Imaging of pulmonary arterial hypertension - 17/06/09

Introduction The investigation of pulmonary arterial hypertension (PAH) imposes a rigorous aetiological assessment in which modern imaging techniques play an important role.

Background A plain chest x-ray may show non-specific signs such as cardiomegaly and dilatation of the pulmonary arteries and also provides details of the lung parenchyma. Echocardiography is the essential screening tool to evaluate left ventricular function. Pulmonary ventilation/perfusion scanning is essential to confirm post embolic PAH. Spiral CT has also become an essential examination, yielding a detailed study of the lung parenchyma, the pulmonary vessels and the heart chambers; it is also helpful in determining the aetiology and completes the pre-treatment assessment. Magnetic resonance imaging can be used to calculate several haemodynamic parameters and also provides a morphological study of the cardiac chambers and pulmonary vessels but requires further evaluation.

Viewpoint The improvement in the quality of vascular images and the development of complementary MRI techniques may lead to an increase in the use of this MRI technology in the study of PAH.

Conclusion Imaging plays a fundamental role in the management of patients suffering from PAH.