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Quantitative Magnetic Resonance Imaging of Pulmonary Hypertension: A Practical Approach to the Current State of the Art

Swift, Andrew J. PhD*; Wild, Jim M. PhD*; Nagle, Scott K. MD, PhD†,‡,§; Roldán-Alzate, Alejandro PhD; François, Christopher J. MD; Fain, Sean PhD†,§; Johnson, Kevin PhD; Capener, Dave MSc*; van Beek, Edwin J.R. MD, PhD; Kiely, David G. MD#; Wang, Kang PhD**; Schiebler, Mark L. MD

doi: 10.1097/RTI.0000000000000079
Symposium Review Articles

Pulmonary hypertension is a condition of varied etiology, commonly associated with poor clinical outcome. Patients are categorized on the basis of pathophysiological, clinical, radiologic, and therapeutic similarities. Pulmonary arterial hypertension (PAH) is often diagnosed late in its disease course, with outcome dependent on etiology, disease severity, and response to treatment. Recent advances in quantitative magnetic resonance imaging (MRI) allow for better initial characterization and measurement of the morphologic and flow-related changes that accompany the response of the heart-lung axis to prolonged elevation of pulmonary arterial pressure and resistance and provide a reproducible, comprehensive, and noninvasive means of assessing the course of the disease and response to treatment. Typical features of PAH occur primarily as a result of increased pulmonary vascular resistance and the resultant increased right ventricular (RV) afterload. Several MRI-derived diagnostic markers have emerged, such as ventricular mass index, interventricular septal configuration, and average pulmonary artery velocity, with diagnostic accuracy similar to that of Doppler echocardiography. Furthermore, prognostic markers have been identified with independent predictive value for identification of treatment failure. Such markers include large RV end-diastolic volume index, low left ventricular end-diastolic volume index, low RV ejection fraction, and relative area change of the pulmonary trunk. MRI is ideally suited for longitudinal follow-up of patients with PAH because of its noninvasive nature and high reproducibility and is advantageous over other biomarkers in the study of PAH because of its sensitivity to change in morphologic, functional, and flow-related parameters. Further study on the role of MRI image based biomarkers in the clinical environment is warranted.

*Academic Unit of Radiology, Department of Cardiovascular Science, University of Sheffield

#Sheffield Pulmonary Vascular Disease Unit, Royal Hammashire Hospital, Sheffield

Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health

Departments of Pediatrics

§Medical Physics

Biomedical Engineering, University of Wisconsin-Madison

**General Electric Medical Systems, Advanced Science Laboratory, Madison, WI

Kang Wang is an employee of General Electric Medical Systems. The remaining authors declare no conflicts of interest.

Reprints: Jim M. Wild, PhD, Academic Unit of Radiology, University of Sheffield, C Floor, Royal Hallamshire Hospital, Sheffield S10 2JF, UK (e-mail:

© 2014 by Lippincott Williams & Wilkins