Open AccessCardiac MRI in Pulmonary Hypertension: From Magnet to Bedside
Author(s) -
Jordi Broncano,
Sanjeev Bhalla,
Fernando R. Gutiérrez,
Daniel Vargas,
Eric E. Williamson,
Majesh Makan,
Antonio Luna
Publication year - 2020
Publication title -
radiographics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.866
H-Index - 172
eISSN - 1527-1323
pISSN - 0271-5333
DOI - 10.1148/rg.2020190179
Subject(s) - medicine , steady state free precession imaging , cardiology , pulmonary hypertension , heart failure , ejection fraction , feature tracking , diastole , hemodynamics , radiology , heart failure with preserved ejection fraction , magnetic resonance imaging , blood pressure , physics , quantum mechanics , harp
Pulmonary hypertension (PH) is a disease characterized by progressive rise of pulmonary artery (PA) pressure, which can lead to right ventricular (RV) failure. It is usually diagnosed late because of the nonspecificity of its symptoms. RV performance and adaptation to an increased afterload, reflecting the interaction of the PA and RV as a morphofunctional unit, constitute a critical determinant of morbidity and mortality in these patients. Therefore, early detection of dysfunction may prevent treatment failure. Cardiac MRI constitutes one of the most complete diagnostic modalities for diagnosing PH. It allows evaluation of the morphology and hemodynamics of the PA and RV. Several cine steady-state free-precession (SSFP)-derived parameters (indexed RV end-diastolic volume or RV systolic volume) and phase-contrast regional area change have been suggested as powerful biomarkers for prognosis and treatment. Recently, new cardiac MRI sequences have been added to clinical protocols for PH evaluation, providing brand-new information. Strain analysis with myocardial feature tracking can help detect early RV dysfunction, even with preserved ejection fraction. Four-dimensional flow cardiac MRI can enhance assessment of advanced RV and PA hemodynamics. Late gadolinium enhancement (LGE) imaging may allow detection of replacement fibrosis in PH patients, which is associated with poor outcome. T1 mapping may help detect interstitial fibrosis, even with normal LGE imaging results. The authors analyze the imaging workup of PH with a focus on the role of morphologic and functional cardiac MRI in diagnosis and management of PH, including some of the newer techniques. Online supplemental material is available for this article. © RSNA, 2020.