108, Cyprus
| | - Xenios Milidonis
- Deep Camera MRG, CYENS Centre of Excellence, Nicosia, Cyprus, Nicosia 1016, Cyprus
| | - Hadeer Hasaneen
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Kings Coll London, Div Imaging Sci, St Thomas Hospital, London WC2R 2LS, United Kingdom
| | - Giulia Benedetti
- Department of Cardiovascular Imaging and Biomedical Engineering, King’s College London, London WC2R 2LS, United Kingdom
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5
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Edwards L, Waterton JC, Naish J, Short C, Semple T, Jm Parker G, Tibiletti M. Imaging human lung perfusion with contrast media: A meta-analysis. Eur J Radiol 2023; 164:110850. [PMID: 37178490 DOI: 10.1016/j.ejrad.2023.110850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To pool and summarise published data of pulmonary blood flow (PBF), pulmonary blood volume (PBV) and mean transit time (MTT) of the human lung, obtained with perfusion MRI or CT to provide reliable reference values of healthy lung tissue. In addition, the available data regarding diseased lung was investigated. METHODS PubMed was systematically searched to identify studies that quantified PBF/PBV/MTT in the human lung by injection of contrast agent, imaged by MRI or CT. Only data analysed by 'indicator dilution theory' were considered numerically. Weighted mean (wM), weighted standard deviation (wSD) and weighted coefficient of variance (wCoV) were obtained for healthy volunteers (HV), weighted according to the size of the datasets. Signal to concentration conversion method, breath holding method and presence of 'pre-bolus' were noted. RESULTS PBV was obtained from 313 measurements from 14 publications (wM: 13.97 ml/100 ml, wSD: 4.21 ml/100 ml, wCoV 0.30). MTT was obtained from 188 measurements from 10 publications (wM: 5.91 s, wSD: 1.84 s wCoV 0.31). PBF was obtained from 349 measurements from 14 publications (wM: 246.26 ml/100 ml ml/min, wSD: 93.13 ml/100 ml ml/min, wCoV 0.38). PBV and PBF were higher when the signal was normalised than when it was not. No significant differences were found for PBV and PBF between breathing states or between pre-bolus and no pre-bolus. Data for diseased lung were insufficient for meta-analysis. CONCLUSION Reference values for PBF, MTT and PBV were obtained in HV. The literature data are insufficient to draw strong conclusions regarding disease reference values.
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Affiliation(s)
- Lucy Edwards
- Bioxydyn Limited, St James Tower, 7 Charlotte Street, Manchester, M1 4DZ, UK
| | - John C Waterton
- Bioxydyn Limited, St James Tower, 7 Charlotte Street, Manchester, M1 4DZ, UK; Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - Josephine Naish
- Bioxydyn Limited, St James Tower, 7 Charlotte Street, Manchester, M1 4DZ, UK; MCMR, Manchester University NHS Foundation Trust, Wythenshawe, Manchester, UK
| | - Christopher Short
- ECFS CTN - LCI Core Facility, Imperial College London, London, UK; Departments of Imaging, Royal Brompton Hospital, Sydney Street, London SW3 6NP, London, UK
| | - Thomas Semple
- Department of Radiology, The Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Geoff Jm Parker
- Bioxydyn Limited, St James Tower, 7 Charlotte Street, Manchester, M1 4DZ, UK; Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
| | - Marta Tibiletti
- Bioxydyn Limited, St James Tower, 7 Charlotte Street, Manchester, M1 4DZ, UK
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Zhang X, Guo X, Zhang B, Yang Q, Gong J, Yang S, Li J, Kuang T, Miao R, Yang Y. The Role of Strain by Cardiac Magnetic Resonance Imaging in Predicting the Prognosis of Patients with Chronic Thromboembolic Pulmonary Hypertension. Clin Appl Thromb Hemost 2023; 29:10760296231176253. [PMID: 37700697 PMCID: PMC10501068 DOI: 10.1177/10760296231176253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 09/14/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by thrombotic obstruction of the pulmonary arteries, and right ventricular (RV) dysfunction is a major cause of death. Cardiac magnetic resonance (CMR) is the gold standard for assessing heart wall deformation; therefore, we aimed to determine the prognostic value of CMR strain in patients with CTEPH. Strain derived by CMR was measured at the time of diagnosis in 45 patients with CTEPH, and the relationship between RV strain and prognosis was determined through follow-up. The value of RV strain in the prognostic model was compared with that of pulmonary arterial hypertension (PAH) risk stratification. The RV global peak longitudinal strain (GLS) and global peak circumferential strain (GCS) in CTEPH patients were lower than the normal references of RV strain in the control group. GLS and longitudinal strain in the basal segment were independent risk factors for adverse events (P < .050). Adding CMR parameters to PAH risk stratification improved its predictive power in patients with CTEPH. GLS and GCS scores were impaired in patients with chronic RV overload. RV strain derived by CMR imaging is a promising noninvasive tool for the follow-up of patients with CTEPH.
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Affiliation(s)
- Xuefei Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Xiaojuan Guo
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Bowen Zhang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Qi Yang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Juanni Gong
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Suqiao Yang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Jifeng Li
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Tuguang Kuang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Ran Miao
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Yuanhua Yang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
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7
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Nishiyama A, Kawata N, Yokota H, Hayano K, Matsuoka S, Shigeta A, Sugiura T, Tanabe N, Ishida K, Tatsumi K, Suzuki T, Uno T. Heterogeneity of Lung Density in Patients With Chronic Thromboembolic Pulmonary Hypertension (CTEPH). Acad Radiol 2022; 29:e229-e239. [PMID: 35466051 DOI: 10.1016/j.acra.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES Pulmonary endarterectomy (PEA) is one of the most effective treatments for chronic thromboembolic pulmonary hypertension (CTEPH). Right heart catheterization (RHC) is the gold standard assessment for pulmonary circulatory dynamics. However, computed tomography (CT) is less invasive than RHC and can elucidate some of the morphological changes caused by thromboembolism. We hypothesized that CT could facilitate the evaluation of heterogeneous pulmonary perfusion. This study investigated whether CT imaging features reflect the disease severity and changes in pulmonary circulatory dynamics in patients with CTEPH before and after PEA. MATERIALS AND METHODS This retrospective study included 58 patients with CTEPH who underwent PEA. Pre-PEA and post-PEA CT images were assessed for heterogeneity using CT texture analysis (CTTA). The CT parameters were compared with the results of the RHC and other clinical indices and analyzed with receiver operating characteristic curves analysis for patients with and without residual pulmonary hypertension (PH) (post-PEA mean pulmonary artery pressure ≥ 25 mmHg). RESULTS CT measurements reflecting heterogeneity were significantly correlated with mean pulmonary artery pressure. Kurtosis, skewness, and uniformity were significantly lower, and entropy was significantly higher in patients with residual PH than patients without residual PH. Area under the curve values of pre-PEA and post-PEA entropy between patients with and without residual PH were 0.71 (95% confidence interval 0.57-0.84) and 0.75 (0.63-0.88), respectively. CONCLUSION Heterogeneity of lung density might reflect pulmonary circulatory dynamics, and CTTA for heterogeneity could be a less invasive technique for evaluation of changes in pulmonary circulatory dynamics in patients with CTEPH undergoing PEA.
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Affiliation(s)
- Akira Nishiyama
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan.
| | - Naoko Kawata
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Hajime Yokota
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Koichi Hayano
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Shin Matsuoka
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Ayako Shigeta
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Toshihiko Sugiura
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Nobuhiko Tanabe
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Keiichi Ishida
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Koichiro Tatsumi
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Takuji Suzuki
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Takashi Uno
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
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8
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Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed, but potentially curable pulmonary vascular disease. The increased pulmonary vascular resistance in CTEPH is caused by unresolved proximal thrombus and secondary microvasculopathy in the pulmonary vasculature, leading to adaptive and maladaptive remodeling of the right ventricle (RV), eventual right heart failure, and death. Knowledge on the RV remodeling process in CTEPH is limited. The progression to RV failure in CTEPH is a markedly slower process. A detailed understanding of the pathophysiology and underlying mechanisms of RV remodeling may facilitate early diagnosis and the development of targeted therapy. While ultrasound, magnetic resonance imaging, right heart catheterization, and serum biomarkers have been used to assess cardiac function, the current treatment strategies reduce the afterload of the right heart, but are less effective in improving the maladaptive remodeling of the right heart. This review systematically summarizes the current knowledge on adaptive and maladaptive remodeling of the right heart in CTEPH from molecular mechanisms to clinical practice.
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9
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Saunders LC, Hughes PJC, Alabed S, Capener DJ, Marshall H, Vogel-Claussen J, van Beek EJR, Kiely DG, Swift AJ, Wild JM. Integrated Cardiopulmonary MRI Assessment of Pulmonary Hypertension. J Magn Reson Imaging 2022; 55:633-652. [PMID: 34350655 DOI: 10.1002/jmri.27849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/12/2022] Open
Abstract
Pulmonary hypertension (PH) is a heterogeneous condition that can affect the lung parenchyma, pulmonary vasculature, and cardiac chambers. Accurate diagnosis often requires multiple complex assessments of the cardiac and pulmonary systems. MRI is able to comprehensively assess cardiac structure and function, as well as lung parenchymal, pulmonary vascular, and functional lung changes. Therefore, MRI has the potential to provide an integrated functional and structural assessment of the cardiopulmonary system in a single exam. Cardiac MRI is used in the assessment of PH in most large PH centers, whereas lung MRI is an emerging technique in patients with PH. This article reviews the current literature on cardiopulmonary MRI in PH, including cine MRI, black-blood imaging, late gadolinium enhancement, T1 mapping, myocardial strain analysis, contrast-enhanced perfusion imaging and contrast-enhanced MR angiography, and hyperpolarized gas functional lung imaging. This article also highlights recent developments in this field and areas of interest for future research including cardiac MRI-based diagnostic models, machine learning in cardiac MRI, oxygen-enhanced 1 H imaging, contrast-free 1 H perfusion and ventilation imaging, contrast-free angiography and UTE imaging. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Laura C Saunders
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul J C Hughes
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Helen Marshall
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | - David G Kiely
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Imaging, Sheffield Teaching Hospitals, Sheffield, UK
| | - Jim M Wild
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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10
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Wang L, Han X, Wang M, Ma X, Zhang H, Yan C, Fang W. Ventilation/perfusion imaging predicts response to balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. Ann Nucl Med 2022; 36:515-522. [PMID: 35194769 DOI: 10.1007/s12149-022-01731-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
OBJECTS Although balloon pulmonary angioplasty (BPA) has emerged as an alternative treatment option for chronic thromboembolic pulmonary hypertension (CTEPH), it is followed in some patients by residual PH. We studied the efficacy of BPA on pulmonary blood flow and the predictive value of ventilation/perfusion (V/Q) scanning. METHODS We retrospectively reviewed the clinical database, which included patients diagnosed with CTEPH who had received BPA. All patients undergone V/Q scanning to quantify the extent of pulmonary perfusion abnormality before and after BPA. Pulmonary hemodynamics were assessed by right heart catheterization, and cardiac function and exercise capacity were evaluated at baseline and post-BPA. A total of 120 CTEPH patients were included for analysis. RESULTS BPA significantly alleviated mean pulmonary arterial pressure (mPAP: 48.0 ± 12.9 mmHg vs 34.7 ± 10.3 mmHg, P < 0.001) and pulmonary vascular resistance (PVR: 8.8 ± 4.1 Wood units vs 5.2 ± 3.0 Wood units, P < 0.001), and improved cardiac function (N-terminal pro B-type natriuretic peptide: 1628.7 ± 2887.2 pg/mL vs 400.4 ± 669.3 pg/mL, P < 0.001) and exercise capacity (6-minute walking distance: 386 ± 122 m vs 461 ± 86 m, P < 0.001). The extent of pulmonary perfusion abnormality represented by the percentage of perfusion defects (PPDs%) was improved after BPA (50.1 ± 13.6 vs 35.6 ± 14.2, P < 0.001), with the right and inferior lung lobes benefitting the most. PPDs% < 35.5 at baseline and greater restoration of PPDs% after BPA (∆PPDs% > 20.6) were associated with a better response to BPA (PPDs% < 35.5: odds ratio [OR] 10.857, 95% confidence interval [95%CI] 1.393-84.635, P = 0.023; ∆PPDs% > 20.6: OR 1.035, 95% CI 1.002-1.068, P = 0.036). CONCLUSION BPA significantly restored pulmonary blood flow, predominantly in the right and inferior lobes. V/Q scanning has the potential to predict the therapeutic response to BPA for CTEPH.
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Affiliation(s)
- Lei Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Xu Han
- Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Meng Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Xinghong Ma
- Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Hailong Zhang
- Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Chaowu Yan
- Department of Structural Heart Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China.
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11
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Shahin Y, Alabed S, Rehan Quadery S, Lewis RA, Johns C, Alkhanfar D, Sukhanenko M, Alandejani F, Garg P, Elliot CA, Hameed A, Charalampopoulos A, Wild JM, Condliffe R, Swift AJ, Kiely DG. CMR Measures of Left Atrial Volume Index and Right Ventricular Function Have Prognostic Value in Chronic Thromboembolic Pulmonary Hypertension. Front Med (Lausanne) 2022; 9:840196. [PMID: 35360708 PMCID: PMC8964043 DOI: 10.3389/fmed.2022.840196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Providing prognostic information is important when counseling patients and planning treatment strategies in chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to assess the prognostic value of gold standard imaging of cardiac structure and function using cardiac magnetic resonance imaging (CMR) in CTEPH. Consecutive treatment-naive patients with CTEPH who underwent right heart catheterization and CMR between 2011 and 2017 were identified from the ASPIRE (Assessing-the-Specturm-of-Pulmonary-hypertensIon-at-a-REferral-center) registry. CMR metrics were corrected for age and sex where appropriate. Univariate and multivariate regression models were generated to assess the prognostic ability of CMR metrics in CTEPH. Three hundred and seventy-five patients (mean+/-standard deviation: age 64+/-14 years, 49% female) were identified and 181 (48%) had pulmonary endarterectomy (PEA). For all patients with CTEPH, left-ventricular-stroke-volume-index-%predicted (LVSVI%predicted) (p = 0.040), left-atrial-volume-index (LAVI) (p = 0.030), the presence of comorbidities, incremental shuttle walking test distance (ISWD), mixed venous oxygen saturation and undergoing PEA were independent predictors of mortality at multivariate analysis. In patients undergoing PEA, LAVI (p < 0.010), ISWD and comorbidities and in patients not undergoing surgery, right-ventricular-ejection-fraction-%predicted (RVEF%pred) (p = 0.040), age and ISWD were independent predictors of mortality. CMR metrics reflecting cardiac function and left heart disease have prognostic value in CTEPH. In those undergoing PEA, LAVI predicts outcome whereas in patients not undergoing PEA RVEF%pred predicts outcome. This study highlights the prognostic value of imaging cardiac structure and function in CTEPH and the importance of considering left heart disease in patients considered for PEA.
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Affiliation(s)
- Yousef Shahin
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Department of Clinical Radiology, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Department of Clinical Radiology, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom
| | - Syed Rehan Quadery
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom
| | - Robert A Lewis
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom
| | - Christopher Johns
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom
| | - Dheyaa Alkhanfar
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Maria Sukhanenko
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom
| | - Faisal Alandejani
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Charlie A Elliot
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom
| | - Abdul Hameed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom
| | - Athaniosis Charalampopoulos
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom
| | - James M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Department of Clinical Radiology, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom.,INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom.,INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
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12
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Deshwal H, Weinstein T, Sulica R. Advances in the management of pulmonary arterial hypertension. J Investig Med 2021; 69:1270-1280. [PMID: 34580123 PMCID: PMC8485135 DOI: 10.1136/jim-2021-002027] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 12/13/2022]
Abstract
The management of pulmonary arterial hypertension (PAH) has significantly evolved over the last decades in the wake of more sensitive diagnostics and specialized clinical programs that can provide focused medical care. In the current era of PAH care, 1-year survival rates have increased to 86%–90% from 65% in the 1980s, and average long-term survival has increased to 6 years from 2.8 years. The heterogeneity in the etiology and disease course has opened doors to focusing research in phenotyping the disease and understanding the pathophysiology at a cellular and genetic level. This may eventually lead to precision medicine and the development of medications that may prevent or reverse pulmonary vascular remodeling. With more insight, clinical trial designs and primary end-points may change to identify the true survival benefit of pharmacotherapy. Identifying responders from non-responders to therapy may help provide individualized patient-centered care rather than an algorithm-based approach. The purpose of this review is to highlight the latest advances in screening, diagnosis, and management of PAH.
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Affiliation(s)
- Himanshu Deshwal
- Pulmonary, Sleep and Critical Care Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Tatiana Weinstein
- Pulmonary, Sleep and Critical Care Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Roxana Sulica
- Pulmonary, Sleep and Critical Care Medicine, New York University Grossman School of Medicine, New York, New York, USA
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13
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Moher Alsady T, Kaireit TF, Behrendt L, Winther HB, Olsson KM, Wacker F, Hoeper MM, Cebotari S, Vogel-Claussen J. Comparison of dual-energy computer tomography and dynamic contrast-enhanced MRI for evaluating lung perfusion defects in chronic thromboembolic pulmonary hypertension. PLoS One 2021; 16:e0251740. [PMID: 34138864 PMCID: PMC8211171 DOI: 10.1371/journal.pone.0251740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/01/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate the agreement in detecting pulmonary perfusion defects in patients with chronic thromboembolic pulmonary hypertension using dual-energy CT and dynamic contrast-enhanced MRI. Second, to compare both imaging modalities in monitoring lung perfusion changes in these patients after undergoing pulmonary endarterectomy. METHODS 20 patients were examined with CT and MRI before and/or after pulmonary endarterectomy. Estimated perfusion defect percentage from both modalities was compared in a lobe-based analysis. Spatial agreement of perfusion defect maps was also assessed. RESULTS A significant correlation between CT and MRI based perfusion defect percentage was calculated in all lung lobes (r > 0.78; p < 0.001). In addition, a good spatial agreement between perfusion defect maps was found (mean spatial overlap for the whole lung was 68.2%; SD = 6.9). Both CT and MRI detected improvements in pulmonary perfusion after pulmonary endarterectomy: 8% and 7% decrease in whole lung perfusion defect percentage (p = 0.007 and 0.004), respectively. In a lobe-wise analysis, improvements were statistically significant only in lower lobes using both modalities (reduction in defect percentage ranged from 16-29%; p < 0.02). CONCLUSIONS Dual-energy CT is an alternative to MRI in monitoring chronic thromboembolic pulmonary hypertension. Both imaging modalities provided comparable estimations of perfusion defects and could detect similar improvement in lung perfusion after pulmonary endarterectomy.
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Affiliation(s)
- Tawfik Moher Alsady
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
| | - Till F. Kaireit
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
| | - Lea Behrendt
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
| | - Hinrich B. Winther
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Karen M. Olsson
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
| | - Marius M. Hoeper
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG), Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
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14
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Tanaka Y, Ohno Y, Hanamatsu S, Obama Y, Ueda T, Ikeda H, Iwase A, Fukuba T, Hattori H, Murayama K, Yoshikawa T, Takenaka D, Koyama H, Toyama H. State-of-the-art MR Imaging for Thoracic Diseases. Magn Reson Med Sci 2021; 21:212-234. [PMID: 33952785 PMCID: PMC9199970 DOI: 10.2463/mrms.rev.2020-0184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Since thoracic MR imaging was first used in a clinical setting, it has been suggested that MR imaging has limited clinical utility for thoracic diseases, especially lung diseases, in comparison with x-ray CT and positron emission tomography (PET)/CT. However, in many countries and states and for specific indications, MR imaging has recently become practicable. In addition, recently developed pulmonary MR imaging with ultra-short TE (UTE) and zero TE (ZTE) has enhanced the utility of MR imaging for thoracic diseases in routine clinical practice. Furthermore, MR imaging has been introduced as being capable of assessing pulmonary function. It should be borne in mind, however, that these applications have so far been academically and clinically used only for healthy volunteers, but not for patients with various pulmonary diseases in Japan or other countries. In 2020, the Fleischner Society published a new report, which provides consensus expert opinions regarding appropriate clinical indications of pulmonary MR imaging for not only oncologic but also pulmonary diseases. This review article presents a brief history of MR imaging for thoracic diseases regarding its technical aspects and major clinical indications in Japan 1) in terms of what is currently available, 2) promising but requiring further validation or evaluation, and 3) developments warranting research investigations in preclinical or patient studies. State-of-the-art MR imaging can non-invasively visualize lung structural and functional abnormalities without ionizing radiation and thus provide an alternative to CT. MR imaging is considered as a tool for providing unique information. Moreover, prospective, randomized, and multi-center trials should be conducted to directly compare MR imaging with conventional methods to determine whether the former has equal or superior clinical relevance. The results of these trials together with continued improvements are expected to update or modify recommendations for the use of MRI in near future.
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Affiliation(s)
- Yumi Tanaka
- Department of Radiology, Fujita Health University School of Medicine
| | - Yoshiharu Ohno
- Department of Radiology, Fujita Health University School of Medicine.,Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine
| | - Satomu Hanamatsu
- Department of Radiology, Fujita Health University School of Medicine
| | - Yuki Obama
- Department of Radiology, Fujita Health University School of Medicine
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine
| | - Hirotaka Ikeda
- Department of Radiology, Fujita Health University School of Medicine
| | - Akiyoshi Iwase
- Department of Radiology, Fujita Health University Hospital
| | - Takashi Fukuba
- Department of Radiology, Fujita Health University Hospital
| | - Hidekazu Hattori
- Department of Radiology, Fujita Health University School of Medicine
| | - Kazuhiro Murayama
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine
| | | | | | | | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine
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15
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Gefter WB, Lee KS, Schiebler ML, Parraga G, Seo JB, Ohno Y, Hatabu H. Pulmonary Functional Imaging: Part 2-State-of-the-Art Clinical Applications and Opportunities for Improved Patient Care. Radiology 2021; 299:524-538. [PMID: 33847518 DOI: 10.1148/radiol.2021204033] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary functional imaging may be defined as the regional quantification of lung function by using primarily CT, MRI, and nuclear medicine techniques. The distribution of pulmonary physiologic parameters, including ventilation, perfusion, gas exchange, and biomechanics, can be noninvasively mapped and measured throughout the lungs. This information is not accessible by using conventional pulmonary function tests, which measure total lung function without viewing the regional distribution. The latter is important because of the heterogeneous distribution of virtually all lung disorders. Moreover, techniques such as hyperpolarized xenon 129 and helium 3 MRI can probe lung physiologic structure and microstructure at the level of the alveolar-air and alveolar-red blood cell interface, which is well beyond the spatial resolution of other clinical methods. The opportunities, challenges, and current stage of clinical deployment of pulmonary functional imaging are reviewed, including applications to chronic obstructive pulmonary disease, asthma, interstitial lung disease, pulmonary embolism, and pulmonary hypertension. Among the challenges to the deployment of pulmonary functional imaging in routine clinical practice are the need for further validation, establishment of normal values, standardization of imaging acquisition and analysis, and evidence of patient outcomes benefit. When these challenges are addressed, it is anticipated that pulmonary functional imaging will have an expanding role in the evaluation and management of patients with lung disease.
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Affiliation(s)
- Warren B Gefter
- From the Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea (K.S.L.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Departments of Medicine and Medical Biophysics, Robarts Research Institute, Western University, London, Canada (G.P.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Department of Radiology and Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); and Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215 (H.H.)
| | - Kyung Soo Lee
- From the Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea (K.S.L.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Departments of Medicine and Medical Biophysics, Robarts Research Institute, Western University, London, Canada (G.P.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Department of Radiology and Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); and Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215 (H.H.)
| | - Mark L Schiebler
- From the Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea (K.S.L.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Departments of Medicine and Medical Biophysics, Robarts Research Institute, Western University, London, Canada (G.P.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Department of Radiology and Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); and Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215 (H.H.)
| | - Grace Parraga
- From the Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea (K.S.L.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Departments of Medicine and Medical Biophysics, Robarts Research Institute, Western University, London, Canada (G.P.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Department of Radiology and Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); and Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215 (H.H.)
| | - Joon Beom Seo
- From the Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea (K.S.L.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Departments of Medicine and Medical Biophysics, Robarts Research Institute, Western University, London, Canada (G.P.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Department of Radiology and Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); and Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215 (H.H.)
| | - Yoshiharu Ohno
- From the Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea (K.S.L.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Departments of Medicine and Medical Biophysics, Robarts Research Institute, Western University, London, Canada (G.P.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Department of Radiology and Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); and Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215 (H.H.)
| | - Hiroto Hatabu
- From the Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea (K.S.L.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Departments of Medicine and Medical Biophysics, Robarts Research Institute, Western University, London, Canada (G.P.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Department of Radiology and Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); and Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215 (H.H.)
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16
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Glandorf J, Klimeš F, Behrendt L, Voskrebenzev A, Kaireit TF, Gutberlet M, Wacker F, Vogel-Claussen J. Perfusion quantification using voxel-wise proton density and median signal decay in PREFUL MRI. Magn Reson Med 2021; 86:1482-1493. [PMID: 33837557 DOI: 10.1002/mrm.28787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE Contrast-free lung MRI based on Fourier decomposition is an attractive method to monitor various lung diseases. However, the accuracy of the current perfusion quantification is limited. In this study, a new approach for perfusion quantification based on voxel-wise proton density and median signal decay toward the steady state for Fourier decomposition-based techniques is proposed called QQuantified (QQuant ). METHODS Twenty patients with chronic obstructive pulmonary disease and 18 patients with chronic thromboembolic pulmonary hypertension received phase-resolved functional lung-MRI (PREFUL) and dynamic contrast-enhanced (DCE)-MRI. Nine healthy participants received phase-resolved functional lung-MRI only. Median values of QQuant were compared to a Fourier decomposition perfusion quantification presented by Kjørstad et al (QKjørstad ) and validated toward pulmonary blood flow derived by DCE-MRI (PBFDCE ). Blood fraction maps determined by the new approach were calculated. Regional and global correlation coefficients were calculated, and Bland-Altman plots were created. Histogram analyses of all cohorts were created. RESULTS The introduced parameter QQuant showed only 2 mL/min/100 mL mean deviation to PBFDCE in the patient cohort and showed less bias than QKjørstad . Significant increases of regional correlation with PBFDCE were achieved (r = 0.3 vs. r = 0.2, P < .01*). The trend of global correlation toward PBFDCE is not uniform, showing higher values for QKjørstad in the chronic obstructive pulmonary disease cohort than for QQuant and vice versa in the chronic thromboembolic pulmonary hypertension cohort. In contrast to QKjørstad , QQuant perfusion maps indicate a physiologic dorsoventral gradient in supine position similar to PBFDCE with similar value distribution in the histograms. CONCLUSION We proposed a new approach for perfusion quantification of phase-resolved functional lung measurements. The developed parameter QQuant reveals a higher accuracy compared to QKjørstad .
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Affiliation(s)
- Julian Glandorf
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Filip Klimeš
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Lea Behrendt
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Andreas Voskrebenzev
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Till F Kaireit
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
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Hansmann G, Sallmon H, Roehr CC, Kourembanas S, Austin ED, Koestenberger M. Pulmonary hypertension in bronchopulmonary dysplasia. Pediatr Res 2021; 89:446-455. [PMID: 32521539 PMCID: PMC7979539 DOI: 10.1038/s41390-020-0993-4] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a major complication in prematurely born infants. Pulmonary hypertension (PH) associated with BPD (BPD-PH) is characterized by alveolar diffusion impairment, abnormal vascular remodeling, and rarefication of pulmonary vessels (vascular growth arrest), which lead to increased pulmonary vascular resistance and right heart failure. About 25% of infants with moderate to severe BPD develop BPD-PH that is associated with high morbidity and mortality. The recent evolution of broader PH-targeted pharmacotherapy in adults has opened up new treatment options for infants with BPD-PH. Sildenafil became the mainstay of contemporary BPD-PH therapy. Additional medications, such as endothelin receptor antagonists and prostacyclin analogs/mimetics, are increasingly being investigated in infants with PH. However, pediatric data from prospective or randomized controlled trials are still sparse. We discuss comprehensive diagnostic and therapeutic strategies for BPD-PH and briefly review the relevant differential diagnoses of parenchymal and interstitial developmental lung diseases. In addition, we provide a practical framework for the management of children with BPD-PH, incorporating the modified definition and classification of pediatric PH from the 2018 World Symposium on Pulmonary Hypertension, and the 2019 EPPVDN consensus recommendations on established and newly developed therapeutic strategies. Finally, current gaps of knowledge and future research directions are discussed. IMPACT: PH in BPD substantially increases mortality. Treatment of BPD-PH should be conducted by an interdisciplinary team and follow our new treatment algorithm while still kept tailored to the individual patient. We discuss recent developments in BPD-PH, make recommendations on diagnosis, monitoring and treatment of PH in BPD, and address current gaps of knowledge and potential research directions. We provide a practical framework, including a new treatment algorithm, for the management of children with BPD-PH, incorporating the modified definition and classification of pediatric PH (2018 WSPH) and the 2019 EPPVDN consensus recommendations on established and newly developed therapeutic strategies for BPD-PH.
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Affiliation(s)
- Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany.
| | - Hannes Sallmon
- grid.6363.00000 0001 2218 4662Department of Pediatric Cardiology, Charité University Medical Center, Berlin, Germany
| | - Charles C. Roehr
- grid.410556.30000 0001 0440 1440Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK ,grid.4991.50000 0004 1936 8948National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Stella Kourembanas
- grid.38142.3c000000041936754XDivision of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Eric D. Austin
- grid.152326.10000 0001 2264 7217Division of Pediatric Pulmonary Medicine, Vanderbilt University, Nashville, TN USA
| | - Martin Koestenberger
- grid.11598.340000 0000 8988 2476Division of Pediatric Cardiology, Medical University of Graz, Graz, Austria
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18
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Comparison of phase-resolved functional lung (PREFUL) MRI derived perfusion and ventilation parameters at 1.5T and 3T in healthy volunteers. PLoS One 2020; 15:e0244638. [PMID: 33378373 PMCID: PMC7773267 DOI: 10.1371/journal.pone.0244638] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/15/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study is to evaluate the influence of different field strengths on perfusion and ventilation parameters, SNR and CNR derived by PREFUL MRI using predefined sequence parameters. Methods Data sets of free breathing 2d FLASH lung MRI were acquired from 15 healthy subjects at 1.5T and 3T (Magnetom Avanto and Skyra, Siemens Healthcare, Erlangen, Germany) with a maximum period of 3 days in between. The processed functional parameters regional ventilation (RVent), perfusion (Q), quantified perfusion (QQuant), perfusion defect percentage (QDP), ventilation defect percentage (VDP) and ventilation-perfusion match (VQM) were compared for systematic differences. Signal- and contrast-to-noise ratio (SNR and CNR) of both acquisitions were analyzed. Results RVent, Q, VDP, SNR and CNR presented no significant differences between 1.5T and 3T. QQuant (1.5T vs. 3T, P = 0.04), and QDP (1.5T vs. 3T, P≤0.01) decreased significantly at 3T. Consequently, VQM increased significantly (1.5T vs. 3T, P≤0.01). Skewness and kurtosis of the Q-values increased significantly at 3T (P≤0.01). The mean Sørensen-Dice coefficients between both series were 0.91 for QDP and 0.94 for VDP. The Bland-Altman analysis of both series showed mean differences of 4.29% for QDP, 1.23% for VDP and -5.15% for VQM. Using the above-mentioned parameters for three-day repeatability at two different scanners and field strengths, the retrospective power calculation showed, that a sample size of 15 can detect differences of 3.7% for QDP, of 2.9% for VDP and differences of 2.6% for VQM. Conclusion Significant differences in QDP may be related to field inhomogeneities, which is expressed by increasing skewness and kurtosis at 3T. QQuant reveals only poor reproducibility between 1.5T and 3T. RVent, Q, VDP, SNR and CNR were not altered significantly at the used sequence parameters. Healthy participants with minimal defects present high spatial agreement of QDP and VDP.
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19
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Gopalan D, Gibbs JSR. From Early Morphometrics to Machine Learning-What Future for Cardiovascular Imaging of the Pulmonary Circulation? Diagnostics (Basel) 2020; 10:diagnostics10121004. [PMID: 33255668 PMCID: PMC7760106 DOI: 10.3390/diagnostics10121004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023] Open
Abstract
Imaging plays a cardinal role in the diagnosis and management of diseases of the pulmonary circulation. Behind the picture itself, every digital image contains a wealth of quantitative data, which are hardly analysed in current routine clinical practice and this is now being transformed by radiomics. Mathematical analyses of these data using novel techniques, such as vascular morphometry (including vascular tortuosity and vascular volumes), blood flow imaging (including quantitative lung perfusion and computational flow dynamics), and artificial intelligence, are opening a window on the complex pathophysiology and structure-function relationships of pulmonary vascular diseases. They have the potential to make dramatic alterations to how clinicians investigate the pulmonary circulation, with the consequences of more rapid diagnosis and a reduction in the need for invasive procedures in the future. Applied to multimodality imaging, they can provide new information to improve disease characterization and increase diagnostic accuracy. These new technologies may be used as sophisticated biomarkers for risk prediction modelling of prognosis and for optimising the long-term management of pulmonary circulatory diseases. These innovative techniques will require evaluation in clinical trials and may in themselves serve as successful surrogate end points in trials in the years to come.
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Affiliation(s)
- Deepa Gopalan
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
- Imperial College London, London SW7 2AZ, UK;
- Cambridge University Hospital, Cambridge CB2 0QQ, UK
- Correspondence: ; Tel.: +44-77-3000-7780
| | - J. Simon R. Gibbs
- Imperial College London, London SW7 2AZ, UK;
- National Heart & Lung Institute, Imperial College London, London SW3 6LY, UK
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20
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Becker LS, Maschke SK, Dewald CLA, Meine TC, Winther HBM, Kirstein MM, Kloeckner R, Meyer BC, Wacker F, Hinrichs JB. Two-dimensional parametric parenchymal blood flow in transarterial chemoembolisation for hepatocellular carcinoma: perfusion change quantification and tumour response prediction at 3 months post-intervention. Clin Radiol 2020; 76:160.e27-160.e33. [PMID: 33028487 DOI: 10.1016/j.crad.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the feasibility and potential value of two-dimensional (2D) parametric parenchymal blood flow (2D-PPBF) for the assessment of perfusion changes during transarterial chemoembolisation with drug-eluting beads (DEB-TACE) and to analyse correlations of 2D-PPBF parameters and tumour response. MATERIALS AND METHODS Thirty-two patients (six women, 26 men, mean age: 67±8.9 years) with unresectable hepatocellular carcinoma (HCC) who underwent their first DEB-TACE were included in this study. To quantify perfusion changes using 2D-PPBF, the acquired digital subtraction angiography (DSA) series were post-processed. Ratios were calculated between the reference region of interest (ROI) and the wash-in rate (WIR), the arrival to peak (AP) and the area under the curve (AUC) of the generated time-density curves. Comparisons between pre- and post-embolisation data were made using the Wilcoxon signed-rank test. Tumour response was assessed at 3 months using the modified Response Evaluation Criteria in Solid Tumours (mRECIST) and correlated to changes of 2D-PPBF parameters. RESULTS All 2D-PPBF parameters derived from the ROI-based time-attenuation curves were significantly different pre-versus post-DEB-TACE. Although the AUC, the WIR and target lesion size measured in accordance with mRECIST decreased (p≤0.0001) significantly, AP values showed a significant increase (p = 0.0033). Tumour response after DEB-TACE correlated with changes in the AUC (p = 0.01, r = -0.45). CONCLUSION 2D-PPBF offers an objective approach to analyse perfusion changes of embolised tumour tissue following DEB-TACE and can therefore be used to predict tumour response.
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Affiliation(s)
- L S Becker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - S K Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - C L A Dewald
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - T C Meine
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - H B M Winther
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - M M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - R Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Mainz, Germany
| | - B C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - F Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - J B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
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21
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Santens B, Van De Bruaene A, De Meester P, D'Alto M, Reddy S, Bernstein D, Koestenberger M, Hansmann G, Budts W. Diagnosis and treatment of right ventricular dysfunction in congenital heart disease. Cardiovasc Diagn Ther 2020; 10:1625-1645. [PMID: 33224777 DOI: 10.21037/cdt-20-370] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Right ventricular (RV) function is important for clinical status and outcomes in children and adults with congenital heart disease (CHD). In the normal RV, longitudinal systolic function is the major contributor to global RV systolic function. A variety of factors contribute to RV failure including increased pressure- or volume-loading, electromechanical dyssynchrony, increased myocardial fibrosis, abnormal coronary perfusion, restricted filling capacity and adverse interactions between left ventricle (LV) and RV. We discuss the different imaging techniques both at rest and during exercise to define and detect RV failure. We identify the most important biomarkers for risk stratification in RV dysfunction, including abnormal NYHA class, decreased exercise capacity, low blood pressure, and increased levels of NTproBNP, troponin T, galectin-3 and growth differentiation factor 15. In adults with CHD (ACHD), fragmented QRS is independently associated with heart failure (HF) symptoms and impaired ventricular function. Furthermore, we discuss the different HF therapies in CHD but given the broad clinical spectrum of CHD, it is important to treat RV failure in a disease-specific manner and based on the specific alterations in hemodynamics. Here, we discuss how to detect and treat RV dysfunction in CHD in order to prevent or postpone RV failure.
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Affiliation(s)
- Béatrice Santens
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Michele D'Alto
- Department of Cardiology, University "L. Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Sushma Reddy
- Department of Pediatrics (Cardiology), Stanford University, California, United States of America
| | - Daniel Bernstein
- Department of Pediatrics (Cardiology), Stanford University, California, United States of America
| | | | - Georg Hansmann
- Department of Pediatric Cardiology and Critical care, Hannover Medical School, Hannover, Germany
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
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22
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Non-occlusive mesenteric ischemia (NOMI): evaluation of 2D-perfusion angiography (2D-PA) for early treatment response assessment. Abdom Radiol (NY) 2020; 45:3342-3351. [PMID: 32103299 PMCID: PMC7455582 DOI: 10.1007/s00261-020-02457-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose To evaluate the feasibility of 2D-perfusion angiography (2D-PA) for the analysis of intra-procedural treatment response after intra-arterial prostaglandin E1 therapy in patients with non-occlusive mesenteric ischemia (NOMI). Methods Overall, 20 procedures in 18 NOMI patients were included in this retrospective case–control study. To evaluate intra-procedural splanchnic circulation changes, post-processing of digital subtraction angiography (DSA) series was performed. Regions of interest (ROIs) were placed in the superior mesenteric artery (SMA; reference), the portal vein (PV; ROIPV), as well as the aorta next to the origin of the SMA (ROIAorta). Peak density (PD), time to peak (TTP), and area under the curve (AUC) were assessed, and parametric ratios ‘target ROIPD, TTP, AUC/reference ROI’ were computed and compared within treatment and control group. Additionally, a NOMI score was assessed pre- and post-treatment compared to 2D-PA. Results Vasodilator therapy leads to a significant decrease of the 2D-PA-derived values PDAorta (p = 0.04) and AUCAorta (p = 0.03). These findings correlated with changes of the simplified NOMI score, both for overall (4 to 1, p < 0.0001) and for each category. Prostaglandin application caused a significant increase of the AUCPV (p = 0.04) and TTPPV was accelerated without reaching statistical significance (p = 0.13). When compared to a control group, all 2D-PA values in the NOMI group (pre- and post-intervention) differed significantly (p < 0.05) with longer TTPAorta/PV and lower AUCAorta/PV and PD Aorta/PV. Conclusion 2D-PA offers an objective approach to analyze immediate flow and perfusion changes following vasodilatory therapies of NOMI patients and may be a valuable tool for assessing treatment response.
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23
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Czerner CP, Schoenfeld C, Cebotari S, Renne J, Kaireit TF, Winther HB, Pöhler GH, Olsson KM, Hoeper MM, Wacker F, Vogel-Claussen J. Perioperative CTEPH patient monitoring with 2D phase-contrast MRI reflects clinical, cardiac and pulmonary perfusion changes after pulmonary endarterectomy. PLoS One 2020; 15:e0238171. [PMID: 32925924 PMCID: PMC7489536 DOI: 10.1371/journal.pone.0238171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 08/11/2020] [Indexed: 11/18/2022] Open
Abstract
Magnetic resonance imaging (MRI) is an emerging tool for diagnosis and treatment monitoring of chronic thromboembolic pulmonary hypertension (CTEPH). The current study aims to identify central pulmonary arterial hemodynamic parameters that reflect clinical, cardiac and pulmonary changes after PEA. 31 CTEPH patients, who underwent PEA and received pre- and postoperative MRI, were analyzed retrospectively. Central pulmonary arterial blood flow, lung perfusion and right heart function data were derived from MRI. Mean pulmonary arterial pressure (mPAP) and 5-month follow-up six-minute walk-distance (6MWD) were assessed. After PEA, mPAP decreased significantly and patients achieved a higher 6MWD. Central pulmonary arterial blood flow velocities, pulmonary blood flow (PBF) and right ventricular function increased significantly. Two-dimensional (2D) phase-contrast (PC) MRI-derived average mean velocity, maximum mean velocity and deceleration volume changes after PEA correlated with changes of 6MWD and right heart ejection fraction (RVEF). Deceleration volume is a novel 2D PC MRI parameter showing further correlation with PBF changes. In conclusion, 2D PC MRI-derived main pulmonary hemodynamic changes reflect changes of RVEF, PBF and 5-month follow-up 6MWD and may be used for future CTEPH patient monitoring after PEA.
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Affiliation(s)
- Christoph P. Czerner
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Christian Schoenfeld
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Julius Renne
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Till F. Kaireit
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Hinrich B. Winther
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Gesa H. Pöhler
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Karen M. Olsson
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
- Clinic for Pneumology, Hannover Medical School, Hannover, Germany
| | - Marius M. Hoeper
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
- Clinic for Pneumology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
- * E-mail:
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Benedetti G. Editorial for “Chronic Thromboembolic Pulmonary Hypertension Perioperative Monitoring Using Phase‐ResolvedFunctional Lung ( PREFUL)‐ MRI”. J Magn Reson Imaging 2020; 52:620-621. [DOI: 10.1002/jmri.27242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Giulia Benedetti
- Radiology Department, Cardiothoracic RadiologyGuy's and St Thomas' NHS Foundation Trust London UK
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25
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Voskrebenzev A, Vogel-Claussen J. Proton MRI of the Lung: How to Tame Scarce Protons and Fast Signal Decay. J Magn Reson Imaging 2020; 53:1344-1357. [PMID: 32166832 DOI: 10.1002/jmri.27122] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 12/19/2022] Open
Abstract
Pulmonary proton MRI techniques offer the unique possibility of assessing lung function and structure without the requirement for hyperpolarization or dedicated hardware, which is mandatory for multinuclear acquisition. Five popular approaches are presented and discussed in this review: 1) oxygen enhanced (OE)-MRI; 2) arterial spin labeling (ASL); 3) Fourier decomposition (FD) MRI and other related methods including self-gated noncontrast-enhanced functional lung (SENCEFUL) MR and phase-resolved functional lung (PREFUL) imaging; 4) dynamic contrast-enhanced (DCE) MRI; and 5) ultrashort TE (UTE) MRI. While DCE MRI is the most established and well-studied perfusion measurement, FD MRI offers a free-breathing test without any contrast agent and is predestined for application in patients with renal failure or with low compliance. Additionally, FD MRI and related methods like PREFUL and SENCEFUL can act as an ionizing radiation-free V/Q scan, since ventilation and perfusion information is acquired simultaneously during one scan. For OE-MRI, different concentrations of oxygen are applied via a facemask to assess the regional change in T1 , which is caused by the paramagnetic property of oxygen. Since this change is governed by a combination of ventilation, diffusion, and perfusion, a compound functional measurement can be achieved with OE-MRI. The known problem of fast T2 * decay of the lung parenchyma leading to a low signal-to-noise ratio is bypassed by the UTE acquisition strategy. Computed tomography (CT)-like images allow the assessment of lung structure with high spatial resolution without ionizing radiation. Despite these different branches of proton MRI, common trends are evident among pulmonary proton MRI: 1) free-breathing acquisition with self-gating; 2) application of UTE to preserve a stronger parenchymal signal; and 3) transition from 2D to 3D acquisition. On that note, there is a visible convergence of the different methods and it is not difficult to imagine that future methods will combine different aspects of the presented methods.
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Affiliation(s)
- Andreas Voskrebenzev
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
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26
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Pulmonary vascular imaging characteristics after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 2020; 39:248-256. [DOI: 10.1016/j.healun.2019.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/17/2019] [Accepted: 11/27/2019] [Indexed: 01/24/2023] Open
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Pöhler GH, Klimes F, Voskrebenzev A, Behrendt L, Czerner C, Gutberlet M, Cebotari S, Ius F, Fegbeutel C, Schoenfeld C, Kaireit TF, Hauck EF, Olsson KM, Hoeper MM, Wacker F, Vogel‐Claussen J. Chronic Thromboembolic Pulmonary Hypertension Perioperative Monitoring Using Phase‐Resolved Functional Lung (PREFUL)‐MRI. J Magn Reson Imaging 2020; 52:610-619. [DOI: 10.1002/jmri.27097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Gesa H. Pöhler
- Department of Diagnostic and Interventional Radiology, Hannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
| | - Filip Klimes
- Department of Diagnostic and Interventional Radiology, Hannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
| | - Andreas Voskrebenzev
- Department of Diagnostic and Interventional Radiology, Hannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
| | - Lea Behrendt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
| | - Christoph Czerner
- Department of Diagnostic and Interventional Radiology, Hannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
| | - Marcel Gutberlet
- Department of Diagnostic and Interventional Radiology, Hannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
| | - Serghei Cebotari
- Department of CardiothoracicTransplantation and Vascular Surgery, Hannover Medical School Hannover Germany
| | - Fabio Ius
- Department of CardiothoracicTransplantation and Vascular Surgery, Hannover Medical School Hannover Germany
| | - Christine Fegbeutel
- Department of CardiothoracicTransplantation and Vascular Surgery, Hannover Medical School Hannover Germany
| | - Christian Schoenfeld
- Department of Diagnostic and Interventional Radiology, Hannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
| | - Till F. Kaireit
- Department of Diagnostic and Interventional Radiology, Hannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
| | - Erik F. Hauck
- Department of NeurosurgeryDuke Hospital Durham North Carolina USA
| | - Karen M. Olsson
- Department of Respiratory MedicineHannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
| | - Marius M. Hoeper
- Department of Respiratory MedicineHannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
| | - Jens Vogel‐Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School Hannover Germany
- German Centre for Lung Research, BREATH Hannover Germany
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Glandorf J, Klimeš F, Voskrebenzev A, Gutberlet M, Wacker F, Vogel-Claussen J. Effect of intravenously injected gadolinium-based contrast agents on functional lung parameters derived by PREFUL MRI. Magn Reson Med 2019; 83:1045-1054. [PMID: 31517406 DOI: 10.1002/mrm.27991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the influence of intravenously administered gadolinium-based contrast agents on functional ventilation and perfusion parameters derived by phase-resolved functional lung (PREFUL) MRI. METHODS Fourteen participants underwent functional MRI at 1.5T using a 2D spoiled gradient echo sequence during free breathing. Three data sets of PREFUL images were obtained-the 1st data set was acquired in mean 33:46 min (SD = 6:20 min) prior, the 2nd and 3rd data sets 43 and 91 s (both SD = 1.9 s), respectively, after i.v. application of gadobutrol. Full respiratory and cardiac cycles were reconstructed and functional parameters of regional ventilation (RV), perfusion (Q), and quantified perfusion (QQuant ) together with perfusion-defected percentages (QDP), ventilation-defected percentages (VDP), and ventilation-perfusion match (VQM) were calculated and compared for systematic differences between the acquired data sets. RESULTS RV- and Q-values presented no significant alteration after gadobutrol administration. Consequently, QDP, VDP, and VQ maps were not significantly different. Sørensen-Dice coefficients of QDP and VDP maps between the different series varied up to ±9%. QQuant was significantly increased after the application of gadobutrol (1st vs. 2nd series, P = 0.0021; 1st vs. 3rd, P = 0.0188), which can be explained by the velocity-dependent signal in the completely blood-filled voxel (ROI of the aorta) after shortening of T1 relaxation time (1st vs. 2nd series, P = 0.0003; 1st vs. 3rd series, P = 0.0008). CONCLUSION Except for quantified perfusion, all evaluated functional parameters including ventilation- and perfusion-weighted maps derived by PREFUL MRI were independent of gadolinium-based contrast agents, which is important for the design of MRI protocols in future studies.
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Affiliation(s)
- Julian Glandorf
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Filip Klimeš
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Andreas Voskrebenzev
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
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29
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Vogel-Claussen J, Schönfeld CO, Kaireit TF, Voskrebenzev A, Czerner CP, Renne J, Tillmann HC, Berschneider K, Hiltl S, Bauersachs J, Welte T, Hohlfeld JM. Effect of Indacaterol/Glycopyrronium on Pulmonary Perfusion and Ventilation in Hyperinflated Patients with Chronic Obstructive Pulmonary Disease (CLAIM). A Double-Blind, Randomized, Crossover Trial. Am J Respir Crit Care Med 2019; 199:1086-1096. [DOI: 10.1164/rccm.201805-0995oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Christian-Olaf Schönfeld
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Till F. Kaireit
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Andreas Voskrebenzev
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Christoph P. Czerner
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Julius Renne
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | | | | | - Simone Hiltl
- Novartis Pharma GmbH, Clinical Research Respiratory, Nuremberg, Germany; and
| | | | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Jens M. Hohlfeld
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (BREATH), Hannover, Germany
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
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30
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Update on MR imaging of the pulmonary vasculature. Int J Cardiovasc Imaging 2019; 35:1483-1497. [PMID: 31030315 DOI: 10.1007/s10554-019-01603-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/11/2019] [Indexed: 01/01/2023]
Abstract
Magnetic 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.
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31
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Seki S, Fujisawa Y, Yui M, Kishida Y, Koyama H, Ohyu S, Sugihara N, Yoshikawa T, Ohno Y. Dynamic Contrast-enhanced Area-detector CT vs Dynamic Contrast-enhanced Perfusion MRI vs FDG-PET/CT: Comparison of Utility for Quantitative Therapeutic Outcome Prediction for NSCLC Patients Undergoing Chemoradiotherapy. Magn Reson Med Sci 2019; 19:29-39. [PMID: 30880291 PMCID: PMC7067914 DOI: 10.2463/mrms.mp.2018-0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To directly compare the utility for therapeutic outcome prediction of dynamic first-pass contrast-enhanced (CE)-perfusion area-detector computed tomography (ADCT), MR imaging assessed with the same mathematical method and 2-[fluorine-18]-fluoro-2-deoxy-d-glucose-positron emission tomography combined with CT (PET/CT) for non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy. MATERIALS AND METHODS Forty-three consecutive stage IIIB NSCLC patients, consisting of 25 males (mean age ± standard deviation: 66.6 ± 8.7 years) and 18 females (66.4 ± 8.2 years) underwent PET/CT, dynamic CE-perfusion ADCT and MR imaging, chemoradiotherapy, and follow-up examination. In each patient, total, pulmonary arterial, and systemic arterial perfusions were calculated from both perfusion data and SUVmax on PET/CT, assessed for each targeted lesion, and averaged to determine final values. Receiver operating characteristics analyses were performed to compare the utility for distinguishing responders from non-responders using Response Evaluation Criteria in Solid Tumor (RECIST) 1.1 criteria. Overall survival (OS) assessed with each index were compared between two groups by means of the Kaplan-Meier method followed by the log-rank test. RESULTS Area under the curve (Az) for total perfusion on ADCT was significantly larger than that of pulmonary arterial perfusion (P < 0.05). Az of total perfusion on MR imaging was significantly larger than that of pulmonary arterial perfusion (P < 0.05). Mean OS of responder and non-responder groups were significantly different for total and systemic arterial (P < 0.05) perfusion. CONCLUSION Dynamic first-pass CE-perfusion ADCT and MR imaging as well as PET/CT are useful for early prediction of treatment response by NSCLC patients treated with chemoradiotherapy.
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Affiliation(s)
- Shinichiro Seki
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine.,Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine
| | | | | | - Yuji Kishida
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine
| | - Hisanobu Koyama
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine
| | | | | | - Takeshi Yoshikawa
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine.,Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine
| | - Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine.,Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine
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32
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Kiely DG, Levin DL, Hassoun PM, Ivy D, Jone PN, Bwika J, Kawut SM, Lordan J, Lungu A, Mazurek JA, Moledina S, Olschewski H, Peacock AJ, Puri G, Rahaghi FN, Schafer M, Schiebler M, Screaton N, Tawhai M, van Beek EJ, Vonk-Noordegraaf A, Vandepool R, Wort SJ, Zhao L, Wild JM, Vogel-Claussen J, Swift AJ. EXPRESS: Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI). Pulm Circ 2019; 9:2045894019841990. [PMID: 30880632 PMCID: PMC6732869 DOI: 10.1177/2045894019841990] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/01/2019] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension (PH) is highly heterogeneous and despite treatment advances it remains a life-shortening condition. There have been significant advances in imaging technologies, but despite evidence of their potential clinical utility, practice remains variable, dependent in part on imaging availability and expertise. This statement summarizes current and emerging imaging modalities and their potential role in the diagnosis and assessment of suspected PH. It also includes a review of commonly encountered clinical and radiological scenarios, and imaging and modeling-based biomarkers. An expert panel was formed including clinicians, radiologists, imaging scientists, and computational modelers. Section editors generated a series of summary statements based on a review of the literature and professional experience and, following consensus review, a diagnostic algorithm and 55 statements were agreed. The diagnostic algorithm and summary statements emphasize the key role and added value of imaging in the diagnosis and assessment of PH and highlight areas requiring further research.
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Affiliation(s)
- David G. Kiely
- Sheffield Pulmonary Vascular Disease
Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
| | - David L. Levin
- Department of Radiology, Mayo Clinic,
Rochester, MN, USA
| | - Paul M. Hassoun
- Department of Medicine John Hopkins
University, Baltimore, MD, USA
| | - Dunbar Ivy
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Pei-Ni Jone
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | | | - Steven M. Kawut
- Department of Medicine, Perelman School
of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jim Lordan
- Freeman Hospital, Newcastle Upon Tyne,
Newcastle, UK
| | - Angela Lungu
- Technical University of Cluj-Napoca,
Cluj-Napoca, Romania
| | - Jeremy A. Mazurek
- Division of Cardiovascular Medicine,
Hospital
of the University of Pennsylvania,
Philadelphia, PA, USA
| | | | - Horst Olschewski
- Division of Pulmonology, Ludwig
Boltzmann Institute Lung Vascular Research, Graz, Austria
| | - Andrew J. Peacock
- Scottish Pulmonary Vascular Disease,
Unit, University of Glasgow, Glasgow, UK
| | - G.D. Puri
- Department of Anaesthesiology and
Intensive Care, Post Graduate Institute of Medical Education and Research,
Chandigarh, India
| | - Farbod N. Rahaghi
- Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
| | - Michal Schafer
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Mark Schiebler
- Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Merryn Tawhai
- Auckland Bioengineering Institute,
Auckland, New Zealand
| | - Edwin J.R. van Beek
- Edinburgh Imaging, Queens Medical
Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Rebecca Vandepool
- University of Arizona, Division of
Translational and Regenerative Medicine, Tucson, AZ, USA
| | - Stephen J. Wort
- Royal Brompton Hospital, London,
UK
- Imperial College, London, UK
| | | | - Jim M. Wild
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
| | - Jens Vogel-Claussen
- Institute of diagnostic and
Interventional Radiology, Medical Hospital Hannover, Hannover, Germany
| | - Andrew J. Swift
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
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33
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Maschke SK, Winther HMB, Meine T, Werncke T, Olsson KM, Hoeper MM, Baumgart J, Wacker FK, Meyer BC, Renne J, Hinrichs JB. Evaluation of a newly developed 2D parametric parenchymal blood flow technique with an automated vessel suppression algorithm in patients with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty. Clin Radiol 2019; 74:437-444. [PMID: 30890260 DOI: 10.1016/j.crad.2018.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/03/2018] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the feasibility of two-dimensional parametric parenchymal blood flow (2D-PPBF) to quantify perfusion changes in the lung parenchyma following balloon pulmonary angioplasty (BPA) for treatment of chronic thromboembolic pulmonary hypertension. MATERIALS AND METHODS Overall, 35 consecutive interventions in 18 patients with 98 treated pulmonary arteries were included. To quantify changes in pulmonary blood flow using 2D-PPBF, the acquired digital subtraction angiography (DSA) series were post-processed using dedicated software. A reference region of interest (ROI; arterial inflow) in the treated pulmonary artery and a distal target ROI, including the whole lung parenchyma distal to the targeted stenosis, were placed in corresponding areas on DSA pre- and post-BPA. Half-peak density (HPD), wash-in rate (WIR), arrival to peak (AP), area under the curve (AUC), and mean transit time (MTT) were assessed. The ratios of the reference ROI to the target ROI (HPDparenchyma/HPDinflow, WIRparenchyma/WIRinflow; APparenchyma/APinflow, AUCparenchyma/AUCinflow, MTTparenchyma/MTTinflow) were calculated. The relative differences of the 2D-PPBF parameters were correlated to changes in the pulmonary flow grade score. RESULTS The pulmonary flow grade score improved significantly after BPA (1 versus 3; p<0.0001). Likewise, the mean HPDparenchyma/HPDinflow (-10.2%; p<0.0001), APparenchyma/APinflow (-24.4%; p=0.0007), and MTTparenchyma/MTTinflow (-3.5%; p=0.0449) decreased significantly, whereas WIRparenchyma/WIRinflow (+82.4%) and AUCparenchyma/AUCinflow (+58.6%) showed a significant increase (p<0.0001). Furthermore, a significant correlation between changes of the pulmonary flow grade score and changes of HPDparenchyma/HPDinflow (ρ=-0.21, p=0.04), WIRparenchyma/WIRinflow (ρ=0.43, p<0.0001), APparenchyma/APinflow (ρ=-0.22, p=0.03), AUCparenchyma/AUCinflow (ρ=0.48, p<0.0001), and MTTparenchyma/MTTinflow (ρ=-0.39, p<0.0001) could be observed. CONCLUSION The 2D-PPBF technique is feasible for the quantification of perfusion changes following BPA and has the potential to improve monitoring of BPA.
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Affiliation(s)
- S K Maschke
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - H M B Winther
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - T Meine
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - T Werncke
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - K M Olsson
- Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - M M Hoeper
- Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - J Baumgart
- Siemens Medical Solutions USA, Inc., Angiography, Fluoroscopic and Radiographic Systems, Hoffman Estates, IL, USA
| | - F K Wacker
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - B C Meyer
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - J Renne
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - J B Hinrichs
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.
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Renne J, Gutberlet M, Voskrebenzev A, Kern A, Kaireit T, Hinrichs JB, Braubach P, Falk CS, Höffler K, Warnecke G, Zardo P, Haverich A, Wacker F, Vogel-Claussen J, Zinne N. Functional Pulmonary Magnetic Resonance Imaging for Detection of Ischemic Injury in a Porcine Ex-Vivo Lung Perfusion System Prior to Transplantation. Acad Radiol 2019; 26:170-178. [PMID: 29929935 DOI: 10.1016/j.acra.2018.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the feasibility of multiparametric magnetic resonance imaging (MRI) of the lungs to detect impaired organ function in a porcine model of ischemic injury within an ex-vivo lung perfusion system (EVLP) prior to transplantation. MATERIALS AND METHODS Twelve pigs were anesthetized, and left lungs were clamped to induce warm ischemia for 3 hours. Right lungs remained perfused as controls. Lungs were removed and installed in an EVLP for 12 hours. Lungs in the EVLP were imaged repeatedly using computed tomography, proton MRI (1H-MRI) and fluorine MRI (19F-MRI). Dynamic contrast-enhanced derived parenchymal blood volume, oxygen washout times, and 19F washout times were calculated. PaO2 was measured for ischemic and normal lungs, wet/dry ratio was determined, histologic samples were assessed, and cytokines in the lung tissue were analyzed. Statistical analysis was performed using nonparametric testing. RESULTS Eleven pigs were included in the final analysis. Ischemic lungs showed significantly higher wet/dry ratios (p = 0.024), as well as IL-8 tissue levels (p = 0.0098). Histologic assessment as well as morphologic scoring of computed tomography and 1H-MRI did not reveal significant differences between ischemic and control lungs. 19F washout (p = 0.966) and parenchymal blood flow (p = 0.32) were not significantly different. Oxygen washout was significantly prolonged in ischemic lungs compared to normal control lungs at the beginning (p = 0.018) and further prolonged at the end of the EVLP run (p = 0.005). CONCLUSION Multiparametric pulmonary MRI is feasible in lung allografts within an EVLP system. Oxygen-enhanced imaging seems to be a promising marker for ischemic injury, enabling detection of affected lung segments prior to transplantation.
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35
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Kaireit TF, Voskrebenzev A, Gutberlet M, Freise J, Jobst B, Kauczor H, Welte T, Wacker F, Vogel‐Claussen J. Comparison of quantitative regional perfusion‐weighted phase resolved functional lung (PREFUL) MRI with dynamic gadolinium‐enhanced regional pulmonary perfusion MRI in COPD patients. J Magn Reson Imaging 2018; 49:1122-1132. [DOI: 10.1002/jmri.26342] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Till F. Kaireit
- Department of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL) Hannover Germany
| | - Andreas Voskrebenzev
- Department of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL) Hannover Germany
| | - Marcel Gutberlet
- Department of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL) Hannover Germany
| | - Julia Freise
- Clinic of Pneumology, Hannover Medical School Hannover Germany
| | - Bertram Jobst
- Department of Diagnostic and Interventional RadiologyUniversity Hospital of Heidelberg Heidelberg Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL) Heidelberg Germany
| | - Hans‐Ulrich Kauczor
- Department of Diagnostic and Interventional RadiologyUniversity Hospital of Heidelberg Heidelberg Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL) Heidelberg Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL) Hannover Germany
- Clinic of Pneumology, Hannover Medical School Hannover Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL) Hannover Germany
| | - Jens Vogel‐Claussen
- Department of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL) Hannover Germany
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36
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Schoenfeld C, Hinrichs JB, Olsson KM, Kuettner MA, Renne J, Kaireit T, Czerner C, Wacker F, Hoeper MM, Meyer BC, Vogel-Claussen J. Cardio-pulmonary MRI for detection of treatment response after a single BPA treatment session in CTEPH patients. Eur Radiol 2018; 29:1693-1702. [PMID: 30311032 DOI: 10.1007/s00330-018-5696-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/16/2018] [Accepted: 07/31/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with balloon pulmonary angioplasty (BPA) in inoperable patients. Sensitive non-invasive imaging methods are missing to detect treatment response after a single BPA treatment session. Therefore, the aim of this study was to measure treatment response after a single BPA session using cardio-pulmonary MRI. MATERIALS AND METHODS Overall, 29 patients with CTEPH were examined with cardio-pulmonary MRI before and 62 days after their initial BPA session. Pulmonary blood flow (PBF), first-pass bolus kinetic parameters, and biventricular mass and function were determined. Multiple linear regression analysis was implemented to estimate the relationship of PBF change in the treated lobe with treatment change of full width at half maximum (FWHM), cardiac output (CO), ventricular mass index (VMI), pulmonary transit time (PTT) and PBF change in the non-treated lobes. Paired Wilcoxon rank sum test and Spearman rho correlation were used. RESULTS After BPA regional PBF increased in the treated lobe (p < 0.0001) as well as in non-treated lobes (p = 0.015). PBF treatment changes in the treated lobe were significantly larger compared with the non-treated lobes (p = 0.0049). Change in NT proBNP, MRI-derived mean pulmonary artery pressure (mPAP), PTT, FWHM, right ventricular (RV) ejection fraction, RV stroke volume, CO, VMI and PBF in the non-treated lobes correlated with PBF change in the treated lobe (p < 0.05). PBF changes in the treated lobe were independently predicted by PTT as well as PBF change in the non-treated lobes. CONCLUSION Cardio-pulmonary MRI detects and quantifies treatment response after a single BPA treatment session. KEY POINTS • Two months after BPA regional parenchymal pulmonary perfusion (PBF) increased in the total lung parenchyma (p = 0.005), the treated lobes (p < 0.0001) and non-treated lobes (p = 0.015). • The PBF treatment changes in the treated lobe were significantly larger than in the non-treated lobes (p = 0.0049). • Change in NT proBNP, MRI-derived mean pulmonary artery pressure, pulmonary transit time, full width at half maximum, right ventricular (RV) ejection fraction, RV stroke volume, cardiac output, ventricular mass index and PBF in the non-treated lobes correlated with PBF change in the treated lobe (p < 0.05).
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Affiliation(s)
- Christian Schoenfeld
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Jan B Hinrichs
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Karen M Olsson
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Martin-Alexander Kuettner
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Julius Renne
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Till Kaireit
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Christoph Czerner
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Marius M Hoeper
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Bernhard C Meyer
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.
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Maschke SK, Werncke T, Renne J, Kloeckner R, Marquardt S, Kirstein MM, Potthoff A, Wacker FK, Meyer BC, Hinrichs JB. Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction: quantitative assessment of flow and perfusion changes using 2D-perfusion angiography following shunt revision. Abdom Radiol (NY) 2018; 43:2868-2875. [PMID: 29500653 DOI: 10.1007/s00261-018-1547-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To analyze the feasibility of 2D-perfusion angiography (2D-PA) to quantify flow and perfusion changes pre- and post-transjugular intrahepatic portosystemic shunt (TIPS) revision. MATERIALS AND METHODS Fifteen consecutive patients (54 ± 14 years, seven men and eight women) scheduled for TIPS revision were included in this study. To quantify flow and perfusion changes caused by TIPS revision, digital subtraction angiography (DSA) series acquired during the revision were post-processed using a dedicated software. Reference region-of-interest (ROI) in the main portal vein (input function) and target ROIs in the TIPS lumen, the liver parenchyma and in the right atrium were placed in corresponding areas on DSA pre- and post-TIPS revision. 2D-PA evaluation included time to peak (TTP), peak density (PD), and the area under the curve (AUC) assessment. The ratios of reference ROI to target ROIs pre- and post-TIPS revision were calculated (TTPparenchyma/TTPinflow, PDparenchyma/PDinflow, AUCparenchyma/AUCinflow, TTPTIPS/TTPinflow, PDTIPS/PDinflow, AUCTIPS/AUCinflow, TTPatrium/TTPinflow, PDatrium/PDinflow, and AUCatrium/AUCinflow). Pressure measurements pre- and post-TIPS revision were performed and correlated to the 2D-PA parameters. Reproducibility of 2D-PA was assessed by the intra-class correlation coefficient (ICC). RESULTS The portosystemic pressure gradient was significantly reduced following TIPS revision (17.1 ± 6.3 vs. 8.9 ± 4.3 mmHg; p < 0.0001). PDTIPS/PDinflow (0.22 vs. 0.35; p = 0.0014) and AUCTIPS/AUCinflow (0.24 vs. 0.39; p = 0.0012) increased significantly. Likewise, PDatrium/PDinflow (0.32 vs. 0.78; p = 0.0004) and AUCatrium/AUCinflow (0.3 vs. 0.79; p < 0.0001) increased, whereas PDparenchyma/PDinflow decreased significantly (0.14 vs. 0.1; p = 0.0084). Pressure gradient changes correlated significantly with the increase in PDatrium/PDinflow (r = - 0.77, p = 0.0012) and AUCatrium/AUCinflow (r = - 0.76, p = 0.0018). ICC of the 2D-PA parameters was in the range of 0.88-0.99. CONCLUSION 2D-PA offers a feasible approach to quantify flow and perfusion changes during TIPS revision. Therefore, 2D-PA may be a valuable amendment to mere pressure measurements.
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Affiliation(s)
- Sabine K Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Julius Renne
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Mainz, Germany
| | - Steffen Marquardt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Rengier F, Melzig C, Derlin T, Marra AM, Vogel-Claussen J. Advanced imaging in pulmonary hypertension: emerging techniques and applications. Int J Cardiovasc Imaging 2018; 35:1407-1420. [DOI: 10.1007/s10554-018-1448-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/24/2018] [Indexed: 02/07/2023]
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Maschke SK, Werncke T, Klöckner R, Rodt T, Renne J, Kirstein MM, Vogel A, Wacker FK, Meyer BC, Hinrichs JB. Quantification of perfusion reduction by using 2D-perfusion angiography following transarterial chemoembolization with drug-eluting beads. Abdom Radiol (NY) 2018; 43:1245-1253. [PMID: 28840307 DOI: 10.1007/s00261-017-1296-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the feasibility of 2D-perfusion angiography (2D-PA) for the quantification of perfusion reduction following transarterial chemoembolization with drug-eluting beads (DEB-TACE). METHODS Overall, 24 DEB-TACE procedures in 19 patients were included. To quantify changes in tumor perfusion following DEB-TACE using 2D-PA, the acquired digital subtraction angiography (DSA) series were post-processed. A reference region-of-interest (ROI) in a main hepatic artery and two, distal target ROIs in embolized tumor tissue and in non-target liver parenchyma were placed in corresponding areas on DSA pre- and post-DEB-TACE. The time to peak (TTP), peak density (PD), and the area under the curve (AUC) were assessed and the ratios reference ROI/target ROIs were calculated. RESULTS In the embolized tumor, the 2D-PA ratios changed significantly (p < 0.05) after DEB-TACE, whereas no significant change was observed for non-target liver parenchyma (p > 0.05). PDtumor/PDinflow differed significantly to PDparenchyma/PDinflow pre-DEB-TACE (p < 0.0001), likewise AUCtumor/AUCinflow to AUCparenchyma/AUCinflow (p < 0.0001) with higher values in tumor tissue. The post-DEB-TACE ratios of AUC decreased significantly in the tumor tissue compared to the non-target liver parenchyma (p < 0.05). CONCLUSION 2D-PA offers an objective approach to quantify the immediate perfusion reduction of embolized tumor tissue following DEB-TACE and may therefore be used to monitor peri-interventional stasis and to quantify technical success.
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Affiliation(s)
- Sabine K Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Thomas Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Roman Klöckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Mainz, Germany
| | - Thomas Rodt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Julius Renne
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Hohlfeld JM, Vogel-Claussen J, Biller H, Berliner D, Berschneider K, Tillmann HC, Hiltl S, Bauersachs J, Welte T. Effect of lung deflation with indacaterol plus glycopyrronium on ventricular filling in patients with hyperinflation and COPD (CLAIM): a double-blind, randomised, crossover, placebo-controlled, single-centre trial. THE LANCET RESPIRATORY MEDICINE 2018; 6:368-378. [PMID: 29477448 DOI: 10.1016/s2213-2600(18)30054-7] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pulmonary hyperinflation in chronic obstructive pulmonary disease (COPD) is associated with reduced biventricular end-diastolic volumes and increased morbidity and mortality. The combination of a long-acting β agonist (LABA) and a muscarinic antagonist (LAMA) is more effective in reducing hyperinflation than LABA-inhaled corticosteroid combination therapy but whether dual bronchodilation improves cardiac function is unknown. METHODS We did a double-blind, randomised, two-period crossover, placebo-controlled, single-centre study (CLAIM) at the Fraunhofer Institute of Toxicology and Experimental Medicine (Hannover, Germany), a specialty clinic. Eligible participants were patients aged at least 40 years with COPD, pulmonary hyperinflation (defined by a baseline residual volume >135% of predicted), a smoking history of at least ten pack-years, and airflow limitation (FEV1 <80% predicted and post-bronchodilator FEV1: forced vital capacity <0·7). Patients with stable cardiovascular disease were eligible, but those with arrhythmias, heart failure, unstable ischaemic heart disease, or uncontrolled hypertension were not. We randomly assigned participants (1:1) to either receive a combined inhaled dual bronchodilator containing the LABA indacaterol (110 μg as maleate salt) plus the LAMA glycopyrronium (50 μg as bromide salt) once per day for 14 days, followed by a 14-day washout, then a matched placebo for 14 days, or to receive the same treatments in reverse order. The randomisation was done using lists and was concealed from patients and investigators. The primary endpoint was the effect of indacaterol-glycopyrronium versus placebo on left-ventricular end-diastolic volume measured by MRI done on day 1 (visit 4) and day 15 (visit 5) in treatment period 1 and on day 29 (visit 6) and day 43 (visit 7) in treatment period 2 in the per-protocol population. Left-ventricular end-diastolic volume was indexed to body surface area. Safety was assessed in all participants who received at least one dose of the study drug. This study is registered with ClinicalTrials.gov, number NCT02442206. FINDINGS Between May 18, 2015, and April 20, 2017, we randomly assigned 62 eligible participants to treatment; 30 to indacaterol-glycopyrronium followed by placebo and 32 to placebo followed by indacaterol-glycopyrronium. The 62 randomly assigned patients were included in the intent-to-treat analysis. There were two protocol violations and therefore 60 were included in the per-protocol analysis. 57 patients completed both treatment periods. After indacaterol-glycopyrronium treatment, left-ventricular end-diastolic volume increased from a mean 55·46 mL/m2 (SD 15·89) at baseline to a least-squares (LS) mean of 61·76 mL/m2 (95% CI 57·68-65·84), compared with a change from 56·42 mL/m2 at baseline (13·54) to 56·53 mL/m2 (52·43-60·62) after placebo (LS means treatment difference 5·23 mL/m2 [95% CI 3·22 to 7·25; p<0·0001]). The most common adverse events reported with indacaterol-glycopyrronium were cough (in nine patients [15%] of 59) and throat irritation (in seven [12%]). With placebo, the most common adverse events reported were headache (in five patients [8%] of 61) and upper respiratory tract infection (in four [7%]). Two patients had serious adverse events: one (2%) after indacaterol-glycopyrronium (endometrial cancer) and one (2%) after placebo (myocardial infarction); these were not thought to be treatment related. No patients died during the study. INTERPRETATION This is the first study to analyse the effect of LABA-LAMA combination therapy on cardiac function in patients with COPD and lung hyperinflation. Dual bronchodilation with indacaterol-glycopyrronium significantly improved cardiac function as measured by left-ventricular end-diastolic volume. The results are important because of the known association of cardiovascular impairment with COPD, and support the early use of dual bronchodilation in patients with COPD who show signs of pulmonary hyperinflation. FUNDING Novartis Pharma GmbH.
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Affiliation(s)
- Jens M Hohlfeld
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany; German Center for Lung Research (BREATH), Hannover, Germany; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- German Center for Lung Research (BREATH), Hannover, Germany; Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Heike Biller
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | | | - Simone Hiltl
- Novartis Pharma GmbH, Clinical Research Respiratory, Nuremberg, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- German Center for Lung Research (BREATH), Hannover, Germany; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
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Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable causes of pulmonary hypertension and is definitively treated with pulmonary thromboendartectomy. CTEPH can be overlooked, as its symptoms are nonspecific and can be mimicked by a wide range of diseases that can cause pulmonary hypertension. Early diagnosis of CTEPH and prompt evaluation for surgical candidacy are paramount factors in determining future outcomes. Imaging plays a central role in the diagnosis of CTEPH and patient selection for pulmonary thromboendartectomy and balloon pulmonary angioplasty. Currently, various imaging tools are used in concert, with techniques such as computed tomography (CT) and conventional pulmonary angiography providing detailed structural information, tests such as ventilation-perfusion (V/Q) scanning providing functional data, and magnetic resonance imaging providing a combination of morphologic and functional information. Emerging techniques such as dual-energy CT and single photon emission computed tomography-CT V/Q scanning promise to provide both anatomic and functional information in a single test and may change the way we image these patients in the near future. In this review, we discuss the roles of various imaging techniques and discuss their merits, limitations, and relative strengths in depicting the structural and functional changes of CTEPH. We also explore newer imaging techniques and the potential value they may offer.
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Voskrebenzev A, Gutberlet M, Klimeš F, Kaireit TF, Schönfeld C, Rotärmel A, Wacker F, Vogel-Claussen J. Feasibility of quantitative regional ventilation and perfusion mapping with phase-resolved functional lung (PREFUL) MRI in healthy volunteers and COPD, CTEPH, and CF patients. Magn Reson Med 2017; 79:2306-2314. [PMID: 28856715 DOI: 10.1002/mrm.26893] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE In this feasibility study, a phase-resolved functional lung imaging postprocessing method for extraction of dynamic perfusion (Q) and ventilation (V) parameters using a conventional 1H lung MRI Fourier decomposition acquisition is introduced. METHODS Time series of coronal gradient-echo MR images with a temporal resolution of 288 to 324 ms of two healthy volunteers, one patient with chronic thromboembolic hypertension, one patient with cystic fibrosis, and one patient with chronic obstructive pulmonary disease were acquired at 1.5 T. Using a sine model to estimate cardiac and respiratory phases of each image, all images were sorted to reconstruct full cardiac and respiratory cycles. Time to peak (TTP), V/Q maps, and fractional ventilation flow-volume loops were calculated. RESULTS For the volunteers, homogenous ventilation and perfusion TTP maps (V-TTP, Q-TTP) were obtained. The chronic thromboembolic hypertension patient showed increased perfusion TTP in hypoperfused regions in visual agreement with dynamic contrast-enhanced MRI, which improved postpulmonary endaterectomy surgery. Cystic fibrosis and chronic obstructive pulmonary disease patients showed a pattern of increased V-TTP and Q-TTP in regions of hypoventilation and decreased perfusion. Fractional ventilation flow-volume loops of the chronic obstructive pulmonary disease patient were smaller in comparison with the healthy volunteer, and showed regional differences in visual agreement with functional small airways disease and emphysema on CT. CONCLUSIONS This study shows the feasibility of phase-resolved functional lung imaging to gain quantitative information regarding regional lung perfusion and ventilation without the need for ultrafast imaging, which will be advantageous for future clinical translation. Magn Reson Med 79:2306-2314, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Andreas Voskrebenzev
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Filip Klimeš
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Till F Kaireit
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Christian Schönfeld
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Alexander Rotärmel
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
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Maschke SK, Renne J, Werncke T, Olsson KM, Hoeper MM, Wacker FK, Meyer BC, Hinrichs JB. Chronic thromboembolic pulmonary hypertension: Evaluation of 2D-perfusion angiography in patients who undergo balloon pulmonary angioplasty. Eur Radiol 2017; 27:4264-4270. [PMID: 28361177 DOI: 10.1007/s00330-017-4806-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the feasibility of 2D-perfusion angiography (2D-PA) in order to quantify perfusion changes of the lung parenchyma pre- and post-balloon pulmonary angioplasty (BPA). METHODS Thirty consecutive interventions in 16 patients with 99 treated pulmonary artery segments were included. To quantify changes in pulmonary blood flow using 2D-PA, the acquired digital subtraction angiographies (DSA) pre- and post-BPA were post-processed. A reference ROI in the treated pulmonary artery and a distal target ROI in the lung parenchyma were placed in corresponding areas on DSA pre- and post-BPA. Time to peak (TTP), peak density (PD) and area under the curve (AUC) were assessed. The ratios reference ROI to target ROI (TTPparenchyma/TTPinflow; PDparenchyma/PDinflow; AUCparenchyma/AUCinflow) were calculated. Relative differences of the 2D-PA parameters were correlated to changes in the pulmonary-flow-grade-score. RESULTS The pulmonary-flow-grade-score improved after BPA (p<0.0001). Likewise, the ratio TTPparenchyma/TTPinflow shortened by 10% (p=0.0002), the PDparenchyma/PDinflow increased by 46% (p<0.0001) and the AUCparenchyma/AUCinflow increased by 36% (p<0.0001). A significant correlation between changes in the pulmonary-flow-grade-score and changes in PDparenchyma/PDinflow (ρ=0.48, p<0.0001) and AUCparenchyma/AUCinflow (ρ=0.31, p=0.0018) was observed. CONCLUSION Quantification of pulmonary perfusion pre- and post-BPA using 2D-PA is feasible and has the potential to improve monitoring of BPA. KEY POINTS • Quantification of BPA results by use of 2D-PA is feasible. • 2D-PA allows objective assessment of changes in lung parenchymal perfusion. • 2D-PA has the potential to optimize BPA.
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Affiliation(s)
- Sabine K Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany
| | - Julius Renne
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany
| | - Karen M Olsson
- Clinic for Pneumology, Hannover Medical School, Hannover, Germany
| | - Marius M Hoeper
- Clinic for Pneumology, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany.
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Evaluation of a novel 2D perfusion angiography technique independent of pump injections for assessment of interventional treatment of peripheral vascular disease. Int J Cardiovasc Imaging 2016; 33:295-301. [DOI: 10.1007/s10554-016-1008-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/22/2016] [Indexed: 01/18/2023]
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Luft FC. Editorial Commentary: Chronic thromboembolic pulmonary hypertension evolves diagnostically and therapeutically. Trends Cardiovasc Med 2016; 27:38-40. [PMID: 27544725 DOI: 10.1016/j.tcm.2016.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Friedrich C Luft
- Experimental and Clinical Research Center, A Joint Cooperation between the Max-Delbrück Center for Molecular Medicine and the Charité Medical Faculty, Lindenbergerweg 80, Berlin 13125, Germany.
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Imaging in vascular diseases of the lung. Curr Opin Pulm Med 2016; 22:522-6. [PMID: 27270181 DOI: 10.1097/mcp.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The present review focuses on the recent developments in the field of pulmonary angiography and perfusion by means of computed tomography and magnetic resonance imaging. RECENT FINDINGS Computed tomography allows for a detailed analysis of large and small pulmonary vascular pathologies and simultaneously allows for evaluation of the lung parenchyma. Magnetic resonance imaging allows for large and small vessel evaluation as well as noninvasive pressure assessment. Furthermore, recently non-breath-hold contrast-enhanced and noncontrast-enhanced techniques have been developed making magnetic resonance imaging an ideal tool for comprehensive thoracic imaging, even in challenging patients. SUMMARY Noninvasive imaging using computed tomography and magnetic resonance imaging further increases their value in daily clinical practice when it comes to assessment of large and small pulmonary artery disease. As computed tomography is more easy to use and widely available, it remains the diagnostic modality of choice. However, magnetic resonance imaging is the modality of choice when a comprehensive angiographic and functional assessment is deemed necessary.
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