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Erschienen in: Zeitschrift für Pneumologie 5/2021

02.08.2021 | Szintigrafie | Leitthema

Bildgebung bei pulmonaler Hypertonie

verfasst von: PD Dr. Fabian Rengier, Claudius Melzig, Jens Vogel-Claussen

Erschienen in: Zeitschrift für Pneumologie | Ausgabe 5/2021

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Zusammenfassung

Hintergrund

Die pulmonale Hypertonie (PH) ist eine hämodynamische Störung des Lungenkreislaufs mit einer pathologischen Erhöhung des pulmonalarteriellen Drucks.

Fragestellung

Dieser Beitrag gibt einen Überblick über die Bildgebung bei PH bei Erwachsenen und diskutiert deren Wert für die Erkennung einer PH, die Identifizierung der Ursache und die Beurteilung der Prognose.

Material und Methode

Es werden Grundlagenarbeiten, Leitlinien und Expertenempfehlungen diskutiert.

Ergebnisse

Charakteristische Bildbefunde können auf eine PH hinweisen und zur Identifizierung der Ursache der PH beitragen. Eine Reihe von bildbasierten Parametern hat prognostische Bedeutung. Bei der Abklärung einer PH wird ein strukturiertes Vorgehen für den Einsatz von Bildgebung empfohlen.

Schlussfolgerungen

Der sinnvolle Einsatz von Bildgebung ist unverzichtbar für Patienten mit vermuteter PH, insbesondere für die Identifizierung der Ursache der PH.
Literatur
1.
Zurück zum Zitat Galiè N, Humbert M, Vachiery J‑L et al (2015) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European society of cardiology (ESC) and the European respiratory society (ERS): endorsed by: association for European paediatric and congenital cardiology (AEPC), international society for heart and lung transplantation (ISHLT). Eur Respir J 46:903–975CrossRefPubMed Galiè N, Humbert M, Vachiery J‑L et al (2015) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European society of cardiology (ESC) and the European respiratory society (ERS): endorsed by: association for European paediatric and congenital cardiology (AEPC), international society for heart and lung transplantation (ISHLT). Eur Respir J 46:903–975CrossRefPubMed
4.
Zurück zum Zitat Rengier F, Melzig C, Derlin T et al (2019) Advanced imaging in pulmonary hypertension: emerging techniques and applications. Int J Cardiovasc Imaging 35:1407–1420CrossRefPubMed Rengier F, Melzig C, Derlin T et al (2019) Advanced imaging in pulmonary hypertension: emerging techniques and applications. Int J Cardiovasc Imaging 35:1407–1420CrossRefPubMed
5.
Zurück zum Zitat Remy-Jardin M, Ryerson CJ, Schiebler ML et al (2021) Imaging of pulmonary hypertension in adults: a position paper from the Fleischner society. Radiology 298:531–549CrossRefPubMed Remy-Jardin M, Ryerson CJ, Schiebler ML et al (2021) Imaging of pulmonary hypertension in adults: a position paper from the Fleischner society. Radiology 298:531–549CrossRefPubMed
6.
Zurück zum Zitat Truong QA, Massaro JM, Rogers IS et al (2012) Reference values for normal pulmonary artery dimensions by noncontrast cardiac computed tomography: the Framingham heart study. circ Cardiovasc Imaging 5:147–154CrossRefPubMed Truong QA, Massaro JM, Rogers IS et al (2012) Reference values for normal pulmonary artery dimensions by noncontrast cardiac computed tomography: the Framingham heart study. circ Cardiovasc Imaging 5:147–154CrossRefPubMed
7.
Zurück zum Zitat Lee SH, Kim YJ, Lee HJ et al (2015) Comparison of CT-determined pulmonary artery diameter, aortic diameter, and their ratio in healthy and diverse clinical conditions. PLoS ONE 10:e126646CrossRefPubMedPubMedCentral Lee SH, Kim YJ, Lee HJ et al (2015) Comparison of CT-determined pulmonary artery diameter, aortic diameter, and their ratio in healthy and diverse clinical conditions. PLoS ONE 10:e126646CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Rengier F, Wörz S, Melzig C et al (2016) Automated 3D Volumetry of the pulmonary arteries based on magnetic resonance angiography has potential for predicting pulmonary hypertension. PLoS ONE 11:e162516CrossRefPubMedPubMedCentral Rengier F, Wörz S, Melzig C et al (2016) Automated 3D Volumetry of the pulmonary arteries based on magnetic resonance angiography has potential for predicting pulmonary hypertension. PLoS ONE 11:e162516CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Melzig C, Wörz S, Egenlauf B et al (2019) Combined automated 3D volumetry by pulmonary CT angiography and echocardiography for detection of pulmonary hypertension. Eur Radiol 29:6059–6068CrossRefPubMed Melzig C, Wörz S, Egenlauf B et al (2019) Combined automated 3D volumetry by pulmonary CT angiography and echocardiography for detection of pulmonary hypertension. Eur Radiol 29:6059–6068CrossRefPubMed
10.
Zurück zum Zitat Johns CS, Kiely DG, Rajaram S et al (2019) Diagnosis of pulmonary hypertension with cardiac MRI: derivation and validation of regression models. Radiology 290:61–68CrossRefPubMed Johns CS, Kiely DG, Rajaram S et al (2019) Diagnosis of pulmonary hypertension with cardiac MRI: derivation and validation of regression models. Radiology 290:61–68CrossRefPubMed
11.
Zurück zum Zitat Swift AJ, Rajaram S, Hurdman J et al (2013) Noninvasive estimation of PA pressure, flow, and resistance with CMR imaging: derivation and prospective validation study from the ASPIRE registry. jacc Cardiovasc Imaging 6:1036–1047CrossRefPubMed Swift AJ, Rajaram S, Hurdman J et al (2013) Noninvasive estimation of PA pressure, flow, and resistance with CMR imaging: derivation and prospective validation study from the ASPIRE registry. jacc Cardiovasc Imaging 6:1036–1047CrossRefPubMed
12.
Zurück zum Zitat Montani D, Achouh L, Dorfmüller P et al (2008) Pulmonary veno-occlusive disease: clinical, functional, radiologic, and hemodynamic characteristics and outcome of 24 cases confirmed by histology. Medicine (Baltimore) 87:220–233CrossRef Montani D, Achouh L, Dorfmüller P et al (2008) Pulmonary veno-occlusive disease: clinical, functional, radiologic, and hemodynamic characteristics and outcome of 24 cases confirmed by histology. Medicine (Baltimore) 87:220–233CrossRef
13.
Zurück zum Zitat Tio D, Leter E, Boerrigter B et al (2013) Risk factors for hemoptysis in idiopathic and hereditary pulmonary arterial hypertension. PLoS One 8:e78132CrossRefPubMedPubMedCentral Tio D, Leter E, Boerrigter B et al (2013) Risk factors for hemoptysis in idiopathic and hereditary pulmonary arterial hypertension. PLoS One 8:e78132CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Jivraj K, Bedayat A, Sung YK et al (2017) Left atrium maximal axial cross-sectional area is a specific computed tomographic imaging biomarker of world health organization group 2 pulmonary hypertension. J Thorac Imaging 32:121–126CrossRefPubMed Jivraj K, Bedayat A, Sung YK et al (2017) Left atrium maximal axial cross-sectional area is a specific computed tomographic imaging biomarker of world health organization group 2 pulmonary hypertension. J Thorac Imaging 32:121–126CrossRefPubMed
15.
Zurück zum Zitat Aviram G, Rozenbaum Z, Ziv-Baran T et al (2017) Identification of pulmonary hypertension caused by left-sided heart disease (world health organization group 2) based on cardiac chamber volumes derived from chest CT imaging. Chest 152:792–799CrossRefPubMed Aviram G, Rozenbaum Z, Ziv-Baran T et al (2017) Identification of pulmonary hypertension caused by left-sided heart disease (world health organization group 2) based on cardiac chamber volumes derived from chest CT imaging. Chest 152:792–799CrossRefPubMed
16.
Zurück zum Zitat Phillips JJ, Straiton J, Staff RT (2015) Planar and SPECT ventilation/perfusion imaging and computed tomography for the diagnosis of pulmonary embolism: a systematic review and meta-analysis of the literature, and cost and dose comparison. Eur J Radiol 84:1392–1400CrossRefPubMed Phillips JJ, Straiton J, Staff RT (2015) Planar and SPECT ventilation/perfusion imaging and computed tomography for the diagnosis of pulmonary embolism: a systematic review and meta-analysis of the literature, and cost and dose comparison. Eur J Radiol 84:1392–1400CrossRefPubMed
17.
Zurück zum Zitat Tunariu N, Gibbs SJR, Win Z et al (2007) Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med 48:680–684CrossRefPubMed Tunariu N, Gibbs SJR, Win Z et al (2007) Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med 48:680–684CrossRefPubMed
18.
Zurück zum Zitat Dong C, Zhou M, Liu D et al (2015) Diagnostic accuracy of computed tomography for chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis. PLoS ONE 10:e126985CrossRefPubMedPubMedCentral Dong C, Zhou M, Liu D et al (2015) Diagnostic accuracy of computed tomography for chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis. PLoS ONE 10:e126985CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Palm V, Rengier F, Rajiah P et al (2020) Acute pulmonary embolism: imaging techniques, findings, endovascular treatment and differential diagnoses. Rofo 192:38–49CrossRefPubMed Palm V, Rengier F, Rajiah P et al (2020) Acute pulmonary embolism: imaging techniques, findings, endovascular treatment and differential diagnoses. Rofo 192:38–49CrossRefPubMed
20.
Zurück zum Zitat Tamura M, Yamada Y, Kawakami T et al (2017) Diagnostic accuracy of lung subtraction iodine mapping CT for the evaluation of pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: Correlation with perfusion SPECT/CT. int J Cardiol 243:538–543CrossRefPubMed Tamura M, Yamada Y, Kawakami T et al (2017) Diagnostic accuracy of lung subtraction iodine mapping CT for the evaluation of pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: Correlation with perfusion SPECT/CT. int J Cardiol 243:538–543CrossRefPubMed
21.
Zurück zum Zitat Masy M, Giordano J, Petyt G et al (2018) Dual-energy CT (DECT) lung perfusion in pulmonary hypertension: concordance rate with V/Q scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). Eur Radiol 28:5100–5110CrossRefPubMed Masy M, Giordano J, Petyt G et al (2018) Dual-energy CT (DECT) lung perfusion in pulmonary hypertension: concordance rate with V/Q scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). Eur Radiol 28:5100–5110CrossRefPubMed
22.
Zurück zum Zitat Rajaram S, Swift AJ, Telfer A et al (2013) 3D contrast-enhanced lung perfusion MRI is an effective screening tool for chronic thromboembolic pulmonary hypertension: results from the ASPIRE registry. Thorax 68:677–678CrossRefPubMed Rajaram S, Swift AJ, Telfer A et al (2013) 3D contrast-enhanced lung perfusion MRI is an effective screening tool for chronic thromboembolic pulmonary hypertension: results from the ASPIRE registry. Thorax 68:677–678CrossRefPubMed
23.
Zurück zum Zitat Schönfeld C, Cebotari S, Voskrebenzev A et al (2015) Performance of perfusion-weighted Fourier decomposition MRI for detection of chronic pulmonary emboli. J Magn Reson Imaging 42:72–79CrossRefPubMed Schönfeld C, Cebotari S, Voskrebenzev A et al (2015) Performance of perfusion-weighted Fourier decomposition MRI for detection of chronic pulmonary emboli. J Magn Reson Imaging 42:72–79CrossRefPubMed
24.
Zurück zum Zitat Lasch F, Karch A, Koch A et al (2020) Comparison of MRI and VQ-SPECT as a screening test for patients with suspected CTEPH: CHANGE-MRI study design and rationale. Front Cardiovasc Med 7:51CrossRefPubMedPubMedCentral Lasch F, Karch A, Koch A et al (2020) Comparison of MRI and VQ-SPECT as a screening test for patients with suspected CTEPH: CHANGE-MRI study design and rationale. Front Cardiovasc Med 7:51CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Peacock AJ, Crawley S, McLure L et al (2014) Changes in right ventricular function measured by cardiac magnetic resonance imaging in patients receiving pulmonary arterial hypertension-targeted therapy: the EURO-MR study. circ Cardiovasc Imaging 7:107–114CrossRefPubMed Peacock AJ, Crawley S, McLure L et al (2014) Changes in right ventricular function measured by cardiac magnetic resonance imaging in patients receiving pulmonary arterial hypertension-targeted therapy: the EURO-MR study. circ Cardiovasc Imaging 7:107–114CrossRefPubMed
26.
Zurück zum Zitat Schoenfeld C, Hinrichs JB, Olsson KM et al (2019) Cardio-pulmonary MRI for detection of treatment response after a single BPA treatment session in CTEPH patients. Eur Radiol 29:1693–1702CrossRefPubMed Schoenfeld C, Hinrichs JB, Olsson KM et al (2019) Cardio-pulmonary MRI for detection of treatment response after a single BPA treatment session in CTEPH patients. Eur Radiol 29:1693–1702CrossRefPubMed
27.
Zurück zum Zitat Schoenfeld C, Cebotari S, Hinrichs J et al (2016) MR imaging-derived regional pulmonary parenchymal perfusion and cardiac function for monitoring patients with chronic thromboembolic pulmonary hypertension before and after pulmonary endarterectomy. Radiology 279:925–934CrossRefPubMed Schoenfeld C, Cebotari S, Hinrichs J et al (2016) MR imaging-derived regional pulmonary parenchymal perfusion and cardiac function for monitoring patients with chronic thromboembolic pulmonary hypertension before and after pulmonary endarterectomy. Radiology 279:925–934CrossRefPubMed
Metadaten
Titel
Bildgebung bei pulmonaler Hypertonie
verfasst von
PD Dr. Fabian Rengier
Claudius Melzig
Jens Vogel-Claussen
Publikationsdatum
02.08.2021
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Pneumologie / Ausgabe 5/2021
Print ISSN: 2731-7404
Elektronische ISSN: 2731-7412
DOI
https://doi.org/10.1007/s10405-021-00407-z

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