title: Value of high spatial and high temporal resolution magnetic resonance angiography for differentiation between idiopathic and thromboembolic pulmonary hypertension: initial results.
abstract: Differentiation between different forms of pulmonary hypertension (PH) is essential for correct disease management. The goal of this study was to elucidate the clinical impact of high spatial resolution MR angiography (SR-MRA) and time-resolved MRA (TR-MRA) to differentiate between patients with chronic thromboembolic PH (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH). Ten PH patients and five volunteers were examined. Twenty TR-MRA data sets (TA 1.5 s) and SR-MRA (TA 23 s) were acquired. TR-MRA data sets were subtracted as angiography and perfusion images. Evaluation comprised analysis of vascular pathologies on a segmental basis, detection of perfusion defects, and bronchial arteries by two readers in consensus. Technical evaluation comprised evaluation of image quality, signal-to-noise ratio (SNR) measurements, and contrast-media passage time. Visualization of the pulmonary arteries was possible down to a subsegmental (SR-MRA) and to a segmental (TR-MRA) level. SR-MRA outperformed TR-MRA in direct visualization of intravascular changes. Patients with IPAH predominantly showed tortuous pulmonary arteries while in CTEPH wall irregularities and abnormal proximal-to-distal tapering was found. Perfusion images showed a diffuse pattern in IPAH and focal defects in CTEPH. TR-MRA and SR-MRA resulted in the same final diagnosis. Both MRA techniques allowed for differentiation between IPAH and CTEPH. Therefore, TR-MRA can be used in the clinical setting, especially in dyspneic patients.
authors.affiliation: Department of Radiology (E010), DKFZ, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. ley@gmx.net
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ley
authors.forename: Christian
authors.initials: C
authors.lastname: Fink
authors.forename: Julia
authors.initials: J
authors.lastname: Zaporozhan
authors.forename: Mathias M
authors.initials: MM
authors.lastname: Borst
authors.forename: F Joachim
authors.initials: FJ
authors.lastname: Meyer
authors.forename: Michael
authors.initials: M
authors.lastname: Puderbach
authors.forename: Monika
authors.initials: M
authors.lastname: Eichinger
authors.forename: Christian
authors.initials: C
authors.lastname: Plathow
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Grünig
authors.forename: Karl-Friedrich
authors.initials: KF
authors.lastname: Kreitner
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Kauczor
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications*