Chronic thromboembolic pulmonary hypertension: Role of imaging in diagnosis and guiding the treatment

Abstract

Chronic thromboembolic pulmonary hypertension is a life-threatening condition resulting from unresolved thromboemboli that obstructs pulmonary arteries, leading to increased pulmonary vascular resistance and right heart failure. Accurate and timely diagnosis is critical for effective management and improving patient outcomes. Imaging plays a crucial role in the diagnosis, with CT pulmonary angiography being the primary modality due to its ability to provide detailed visualization of pulmonary vasculature and parenchymal changes. The ventilation/perfusion scan remains an essential tool, particularly for initial screening, given its high sensitivity in detecting perfusion defects. Recent advancements in imaging, including dual-energy CT and magnetic resonance imaging, offer additional functional and anatomical insights, further aiding in comprehensive patient evaluation. Imaging is also crucial for pre-operative planning in candidates for pulmonary endarterectomy and for monitoring post-operative recovery and disease progression. By integrating multiple imaging modalities, clinicians can achieve a more accurate diagnosis, optimize treatment strategies, and improve long-term outcomes for patients with CTEPH.