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Sirajuddin A, Mirmomen SM, Henry TS, Kandathil A, Kelly AM, King CS, Kuzniewski CT, Lai AR, Lee E, Martin MD, Mehta P, Morris MF, Raptis CA, Roberge EA, Sandler KL, Donnelly EF. ACR Appropriateness Criteria® Suspected Pulmonary Hypertension: 2022 Update. J Am Coll Radiol 2022; 19:S502-S512. [PMID: 36436973 DOI: 10.1016/j.jacr.2022.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations may be helpful in diagnosing and determining the etiology of pulmonary hypertension. Imaging examinations discussed in this document include chest radiography, ultrasound echocardiography, ventilation/perfusion scintigraphy, CT, MRI, right heart catheterization, and pulmonary angiography. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Travis S Henry
- Panel Chair, University of California San Francisco, San Francisco, California; Co-Director, ACR Education Center High Resolution CT of the Chest Course; Division Chief of Cardiothoracic Imaging, Duke University
| | - Asha Kandathil
- University of Texas Southwestern Medical Center, Dallas, Texas; Associate Program Director, Cardiothoracic Radiology Fellowship, The University of Texas Southwestern Medical Center
| | - Aine Marie Kelly
- Emory University Hospital, Atlanta, Georgia; Assistant Program Director Radiology Residency
| | - Christopher S King
- Inova Fairfax Hospital, Falls Church, Virginia; American College of Chest Physicians; Associate Medical Director, Advanced Lung Disease and Transplant Program; Associate Medical Director, Pulmonary Hypertension Program; System Director, Respiratory Therapy; Pulmonary Fibrosis Foundation
| | | | - Andrew R Lai
- University of California San Francisco, San Francisco, California; Primary care physician; former Director of the University of California San Francisco Hospitalist Procedure Service; former Director of the University of California San Francisco Division of Hospital Medicine's Case Review Committee, and former Director of procedures/quality improvement rotation for for the UCSF Internal Medicince residency
| | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan; Director M1Radiology Education University of Michigan Medical School, Associated Program Director Diagnostic Radiology Michigan Medicine, Director of Residency Education Cardiothoracic Division Michigan
| | - Maria D Martin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Director Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health
| | - Parth Mehta
- University of Illinois at Chicago College of Medicine, Chicago, Illinois; American College of Physicians
| | - Michael F Morris
- University of Arizona College of Medicine, Phoenix, Arizona; Director of Cardiac CT and MRI
| | | | - Eric A Roberge
- Uniformed Services University of the Health Sciences-Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - Kim L Sandler
- Vanderbilt University Medical Center, Nashville, Tennessee; Imaging Chair Thoracic Committee ECOG-ACRIN; Co-Chair Lung Screening 2.0 Steering Committee; Co-Director Vanderbilt Lung Screening Program
| | - Edwin F Donnelly
- Specialty Chair, The Ohio State University Wexner Medical Center, Columbus, Ohio; Ohio State University Medical Center: Chief of Thoracic Radiology, Interim Vice Chair of Academic Affairs, Department of Radiology
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2
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Lee GM, Carroll MB, Galvin JR, Walker CM. Mosaic Attenuation Pattern. Radiol Clin North Am 2022; 60:963-978. [DOI: 10.1016/j.rcl.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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3
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Zorzo C, Girón RM, Caballero P. Temporal Changes on Pulmonary Artery Size on Computed Tomography in Adults With Cystic Fibrosis. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37497314 PMCID: PMC10369578 DOI: 10.1016/j.opresp.2022.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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4
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Melzig C, Rengier F. [Increased pulmonary arterial and venous pressure]. Radiologe 2021; 62:120-129. [PMID: 34967911 DOI: 10.1007/s00117-021-00951-y] [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] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increases in pressure in the pulmonary arteries or pulmonary veins may be the result of a variety of underlying diseases. Noninvasive imaging plays a crucial role not only for identification, but also for differential diagnosis. OBJECTIVES This article provides a comparative review of the signs of increased pulmonary arterial and pulmonary venous pressure in chest X‑ray and computed tomography (CT). RADIOLOGICAL PROCEDURES Typical signs of a pulmonary arterial or pulmonary venous pressure increase in chest X‑ray and CT facilitate diagnosis of pulmonary hypertension (e.g., enlargement of central pulmonary arteries) and interstitial or alveolar pulmonary edema (e.g., Kerley lines/thickened interlobular septae or butterfly edema). A basic understanding of imaging findings and underlying pathophysiology helps in establishing the differential diagnosis. CONCLUSIONS Chest X‑ray and CT are essential for diagnosis of patients with suspected increased pulmonary arterial or pulmonary venous pressure.
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Affiliation(s)
- Claudius Melzig
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
| | - Fabian Rengier
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland.
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Nahardani A, Leistikow S, Grün K, Krämer M, Herrmann KH, Schrepper A, Jung C, Moradi S, Schulze PC, Linsen L, Reichenbach JR, Hoerr V, Franz M. Pulmonary Arteriovenous Pressure Gradient and Time-Averaged Mean Velocity of Small Pulmonary Arteries Can Serve as Sensitive Biomarkers in the Diagnosis of Pulmonary Arterial Hypertension: A Preclinical Study by 4D-Flow MRI. Diagnostics (Basel) 2021; 12:diagnostics12010058. [PMID: 35054225 PMCID: PMC8774481 DOI: 10.3390/diagnostics12010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022] Open
Abstract
(1) Background: Pulmonary arterial hypertension (PAH) is a serious condition that is associated with many cardiopulmonary diseases. Invasive right heart catheterization (RHC) is currently the only method for the definitive diagnosis and follow-up of PAH. In this study, we sought a non-invasive hemodynamic biomarker for the diagnosis of PAH. (2) Methods: We applied prospectively respiratory and cardiac gated 4D-flow MRI at a 9.4T preclinical scanner on three different groups of Sprague Dawley rats: baseline (n = 11), moderate PAH (n = 8), and severe PAH (n = 8). The pressure gradients as well as the velocity values were analyzed from 4D-flow data and correlated with lung histology. (3) Results: The pressure gradient between the pulmonary artery and vein on the unilateral side as well as the time-averaged mean velocity values of the small pulmonary arteries were capable of distinguishing not only between baseline and severe PAH, but also between the moderate and severe stages of the disease. (4) Conclusions: The current preclinical study suggests the pulmonary arteriovenous pressure gradient and the time-averaged mean velocity as potential biomarkers to diagnose PAH.
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Affiliation(s)
- Ali Nahardani
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (A.N.); (M.K.); (K.-H.H.); (J.R.R.)
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53127 Bonn, Germany;
| | - Simon Leistikow
- Department of Mathematics and Computer Science, Institute of Computer Science, Westfälische Wilhelms-Universität Münster, 48149 Munster, Germany; (S.L.); (L.L.)
| | - Katja Grün
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, Jena University Hospital, 07747 Jena, Germany; (K.G.); (P.C.S.); (M.F.)
| | - Martin Krämer
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (A.N.); (M.K.); (K.-H.H.); (J.R.R.)
| | - Karl-Heinz Herrmann
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (A.N.); (M.K.); (K.-H.H.); (J.R.R.)
| | - Andrea Schrepper
- Department of Cardiothoracic Surgery, Jena University Hospital, 07747 Jena, Germany;
| | - Christian Jung
- Department of Internal Medicine, Division of Cardiology, University Hospital Düsseldorf, 40225 Dusseldorf, Germany;
| | - Sara Moradi
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53127 Bonn, Germany;
| | - Paul Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, Jena University Hospital, 07747 Jena, Germany; (K.G.); (P.C.S.); (M.F.)
| | - Lars Linsen
- Department of Mathematics and Computer Science, Institute of Computer Science, Westfälische Wilhelms-Universität Münster, 48149 Munster, Germany; (S.L.); (L.L.)
| | - Jürgen R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (A.N.); (M.K.); (K.-H.H.); (J.R.R.)
| | - Verena Hoerr
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (A.N.); (M.K.); (K.-H.H.); (J.R.R.)
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53127 Bonn, Germany;
- Translational Research Imaging Center (TRIC), Clinic for Radiology, University Hospital Münster, 48149 Munster, Germany
- Correspondence:
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, Jena University Hospital, 07747 Jena, Germany; (K.G.); (P.C.S.); (M.F.)
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Regalado L, Vitellas C, Wright L, Ganapathi A, Whitson BA, Amadi CC. Pulmonary artery dissection in long standing idiopathic pulmonary arterial hypertension: A case report. Radiol Case Rep 2021; 17:227-231. [PMID: 34824656 PMCID: PMC8605200 DOI: 10.1016/j.radcr.2021.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/16/2021] [Indexed: 12/02/2022] Open
Abstract
Pulmonary arterial dissection (PAD) is a rare and often lethal complication of chronic pulmonary arterial hypertension (PAH), which may occurs in patients with idiopathic pulmonary arterial hypertension (IPAH) and potentially in those with connective tissue disorders. While rare, sudden death often occurs secondary to acute cardiac tamponade, as the pulmonary artery dissects into the pericardium; this diagnosis is often made postmortem. Nevertheless, with the proliferation of multidetector computed tomography (MDCT) as a diagnostic test, patients may be identified very early after symptom onset, prompting rapid intervention with decreased morbidity and mortality. We report a case of IPAH complicated by pulmonary artery aneurysm (PAA) and PAD, diagnosed by CT pulmonary angiogram (CTPA), and treated with bilateral lung transplantation, pulmonic valve replacement, and re-anastomosis of the donor main PA to a pulmonary valve conduit.
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Affiliation(s)
- Luis Regalado
- The Ohio State University, College of Medicine, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Carol Vitellas
- The Ohio State University, College of Medicine, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Lindsay Wright
- Department of Radiology, The Ohio State University, Wexner Medical Center, 395 W 12th Ave, Columbus, OH 43210, USA
| | - Asvin Ganapathi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University, Wexner Medical Center, 410 W. 10th Ave, Columbus OH 43210, USA
| | - Bryan A. Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University, Wexner Medical Center, 410 W. 10th Ave, Columbus OH 43210, USA
| | - Chiemezie Chianotu Amadi
- Department of Radiology, The Ohio State University, Wexner Medical Center, 395 W 12th Ave, Columbus, OH 43210, USA
- Corresponding author.
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Elia D, Caminati A, Zompatori M, Cassandro R, Lonati C, Luisi F, Pelosi G, Provencher S, Harari S. Pulmonary hypertension and chronic lung disease: where are we headed? Eur Respir Rev 2019; 28:28/153/190065. [DOI: 10.1183/16000617.0065-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/22/2019] [Indexed: 12/26/2022] Open
Abstract
Pulmonary hypertension related to chronic lung disease, mainly represented by COPD and idiopathic pulmonary fibrosis, is associated with a worse outcome when compared with patients only affected by parenchymal lung disease. At present, no therapies are available to reverse or slow down the pathological process of this condition and most of the clinical trials conducted to date have had no clinically significant impact. Nevertheless, the importance of chronic lung diseases is always more widely recognised and, along with its increasing incidence, associated pulmonary hypertension is also expected to be growing in frequency and as a health burden worldwide. Therefore, it is desirable to develop useful and reliable tools to obtain an early diagnosis and to monitor and follow-up this condition, while new insights in the therapeutic approach are explored.
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Imaging of Pulmonary Hypertension: Pictorial Essay. Chest 2019; 156:211-227. [PMID: 30981724 DOI: 10.1016/j.chest.2019.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/01/2019] [Indexed: 11/20/2022] Open
Abstract
Pulmonary hypertension (PH) is an end result of a diverse array of complex clinical conditions that invoke hemodynamic and pathophysiological changes in the pulmonary vasculature. Many patients' symptoms begin with dyspnea on exertion for which screening tests such as chest roentgenograms and more definitive noninvasive tests such as CT scans are ordered initially. It is imperative that clinicians are cognizant of subtle clues on these imaging modalities that alert them to the possibility of PH. These clues may serve as a stepping stone towards more advanced noninvasive (echocardiogram) and invasive (right heart catheterization) testing. On the CT scan, the signs are classified into mediastinal and lung parenchymal abnormalities. In addition to suspecting the diagnosis of PH, this paper provides a pictorial essay to guide health care professionals in identifying the etiology of PH. This paper also provides concrete definitions, wherever possible, of what constitutes abnormalities in PH, such as dilated pulmonary arteries, pruning of vessels, and increased thickness of free wall of the right ventricle. The sensitivities and specificities of each sign are enumerated. The common radiographic and clinical features of many different etiologies of PH are tabulated for the convenience of the readers. Some newer imaging modalities such as dual-energy CT of the chest that hold promise for the future are also described.
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9
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Sirajuddin A, Donnelly EF, Crabtree TP, Henry TS, Iannettoni MD, Johnson GB, Kazerooni EA, Maldonado F, Olsen KM, Wu CC, Mohammed TL, Kanne JP. ACR Appropriateness Criteria ® Suspected Pulmonary Hypertension. J Am Coll Radiol 2018; 14:S350-S361. [PMID: 28473092 DOI: 10.1016/j.jacr.2017.01.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 11/15/2022]
Abstract
Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations that may be helpful in diagnosing and determining the etiology of pulmonary hypertension are discussed. Imaging examinations that may aid in the diagnosis of pulmonary hypertension include chest radiography, ultrasound echocardiography, ventilation/perfusion scans, CT, MRI, right heart catheterization, pulmonary angiography, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Edwin F Donnelly
- Panel Vice-Chair, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Traves P Crabtree
- Southern Illinois University School of Medicine, Springfield, Illinois; Society of Thoracic Surgeons
| | - Travis S Henry
- University of California, San Francisco, San Francisco, California
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Carol C Wu
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tan-Lucien Mohammed
- Specialty Chair, University of Florida College of Medicine, Gainesville, Florida
| | - Jeffrey P Kanne
- Panel Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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10
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Aluja Jaramillo F, Gutierrez FR, Díaz Telli FG, Yevenes Aravena S, Javidan-Nejad C, Bhalla S. Approach to Pulmonary Hypertension: From CT to Clinical Diagnosis. Radiographics 2018; 38:357-373. [PMID: 29432063 DOI: 10.1148/rg.2018170046] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pulmonary hypertension (PH) is a condition characterized by increased pressure in the pulmonary circulation. It may be idiopathic or arise in the setting of other clinical conditions. Patients with PH tend to present with nonspecific cardiovascular or respiratory symptoms. The clinical classification of PH was recently revised at the World Health Organization symposium in Nice, France, in 2013. That consensus statement provided an updated classification based on the shared hemodynamic characteristics and management of the different categories of PH. Some features seen at computed tomography (CT) can suggest a subtype or probable cause of PH that may facilitate placing the patient in the correct category. These features include findings in the pulmonary arteries (peripheral calcification, peripheral dilatation, eccentric filling defects, intra-arterial soft tissue), lung parenchyma (centrilobular nodules, mosaic attenuation, interlobular septal thickening, bronchiectasis, subpleural peripheral opacities, ground-glass opacities, diffuse nodules), heart (congenital lesions, left heart disease, valvular disease), and mediastinum (hypertrophied bronchial arteries). An approach based on identification of these CT features in patients with PH will allow the radiologist to play an important role in diagnosis and help guide the clinician in management of PH. ©RSNA, 2018.
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Affiliation(s)
- Felipe Aluja Jaramillo
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
| | - Fernando R Gutierrez
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
| | - Federico G Díaz Telli
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
| | - Sebastian Yevenes Aravena
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
| | - Cylen Javidan-Nejad
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
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Affiliation(s)
- Sara L. Partington
- From the Philadelphia Adult Congenital Heart Disease Program, A Joint Program of the Hospital of the University of Pennsylvania and Children’s Hospital of Philadelphia (S.L.P.); and CMR Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom (P.J.K.)
| | - Philip J. Kilner
- From the Philadelphia Adult Congenital Heart Disease Program, A Joint Program of the Hospital of the University of Pennsylvania and Children’s Hospital of Philadelphia (S.L.P.); and CMR Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom (P.J.K.)
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12
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Katikireddy CK, Singh M, Muhyieddeen K, Acharya T, Ambrose JA, Samim A. Left Atrial Area and Right Ventricle Dimensions in Non-gated Axial Chest CT can Differentiate Pulmonary Hypertension Due to Left Heart Disease from Other Causes. J Cardiovasc Comput Tomogr 2016; 10:246-50. [DOI: 10.1016/j.jcct.2016.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 11/17/2022]
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13
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Affiliation(s)
- Ali Ataya
- Pulmonary Vascular Disease Program, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Florida, Gainesville, Florida
| | - Sheylan Patel
- Pulmonary Vascular Disease Program, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Florida, Gainesville, Florida
| | - Jessica Cope
- Pulmonary Vascular Disease Program, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Florida, Gainesville, Florida
| | - Hassan Alnuaimat
- Pulmonary Vascular Disease Program, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Florida, Gainesville, Florida
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14
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Albà X, Pereañez M, Hoogendoorn C, Swift AJ, Wild JM, Frangi AF, Lekadir K. An Algorithm for the Segmentation of Highly Abnormal Hearts Using a Generic Statistical Shape Model. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:845-859. [PMID: 26552082 DOI: 10.1109/tmi.2015.2497906] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Statistical shape models (SSMs) have been widely employed in cardiac image segmentation. However, in conditions that induce severe shape abnormality and remodeling, such as in the case of pulmonary hypertension (PH) or hypertrophic cardiomyopathy (HCM), a single SSM is rarely capable of capturing the anatomical variability in the extremes of the distribution. This work presents a new algorithm for the segmentation of severely abnormal hearts. The algorithm is highly flexible, as it does not require a priori knowledge of the involved pathology or any specific parameter tuning to be applied to the cardiac image under analysis. The fundamental idea is to approximate the gross effect of the abnormality with a virtual remodeling transformation between the patient-specific geometry and the average shape of the reference model (e.g., average normal morphology). To define this mapping, a set of landmark points are automatically identified during boundary point search, by estimating the reliability of the candidate points. With the obtained transformation, the feature points extracted from the patient image volume are then projected onto the space of the reference SSM, where the model is used to effectively constrain and guide the segmentation process. The extracted shape in the reference space is finally propagated back to the original image of the abnormal heart to obtain the final segmentation. Detailed validation with patients diagnosed with PH and HCM shows the robustness and flexibility of the technique for the segmentation of highly abnormal hearts of different pathologies.
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Ussavarungsi K, Lee AS, Burger CD. Mosaic Pattern of Lung Attenuation on Chest CT in Patients with Pulmonary Hypertension. Diseases 2015; 3:205-212. [PMID: 28943620 PMCID: PMC5548246 DOI: 10.3390/diseases3030205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/21/2015] [Accepted: 09/02/2015] [Indexed: 11/17/2022] Open
Abstract
A mosaic pattern of lung attenuation on chest computed tomography (CT) may be due to various etiologies. There is limited published data on CT results when used to evaluate pulmonary hypertension (PH). We retrospectively studied the frequency of mosaic pattern in patients with PH and the cause of the PH by diagnostic group, as well as the correlation between the mosaic pattern and the following: demographics, severity of the PH, main pulmonary artery (PA) size, PA/aorta (PA/Ao) ratio, pulmonary function tests (PFT), and ventilation perfusion scan results. Overall, 18% of the cohort had CT mosaic pattern (34/189). Mosaic pattern was present in 17/113 (15%) in Group 1 pulmonary arterial hypertension, 5/13 (28%) in Group 2 pulmonary venous hypertension and 8/50 (16%) in Group 3 PH. Conversely, Group 4 chronic thromboembolic PH was more prevalent in 4/8 (50%). Main PA size, PA/Ao ratio, and segmental perfusion defect were positively associated with mosaic pattern. In contrast, factors such as age, gender, body mass index, functional class, hemodynamic data, and PFT values were not associated with mosaic pattern. Mosaic pattern is not specific as an isolated finding for distinguishing the subtype of PH.
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Affiliation(s)
- Kamonpun Ussavarungsi
- Pulmonary and Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Augustine S Lee
- Pulmonary and Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Charles D Burger
- Pulmonary and Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Kligerman SJ, Henry T, Lin CT, Franks TJ, Galvin JR. Mosaic Attenuation: Etiology, Methods of Differentiation, and Pitfalls. Radiographics 2015; 35:1360-80. [PMID: 26274445 DOI: 10.1148/rg.2015140308] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mosaic attenuation is a commonly encountered pattern on computed tomography that is defined as heterogeneous areas of differing lung attenuation. This heterogeneous pattern of attenuation is the result of diverse causes that include diseases of the small airways, pulmonary vasculature, alveoli, and interstitium, alone or in combination. Small airways disease can be a primary disorder, such as respiratory bronchiolitis or constrictive bronchiolitis, or be part of parenchymal lung disease, such as hypersensitivity pneumonitis, or large airways disease, such as bronchiectasis and asthma. Vascular causes resulting in mosaic attenuation are typically chronic thromboembolic pulmonary hypertension, which is characterized by organizing thrombi in the elastic pulmonary arteries, or pulmonary arterial hypertension, a heterogeneous group of diseases affecting the distal pulmonary arterioles. Diffuse ground-glass opacity can result in a mosaic pattern related to a number of processes in acute (eg, infection, pulmonary edema), subacute (eg, organizing pneumonia), or chronic (eg, fibrotic diseases) settings. Imaging clues that can assist the radiologist in pinpointing a diagnosis include evidence of large airway involvement, cardiovascular abnormalities, septal thickening, signs of fibrosis, and demonstration of airtrapping at expiratory imaging.
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Affiliation(s)
- Seth J Kligerman
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Travis Henry
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Cheng T Lin
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Teri J Franks
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Jeffrey R Galvin
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
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Lewis G, Hoey ETD, Reynolds JH, Ganeshan A, Ment J. Multi-detector CT assessment in pulmonary hypertension: techniques, systematic approach to interpretation and key findings. Quant Imaging Med Surg 2015; 5:423-32. [PMID: 26029645 DOI: 10.3978/j.issn.2223-4292.2015.01.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/22/2015] [Indexed: 01/03/2023]
Abstract
Pulmonary arterial hypertension (PAH) may be suspected based on the clinical history, physical examination and electrocardiogram findings but imaging is usually central to confirming the diagnosis, establishing a cause and guiding therapy. The diagnostic pathway of PAH involves a variety of complimentary investigations of which computed tomography pulmonary angiography (CTPA) has established a central role both in helping identify an underlying cause for PAH and assessing resulting functional compromise. In particular CTPA is considered as the gold standard technique for the diagnosis of thromboembolic disease. This article reviews the CTPA evaluation in PAH, describing CTPA techniques, a systematic approach to interpretation and spectrum of key imaging findings.
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Affiliation(s)
- Gareth Lewis
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Edward T D Hoey
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - John H Reynolds
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Arul Ganeshan
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Jerome Ment
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
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Fatahi N, Krupic F, Hellström M. Quality of radiologists' communication with other clinicians--As experienced by radiologists. PATIENT EDUCATION AND COUNSELING 2015; 98:722-727. [PMID: 25766732 DOI: 10.1016/j.pec.2015.02.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 01/29/2015] [Accepted: 02/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The objective was to study radiologists' experiences of written and oral communication with referring clinicians, and its potential implications for decision making and patient care. METHODS Focus group discussions with 12 radiologists were carried out. Content analysis was used for interpretation of the data. RESULTS Radiologists reported many problems with the request forms: improper choice of imaging examinations and procedures, insufficient patient history/information, unclear clinical questions, lack of specific terms and unclear abbreviations on the request form. Radiologists also mentioned other difficulties: insufficient attention among participating clinicians during conferences, difficulties in reaching the referring clinicians by telephone, and communication difficulties in making priorities between patients. To overcome these problems, radiologists suggested increased contacts between radiologists and clinicians, and educational activities. CONCLUSION A number of difficulties in oral and written communication were highlighted. The use of medical imaging may be optimized by joint discussions on indications and methodology and educational activities, such as lectures, seminars and conferences, directed to the medical community at large. PRACTICE IMPLICATIONS Improved communication between radiologists and referring clinicians should be encouraged to ensure diagnostic quality, correct patient prioritization and patient safety, and to avoid unnecessary delays and costs.
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Affiliation(s)
- Nabi Fatahi
- Department of Radiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ferid Krupic
- Department of Orthopedics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Hellström
- Department of Radiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Different sizes of centrilobular ground-glass opacities in chest high-resolution computed tomography of patients with pulmonary veno-occlusive disease and patients with pulmonary capillary hemangiomatosis. Cardiovasc Pathol 2013; 22:287-93. [DOI: 10.1016/j.carpath.2012.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/07/2012] [Accepted: 12/05/2012] [Indexed: 11/21/2022] Open
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Pulmonary arterial hypertension in pediatric patients with hematopoietic stem cell transplant-associated thrombotic microangiopathy. Biol Blood Marrow Transplant 2012; 19:202-7. [PMID: 22960385 DOI: 10.1016/j.bbmt.2012.08.022] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 08/30/2012] [Indexed: 12/19/2022]
Abstract
Pulmonary arterial hypertension (PAH) is rarely included in the differential diagnosis of cardiorespiratory failure after pediatric hematopoietic stem cell transplant (HSCT) as the clinical presentation is nonspecific and may mimic other etiologies. The pathogenesis of PAH in HSCT is poorly understood and the diagnosis requires a high degree of suspicion. We describe 5 children diagnosed with PAH after allogeneic HSCT. All 5 patients had prolonged clinical signs of transplantation-associated thrombotic microangiopathy (TA-TMA) when they presented with hypoxemic respiratory failure and evidence of PAH. Four of the 5 patients had echocardiographic evidence of PAH, and 1 patient was diagnosed with PAH only on autopsy. PAH was diagnosed a median of 76 days (range, 56-101 days) after a diagnosis of TA-TMA. Despite aggressive medical management, including inhaled nitric oxide, 4 of the 5 patients died. One patient recovered from PAH after 11 months of sildenafil therapy. Three of the 4 deceased patients had an autopsy performed, demonstrating severe pulmonary vascular disease consistent with TA-TMA and severe PAH. We conclude that TA-TMA can be associated with significant pulmonary vascular injury presenting as hypoxemic respiratory failure with PAH after HSCT. Pediatric patients with unexplained hypoxemia after HSCT should be evaluated for both transplantation complications, TA-TMA and PAH, accordingly.
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Giant Dilatation of the Right Coronary Aortic Bulb with Compression of the Right Ventricular Outflow Tract Mimicking a Ventricular Septal Defect: Diagnostic workup Using Echocardiography, Heart Catheterization, and Cardiac Computed Tomography. Case Rep Med 2012; 2012:524526. [PMID: 22952479 PMCID: PMC3431150 DOI: 10.1155/2012/524526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 07/30/2012] [Indexed: 11/30/2022] Open
Abstract
Annuloaortic ectasia is a relatively rare diagnosis. Herein, we report an unusual case of an annuloaortic ectasia with asymmetric dilatation of the right coronary bulb mimicking a membranous ventricular septal defect (VSD) with Eisenmenger reaction by transthoracic echocardiography. Aortic angiography showed a dilated aortic root and moderate aortic regurgitation. Right cardiac catheterization, on the other hand, exhibited normal pulmonary artery blood pressure and normal pulmonary resistance, whereas normal venous gas values were measured throughout the caval vein and the right atrium, excluding relevant left-right shunting. Further diagnostic workup by cardiac computed tomography angiography (CCTA) unambiguously illustrated the asymmetric geometry of the ectatic aortic cusp and root causing compression of the right heart and of the right ventricular (RV) outflow tract. After review of echocardiographic acquisitions, the blood flow detected between the left and right ventricles (mimicking VSD) was interpreted as turbulent inflow from the left ventricle into the ectatic right coronary cusp. Furthermore, elevated pulmonary artery blood pressure measured by echocardiography was attributed to “functional pulmonary stenosis” due to compression of the RV outflow tract by the aorta, as demonstrated by CCTA.
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