3D contrast-enhanced lung perfusion MRI is an effective screening tool for chronic thromboembolic pulmonary hypertension: results from the ASPIRE Registry.
BACKGROUND
Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism potentially curable by surgery. Perfusion scintigraphy is currently advocated as the imaging modality of choice to exclude CTEPH due to its high sensitivity. We have evaluated the diagnostic utility of lung perfusion MRI.


METHODS
Consecutive patients attending a pulmonary hypertension referral centre undergoing lung perfusion MRI, perfusion scintigraphy, CT pulmonary angiography (CTPA) and right heart catheterisation within 14 days were identified.


RESULTS
Of 132 patients, 78 were diagnosed as having CTEPH. Lung perfusion MRI correctly identified 76 patients as having CTEPH with an overall sensitivity of 97%, specificity 92%, positive predictive value 95% and negative predictive value 96% compared with perfusion scintigraphy (sensitivity 96%, specificity 90%) and CTPA (sensitivity 94%, specificity 98%). No cases of surgically accessible CTEPH were missed with either modality.


CONCLUSIONS
Lung perfusion MRI has high sensitivity equivalent to perfusion scintigraphy in diagnosing CTEPH but does not require ionising radiation, making it an attractive initial imaging modality to assess patients with suspected CTEPH.
Academic Unit of Radiology, University of Sheffield, Sheffield, UK.
Smitha
S
Rajaram
Andrew J
AJ
Swift
Adam
A
Telfer
Judith
J
Hurdman
Helen
H
Marshall
Eleanor
E
Lorenz
David
D
Capener
Christine
C
Davies
Catherine
C
Hill
Charlie
C
Elliot
Robin
R
Condliffe
Jim M
JM
Wild
David G
DG
Kiely
D002908:Chronic Disease; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology; D021621:Imaging, Three-Dimensional / Q000379:methods*; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results
Imaging/CT MRI etc