Imaging in chronic thromboembolic pulmonary disease: Current practice and advances

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS International journal of cardiology. Congenital heart disease Pub Date : 2024-08-10 DOI:10.1016/j.ijcchd.2024.100536
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Abstract

Chronic thromboembolic pulmonary disease (CTEPD) with or without pulmonary hypertension (PH) occurs when thromboemboli in pulmonary arteries fail to resolve completely. Pulmonary artery obstructions due to chronic thrombi and secondary microvasculopathy can increase pulmonary arterial pressure and resistance leading to chronic thromboembolic PH (CTEPH). Mechanical interventions and/or PH medications can improve cardiopulmonary haemodynamic, alleviate symptoms, and decrease mortality risk. Imaging is pivotal throughout the CTEPD management journey, spanning diagnosis, treatment planning, and assessing treatment outcome. With just computed tomography (CT) pulmonary angiogram and right heart catheterisation, an experienced multidisciplinary team can determine surgical candidacy in most cases. Dual energy CT, lung subtraction iodine mapping CT, and dynamic contrast-enhanced magnetic resonance imaging (MRI) offer comparable sensitivities with ventilation-perfusion scintigraphy in diagnosing CTEPD. Pulmonary angiogram with digital subtraction angiography although considered the gold standard for assessing thrombi extent and vasculature morphology is now mostly used to assess targets for balloon pulmonary angioplasty. Advancements in CT modalities and innovative MRI metrics offer better insight into CTEPD management but are limited by the availability of technology and expertise. Learning from current artificial intelligence application in medical imaging, there is promise in tapping the wealth of data provided by CTEPD imaging through automating cardiopulmonary and vascular morphology analysis.

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慢性血栓栓塞性肺病的成像:当前实践与进展
当肺动脉中的血栓栓塞未能完全消退时,就会发生伴有或不伴有肺动脉高压(PH)的慢性血栓栓塞性肺病(CTEPD)。慢性血栓和继发性微血管病变造成的肺动脉阻塞会增加肺动脉压力和阻力,导致慢性血栓栓塞性肺动脉高压(CTEPH)。机械干预和/或 PH 药物可改善心肺血流动力学、缓解症状并降低死亡风险。在 CTEPD 的整个治疗过程中,影像学在诊断、治疗计划和治疗效果评估方面都起着至关重要的作用。只需进行计算机断层扫描(CT)肺血管造影和右心导管检查,经验丰富的多学科团队就能确定大多数病例是否适合手术。双能量 CT、肺减影碘映射 CT 和动态对比增强磁共振成像(MRI)在诊断 CTEPD 方面的灵敏度与通气-灌注闪烁成像相当。虽然数字减影血管造影被认为是评估血栓范围和血管形态的金标准,但目前主要用于评估球囊肺血管成形术的目标。CT 模式和创新磁共振成像指标的进步为 CTEPD 的管理提供了更好的视角,但受限于技术和专业知识的可用性。借鉴当前人工智能在医学影像领域的应用,通过自动化心肺和血管形态分析,有望利用 CTEPD 成像提供的丰富数据。
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来源期刊
International journal of cardiology. Congenital heart disease
International journal of cardiology. Congenital heart disease Cardiology and Cardiovascular Medicine
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83 days
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