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Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli
Published on: September 25, 2016
State-of-the-art imaging techniques in chronic thromboembolic pulmonary hypertension
1Radiology Department, University Hospitals of Leicester, Glenfield Hospital, Groby Rd., Leicester LE3 9QP UK. richard.coulden@uhl-tr.nhs.uk
Insights
Accurate diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) is vital for effective treatment. Advanced imaging techniques like CT and MR are crucial for identifying CTEPH and guiding surgical interventions.
Area of Science:
- Cardiology
- Radiology
- Pulmonary Medicine
Background:
- Differentiating chronic thromboembolic pulmonary hypertension (CTEPH) from other pulmonary hypertension (PH) forms is critical for treatment and outcomes.
- Misdiagnosis of CTEPH is common, necessitating high-quality imaging for correct diagnosis and patient management.
- Imaging plays a key role in CTEPH diagnosis, surgical candidate identification, surgical planning, and postsurgical monitoring.
Purpose of the Study:
- To review the role of imaging in diagnosing and managing chronic thromboembolic pulmonary hypertension (CTEPH).
- To compare traditional diagnostic methods with advanced cross-sectional imaging techniques for CTEPH.
- To present a diagnostic algorithm for imaging in PH, emphasizing CTEPH evaluation.
Main Methods:
- Review of diagnostic imaging modalities for pulmonary hypertension (PH), including echocardiography, ventilation-perfusion scintigraphy, pulmonary angiography, multislice computed tomography (CT), and magnetic resonance (MR).
- Comparison of CT and MR imaging for CTEPH diagnosis, considering factors like speed, availability, cost, radiation exposure, and suitability for serial examinations.
- Development of a diagnostic algorithm for imaging in PH based on clinical presentation and findings.
Main Results:
- Cross-sectional imaging techniques, particularly CT, are increasingly replacing traditional methods like V/Q scintigraphy and pulmonary angiography for CTEPH diagnosis.
- CT is effective in distinguishing CTEPH from idiopathic pulmonary arterial hypertension and evaluating underlying lung diseases, but involves radiation exposure.
- MR offers a radiation-free alternative, providing unique insights into cardiac function and blood flow, and is complementary to CT.
Conclusions:
- High-quality imaging is essential for accurate CTEPH diagnosis, surgical planning, and monitoring.
- CT and MR are complementary imaging techniques representing the future of PH diagnostics.
- A structured diagnostic algorithm integrating various imaging modalities can optimize the management of patients with suspected PH and CTEPH.
Abstract:
It is important to differentiate chronic thromboembolic pulmonary hypertension (CTEPH) from other forms of pulmonary hypertension (PH) to target treatment and optimize therapeutic outcome. Misdiagnosis is common, and high-quality imaging is essential if CTEPH is to be diagnosed correctly. In addition to making a diagnosis, imaging helps identify patients for surgery, aids surgical planning, and provides postsurgical monitoring. Ventilation-perfusion scintigraphy and pulmonary angiography have been the mainstay of diagnosis and surgical assessment for many years, but cross-sectional techniques are rapidly taking over. Echocardiography is used to confirm or refute the presence of PH and to identify cardiac causes if PH is present. For patients with PH but no evidence of cardiac disease, multislice computed tomography (CT) is the next best step. CT distinguishes CTEPH from idiopathic arterial PH, evaluates underlying lung disease, and may help identify rarer causes of PH. CT is quick, widely available, and inexpensive. There is, however, a significant radiation burden, and it is unsuitable for serial examinations. Magnetic resonance (MR) involves no ionizing radiation and makes an ideal alternative. When combined with techniques for measuring ventricular function and blood flow, MR provides unique insight into structure and function. CT and MR are complementary techniques, and together they represent the future of imaging in PH. How they might be used in routine clinical practice is presented as a diagnostic algorithm developed at Papworth Hospital, the United Kingdom's national center for surgical treatment of CTEPH.
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