Skip to main content

Advertisement

SpringerLink
Log in

Role of Cardiovascular CT in Pulmonary Hypertension

  • Cardiovascular Imaging (K Ordovas, Section Editor)
  • Published:
Current Radiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Pulmonary hypertension (PH) is a disease in which there is an elevated pressure in the pulmonary vasculature leading to anatomic changes that can be identified on imaging. While right heart catheterization (RHC) is the gold standard for definitive diagnosis, there are many steps prior to catheterization in evaluating a patient with suspected PH. Computed Tomography (CT) is often used as one of the initial imaging modalities in the workup of suspected PH and is usually obtained in all patients with suspected or confirmed PH. In other cases, CT scans done for other purposes can suggest findings of PH that would alert clinicians to an additional possible diagnosis. Patients diagnosed with PH often have very complex hemodynamics as well as medical comorbidities, and referral to a center that specializes in PH is always recommended.

Recent Findings

There have been newly proposed classifications for the different groups of PH as well as a new definition for the diagnosis of PH. Various findings may require a specific CT to be completed with or without contrast or an electrocardiogram (ECG)-gated CT.

Summary

This article reviews the current literature and provides a pictorial reference of CT findings associated with PH that can lead to a proposed diagnosis and, possibly, the underlying etiology of PH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

• Of importance •• Of major importance

  1. ••Altschul E, Remy-Jardin M, Machnicki S, et al. Imaging of pulmonary hypertension. Chest. 2019. https://doi.org/10.1016/j.chest.2019.04.003. This is a comprehensive and updated paper that defines and provides imaging examples of specific findings that are associated with PH on CT. Corresponding sensitivities and specificities are stated, providing evidence of the association of certain CT findings in PH. Images of certain characteristic findings are included to give clues to the etiology of PH.

  2. Hoeper MM, Humbert M. The new haemodynamic definition of pulmonary hypertension: evidence prevails, finally! Eur Respir J. 2019;53:1900038. https://doi.org/10.1183/13993003.00038-2019.

    Article  PubMed  Google Scholar 

  3. Condon DF, Nickel NP, Anderson R, Mirza S, de Jesus Perez VA. The 6th world symposium on pulmonary hypertension: what's old is new. F1000Res. 2019. https://doi.org/10.12688/f1000research.18811.1.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wijeratne DT, Lajkosz K, Brogly SB, et al. Increasing incidence and prevalence of World Health Organization Groups 1 to 4 pulmonary hypertension: a population based Cohort Study in Ontario, Canada. Circ Cardiovasc Qual Outcomes. 2018;11(2):e003973. https://doi.org/10.1161/CIRCOUTCOMES.117.003973.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Galie N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Eur Heart J. 2016;37(1):67–119. https://doi.org/10.1093/eurheartj/ehv317.

    Article  PubMed  Google Scholar 

  6. Graham BB, Bandeira AP, Morrell NW, et al. Schistosomiasis-associated pulmonary hypertension: pulmonary vascular disease: the global perspective. Chest. 2010;137(6 suppl):20S–9S.

    Article  Google Scholar 

  7. Rahaghi F, Mehta J, Tonelli A. Session IV- Therapeutic Choices for Pulmonary Artery Hypertension. Pulmonary Hypertension Summit Proceedings Monograph. https://www.clevelandclinicmeded.com/online/monograph/pulmonary-hypertension/therapeutic-choices.htm. Accessed January 24, 2020.

  8. Vachiery JL, Adir Y, Babera JA, et al. Pulmonary hypertension due to left heart disease. J Am Coll Cardiol. 2013;62:D100–D108108.

    Article  Google Scholar 

  9. Arcasoy SM, Christie JD, Ferrari VA, et al. Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Resp Crit Care Med. 2003;167:735–40.

    Article  Google Scholar 

  10. Hoeper MM, Bogaard HJ, Condliffe R, et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013;62(25):D42–D50.

    Article  Google Scholar 

  11. Heresi GA, Bartholomew JR, Lang IM, et al. Session I-acute and chronic pulmonary embolism. pulmonary hypertension summit proceedings monograph. https://www.clevelandclinicmeded.com/online/monograph/pulmonary-hypertension/acute-chronic-embolism.htm. Accessed Jan 24, 2020.

  12. Marvisi M, Balzarini L, Mancini C, et al. Thyroid gland and pulmonary hypertension. What’s the link? Panminerva Med. 2013;55(1):93–7.

    CAS  PubMed  Google Scholar 

  13. Kalantar S, Gomberg-Maitland M. Group 5 pulmonary hypertension: the orphan’s orphan disease. Cardiol Clin. 2016;34(3):443–9. https://doi.org/10.1016/j.ccl.2016.04.004.

    Article  Google Scholar 

  14. Grosse C, Grosse A. CT findings in diseases associated with pulmonary hypertension: a current review. Radiographics. 2010;30(7):1753–77.

    Article  Google Scholar 

  15. Bhatnagar A, Wiesen J, Dweik R, et al. Evaluating suspected pulmonary hypertension: a structured approach. Clevel Clin J Med. 2018;85(6):468–80. https://doi.org/10.3949/ccjm.85a.17065.

    Article  Google Scholar 

  16. Lin FY, Devereux RB, Roman MJ, et al. Cardiac chamber volumes, function, and mass as determined by 64-multidetector row computed tomography: mean values among healthy adults free of hypertension and obesity. JACC Cardiovasc Imaging. 2008;1(6):782–6.

    Article  Google Scholar 

  17. Ho VB, Reddy GP. Cardiovascular imaging. Saunders: Elsevier; 2011.

    Google Scholar 

  18. Hur DJ, Sugeng L. Non-invasive multimodality cardiovascular imaging of the right heart and pulmonary circulation in pulmonary hypertension. Front Cardiovasc Med. 2019;6:24. https://doi.org/10.3389/fcvm.2019.00024.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tadic M. Multimodality evaluation of the right ventricle: an updated review. Clin Cardiol. 2015;38:770–6.

    Article  Google Scholar 

  20. Wai B, Thai WE, Brown H, Truong QA. Novel phase-based noise reduction strategy for quantification of left ventricular function and mass assessment by cardiac CT: comparison with cardiac magnetic resonance. Eur J Radiol. 2013;82:e337–341.

    Article  Google Scholar 

  21. Asferg C, Usinger L, Kristensen TS, Abdulla J. Accuracy of multi-slice computed tomography for measurement of left ventricular ejection fraction compared with cardiac magnetic resonance imaging and two-dimensional transthoracic echocardiography: a systematic review and meta-analysis. Eur J Radiol. 2012;81:e757–762.

    Article  Google Scholar 

  22. Revel MP, Faivre JB, Remy-Jardin M, et al. Pulmonary hypertension: ECG-gated 64-section CT angiographic evaluation of new functional parameters as diagnostic criteria. Radiology. 2009;250:558–66.

    Article  Google Scholar 

  23. Goerne H, Batra K, Rajiah P. Imaging of pulmonary hypertension: an update. Cardiovasc Diagn Ther. 2018;8(3):279–96. https://doi.org/10.21037/cdt.2018.01.10.

    Article  PubMed  PubMed Central  Google Scholar 

  24. •Aluja Jaramillo F, Gutierrez FR, Díaz Telli FG, Yevenes Aravena S, Javidan-Nejad C, Bhalla S. Approach to pulmonary hypertension: from CT to clinical diagnosis. Radiographics. 2018;38(2):357–73. This paper gave a detailed report on the characteristic CT findings which provides guidance for clinicians to accurately categorize the PH according to this classification. This paper further describes how the correct classification is essential in the proper management of the patient.

  25. Currie A, Benjamin J, Chris Johns A, et al. CT derived left atrial size identifies left heard diseases in specified pulmonary hypertension: derivation and validation of predictive thresholds. Int J Cardiol. 2018;260:172–7. https://doi.org/10.1016/j.ijcard.2018.02.114.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lewis G, Hoey ET, Reynolds JH, et al. Multi-detector CT assessment in pulmonary hypertension: techniques, systematic approach to interpretation and key findings. Quant Imaging Med Surg. 2015;5(3):423–32.

    PubMed  PubMed Central  Google Scholar 

  27. Pena E, Dennie C, Veinot J, et al. Pulmonary hypertension: how the radiologist can help. Radiographics. 2012;32(1):9–32.

    Article  Google Scholar 

  28. •Ascha M, Renapurkar RD, Tonelli AR. A review of imaging modalities in pulmonary hypertension. Ann Thorac Med. 2017;12(2):61–73. A thorough review of the different imaging tools available and their role in the diagnosis of PH is provided. Advantages and disadvantages of each modality are discussed, as well as their limitations in the evaluation of patients with potential PH.

  29. Tan RT, Kuzo R, Goodman LR, et al. Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Medical College of Wisconsin Lung Transplant Group. Chest. 1998;113(5):1250–6.

    Article  CAS  Google Scholar 

  30. Gleason JB, Patel KB, Hernandez F, et al. Pulmonary artery dimensions as a prognosticator of transplant-free survival in scleroderma interstitial lung disease. Lung. 2017;195(4):403–9. https://doi.org/10.1007/s00408-017-0005-6.

    Article  PubMed  Google Scholar 

  31. Heinrich M, Uder M, Tscholl D, Grgic A, Kramann B, Schäfers HJ. CT scan findings in chronic thromboembolic pulmonary hypertension: predictors of hemodynamic improvement after pulmonary thromboendarterectomy. Chest. 2005;127(5):1606–13.

    Article  Google Scholar 

  32. Diely D, Levin D, Hassoun P, et al. Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI). Pulmonary Circ. 2019;9(3):1–32. https://doi.org/10.1177/2045894019841990.33.

    Article  Google Scholar 

  33. Rajaram S, Swift AJ, Condliffe R, et al. CT features of Pulmonary arterial hypertension and its major subtypes: a systematic CT evaluation of 292 patients from the ASPIRE Registry. Thorax. 2015;70:382–7. https://doi.org/10.1136/thoraxjnl-2014-206088.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pulmonary and Critical Care, Cleveland Clinic Florida, Weston, FL, 33331, USA

    Samantha Gillenwater, Anas Hadeh & Franck Rahaghi

  2. Department of Imaging, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    Felipe Martinez, Ian Drexler & Jacobo Kirsch

  3. Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, 33331, USA

    Christine Girard

  4. Department of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA, USA

    Farbod N. Rahaghi

Authors
  1. Samantha Gillenwater
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Felipe Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ian Drexler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christine Girard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anas Hadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Farbod N. Rahaghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Franck Rahaghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jacobo Kirsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacobo Kirsch.

Ethics declarations

Conflict of interest

The authors have no conflict of interests nor relevant financial disclosures.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical collection on Cardiovascular Imaging.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gillenwater, S., Martinez, F., Drexler, I. et al. Role of Cardiovascular CT in Pulmonary Hypertension. Curr Radiol Rep 8, 11 (2020). https://doi.org/10.1007/s40134-020-00354-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s40134-020-00354-2

Keywords

Search

Navigation