Table 1.
Relative strengths and limitations of non-invasive imaging modalities used in pulmonary hypertension.
| CXR | Echo | CMR | CT/CTA | Radionuclide (including V/Q) | |
|---|---|---|---|---|---|
| Initial assessment & diagnosis | + | ++ | + | +/+ | |
| Evaluation of etiology | ++ | ++ | ++ | ++/+++ | ++ |
| Cardiac Structures/Cardiovasculature | + | ++ | +++ | ++/++ | ++ |
| Pulmonary vasculature | + | + | ++ | +++/+++ | + |
| Lung parenchyma | + | + | +++/+++ | ||
| LOGISTICAL CONSIDERATIONS | |||||
| Portability | +++ | ||||
| Patient accessibility/Ease of monitoring | +++ | + | ++/++ | ||
| Quickness of study duration | ++ | + | +++/+++ | ||
| Non-contrast capability | +++ | ++ | +++/+ | ||
| Radiation exposure | +++ | +++ | +/+ | ||
| IMAGING CONSIDERATIONS | |||||
| RV Ejection fraction | ++ (3DE) | +++ | ++ | ||
| Regional wall motion | ++ (3DE) | +++ | ++ | ||
| 3D Volumes | ++ (3DE) | +++ | +++ | ||
| RV Morphology | ++ | +++ | +++ | ||
| Tissue characterization | +++ | ++ | |||
| Pulmonary artery pressures | +++ | ++ | |||
| Strengths | Widely available, low cost; ability for portable scans | Radiation-free; readily available; ability for portable scans; good for initial PH eval | Radiation-free; low interobserver variability; tissue characterization | Short scan time; utility in evaluation of etiologies of PH | Good for initial CTEPH eval |
| Limitations | Disease severity does not directly correlate with changes seen on plain film | Need for downstream testing due to reduced image quality related to body habitus | May cause claustrophobia; cannot be used in those with certain ferromagnetic implants; requires breath holding; long scan time; reduced image quality due to motion artifacts | Radiation risk; contraindicated in pregnancy; limited hemodynamic eval | Radiation risk; contraindicated in pregnancy; non-specific or non-diagnostic findings; need for downstream testing |
| Comments | Part of initial work-up for shortness of breath | Imaging study of choice for group 2 PH; can assess systolic and diastolic function, valvular heart disease, congenital heart disease/shunts | Plays role in eval for myocardial scar/fibrosis; can provide complementary information to echo regarding anatomy and RV function | Imaging study of choice for groups 3 and 5 PH; can assess lung diseases (emphysema, ILD) and multifactorial diseases (sarcoidosis, fibrosing mediastinitis); can provide complementary role to echo regarding anatomy | Imaging study of choice for group 4 PH |
+, limited utility; ++, moderate utility; +++, high utility; 3DE, three-dimensional echocardiography; CMR, cardiac magnetic resonance; CT, computed tomography; CTA, computed tomography angiography; CTEPH, chronic thromboembolic pulmonary hypertension; CXR, chest radiography; ILD, interstitial lung disease; PH, pulmonary hypertension; RV, right ventricular; V/Q, ventilation/perfusion scan.