Contemporary Imaging in Chronic Pulmonary Thromboembolic Disease
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Abstract
Pulmonary hypertension is the end result of rarefaction of functioning blood vessels within the lung. This can be caused by a number of pathologies, but in the case of chronic thromboembolic pulmonary hypertension, occlusion of the blood vessel is usually initiated by acute thrombus, which, over time changes to chronic fibrous plaque which has a limited response to medical therapy. The most effective treatment options involve mechanical solutions in the form of surgery or balloon pulmonary angioplasty. Treatments are most effective when introduced early in the disease process. In order that patients may benefit from these treatments, an effective diagnostic pathway is essential. Echocardiogram remains the most effective screening tool in the diagnosis of pulmonary hypertension. Right heart catheterization is the gold standard tool for the assessment of pulmonary hemodynamics. Cardiac magnetic resonance (CMR) imaging is an evolving tool that can be used to evaluate the right ventricular function. It is the gold standard in evaluating right ventricular function and has lower interobserver variability than echocardiography. Despite being a more expensive and less available tool, CMR has the ability to accurately assess blood flow within the pulmonary vasculature, which can enable early detection of disease and response to therapy. Cardiac magnetic resonance imaging is now recognized as an essential component of the imaging armamentarium to assess pulmonary vascular disease.
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