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Imaging in Chronic Thromboembolic Pulmonary Hypertension

Renapurkar, Rahul D. MD; Shrikanthan, Sankaran MD; Heresi, Gustavo A. MD; Lau, Charles T. MD, MBA; Gopalan, Deepa MRCP, FRCR

doi: 10.1097/RTI.0000000000000256
Review Articles

Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable causes of pulmonary hypertension and is definitively treated with pulmonary thromboendartectomy. CTEPH can be overlooked, as its symptoms are nonspecific and can be mimicked by a wide range of diseases that can cause pulmonary hypertension. Early diagnosis of CTEPH and prompt evaluation for surgical candidacy are paramount factors in determining future outcomes. Imaging plays a central role in the diagnosis of CTEPH and patient selection for pulmonary thromboendartectomy and balloon pulmonary angioplasty. Currently, various imaging tools are used in concert, with techniques such as computed tomography (CT) and conventional pulmonary angiography providing detailed structural information, tests such as ventilation-perfusion (V/Q) scanning providing functional data, and magnetic resonance imaging providing a combination of morphologic and functional information. Emerging techniques such as dual-energy CT and single photon emission computed tomography-CT V/Q scanning promise to provide both anatomic and functional information in a single test and may change the way we image these patients in the near future. In this review, we discuss the roles of various imaging techniques and discuss their merits, limitations, and relative strengths in depicting the structural and functional changes of CTEPH. We also explore newer imaging techniques and the potential value they may offer.

*Section of Thoracic Imaging

Cardiovascular Imaging Laboratory

Section of Nuclear Medicine, Imaging Institute

§Section of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH

Department of Radiology, VA Palo Alto Health Care System, Palo Alto, CA

Department of Radiology, Imperial College Hospitals, London, UK

Gustavo Heresi: Bayer Healthcare: speaker's bureau, advisory board and consultant. The remaining authors declare no conflicts of interest.

Correspondence to: Rahul D. Renapurkar, MD, Section of Thoracic Imaging, L10, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195 (e-mail:

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