Pulmonary hypertension MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Richard Channick, M.D.; Assistant Editor(s)-in-Chief: Ralph Matar

Overview

Cardiac MRI provides important prognostic indicators regarding the function of right ventricle in patients with pulmonary hypertension.

MRI

Role of MRI

• Accurately evaluation of the size, morphology and function of the right ventricle.
  • MRI has similar abilities to those of echocardiography in the diagnosis and treatment of patients with pulmonary hypertension.

• Detection of shunts contributing to pulmonary hypertension.

• Detection of acute and chronic pulmonary thromboembolic disease.

• Differentiation between the pulmonary vasculature and mediastinal adenopathy when used with contrast enhancement.

• Follow-up for right heart hemodynamics.
  • Poor right ventricular function is indicated by the following according to the ACCF/AHA 2009 Expert consensus document on pulmonary hypertension:
    • Stroke volume ≤25ml/m^2.
    • Right ventricular end-diastolic volume ≥84ml/m^2( Most appropriate marker of right ventricular failure in the follow-up.)
    • Left ventricvular end-diastolic volume ≤40ml/m^2

• Pulmonary artery stiffness measured by relative cross sectional area change ≤16% also has implications on mortality rate.

MRI Limitations include

• Inability to perform breath hold.

• Claustrophobia.

• Incompatible hardware such as neurostimulators, cochlear implants, aneurysm clips, cardiac pacemakers and defibrillators.

• Limited availability and cost.

• Difficulty in assessing PA pressures.