doi: 10.1161/CIRCIMAGING.108.780247
Original Articles |
Magnetic Resonance–Derived 3-Dimensional Blood Flow Patterns in the Main Pulmonary Artery as a Marker of Pulmonary Hypertension and a Measure of Elevated Mean Pulmonary Arterial Pressure
From Siemens Medical Solutions (G.R.), Graz, Austria; University Clinic of Radiology (U.R., K.S., R.R.), University Clinic of Internal Medicine, Department of Pulmonology (G.K., H.O.) and Department of Cardiology (R.M.) of the Medical University of Graz, Graz, Austria; and the Institute for Computer Graphics and Vision (B.K.), Technical University of Graz, Graz, Austria.
Correspondence to Gert Reiter, Siemens Medical Solutions, Strassgangerstrasse 315, A-8054 Graz, Austria. E-mail gert.reiter{at}siemens.com
Received January 3, 2008; accepted May 14, 2008.
Background— Pulmonary hypertension is a disease characterized by an elevation in pulmonary arterial pressure that is diagnosed invasively via right heart catheterization. Such pathological altered pressures in the pulmonary vascular system should lead to changes in blood flow patterns in the main pulmonary artery.
Methods and Results— Forty-eight subjects (22 with manifest pulmonary hypertension, 13 with latent pulmonary hypertension, and 13 normal control subjects) underwent time-resolved 3D magnetic resonance phase-contrast imaging of the main pulmonary artery. Velocity fields that resulted from measurements were calculated, visualized, and analyzed with dedicated software. Main findings were as follows: (1) Manifest pulmonary hypertension coincides with the appearance of a vortex of blood flow in the main pulmonary artery (sensitivity and specificity of 1.00, 95% confidence intervals of 0.84 to 1.00 and 0.87 to 1.00, respectively), and (2) the relative period of existence of the vortex correlates significantly with mean pulmonary arterial pressure at rest (correlation coefficient of 0.94). To test the diagnostic performance of the vortex criterion, we furthermore investigated 55 patients in a blinded prospective study (22 with manifest pulmonary hypertension, 32 with latent pulmonary hypertension, and 1 healthy subject), which resulted in a sensitivity of 1.00 and specificity of 0.91 (95% confidence intervals of 0.84 to 1.00 and 0.76 to 0.98, respectively). Comparison of catheter-derived mean pulmonary artery pressure measurements and calculated mean pulmonary artery pressure values resulted in a standard deviation of differences of 3.6 mm Hg.
Conclusions— Vortices of blood flow in the main pulmonary artery enable the identification of manifest pulmonary hypertension. Elevated mean pulmonary arterial pressures can be measured from the period of vortex existence.
Key Words: hypertension, pulmonary • magnetic resonance imaging • blood flow • blood pressure • catheterization
CLINICAL PERSPECTIVE
Clinical trial registration information—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00575692.The online-only Data Supplement is available with this article at http://circimaging.ahajournals.org/cgi/content/full/1/1/23/DC1.
*The first 2 authors contributed equally to this work.
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