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01-03-2012 | Magnetic Resonance

Black blood MRI has diagnostic and prognostic value in the assessment of patients with pulmonary hypertension

Authors: Andrew J. Swift, Smitha Rajaram, Helen Marshall, Robin Condliffe, Dave Capener, Catherine Hill, Christine Davies, Judith Hurdman, Charlie A. Elliot, Jim M. Wild, David G. Kiely

Published in: European Radiology | Issue 3/2012

Abstract

Objectives

Double inversion recovery (DIR) “black blood” MRI suppresses the signal from flowing blood, slow flowing blood causes incomplete suppression resulting in pulmonary blood flow artefact (PFA). This study examines the diagnostic utility and prognostic value of a PFA scoring system in a mixed cohort of patients with pulmonary hypertension (PH).

Methods

DIR-MRI images were reviewed for 233 patients referred with suspected PH who underwent right heart catheterisation (RHC) within 48 h of MR. The degree of PFA was visually scored in all patients from 0 to 5 (0 = absent, 1 = segmental, 2 = lobar, 3 = distal main, 4 = proximal main and 5 = trunk). Pulmonary artery (PA), aorta (Ao), and PA main branch diameters were measured from which PA/Ao ratios and mean PA branch diameters (MPAB) were calculated.

Results

PFA >1 demonstrated high sensitivity (86%) and specificity (85%) for the diagnosis PH in our mixed patient cohort. A good correlation was found with PFA and haemodynamic parameters, PVR (r = 0.70), mPAP (r = 0.65) and CI (r = −0.53). PFA predicted mortality (P = 0.005) during the mean follow-up for 19 months. PFA scoring demonstrated good inter-observer agreement (k = 0.83).

Conclusions

PFA scoring is of diagnostic and prognostic value in the assessment of patients with suspected PH. and is a predictor of mortality.

Key Points

• A simple magnetic resonance method of assessing pulmonary blood flow is presented

• This involves a qualitative scoring system of black blood pulmonary flow artefacts

• This is simple to perform and seems reproducible in pulmonary hypertension patients

• The degree of artefact correlates well with right heart catheter measurements

• Prominent pulmonary flow artefact predicts mortality in patients with pulmonary hypertension

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Title: Black blood MRI has diagnostic and prognostic value in the assessment of patients with pulmonary hypertension
Authors: Andrew J. Swift
Smitha Rajaram
Helen Marshall
Robin Condliffe
Dave Capener
Catherine Hill
Christine Davies
Judith Hurdman
Charlie A. Elliot
Jim M. Wild
David G. Kiely
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: European Radiology / Issue 3/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-011-2306-0

At a glance: The STEP trials

Springer Medicine

Black blood MRI has diagnostic and prognostic value in the assessment of patients with pulmonary hypertension

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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