Biederman R W W
Drexel University College of Medicine, Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
Int J Clin Pract Suppl. 2009 Sep(162):20-35. doi: 10.1111/j.1742-1241.2009.02109.x.
Numerous imaging techniques are currently used to evaluate pulmonary arterial hypertension (PAH), including echocardiography, x-ray, electrocardiogram (ECG), computed tomography and magnetic resonance imaging (MRI). All such modalities have inherent advantages and disadvantages governed by physical principles that result in their clinical utility. In that PAH is a progressive disorder characterised by abnormally elevated blood pressure of the pulmonary circulation that leads to extensive vascular remodelling and increased pulmonary vascular resistance, a technique that can encapsulate those specific features that depict the multiple facets of this disease has obvious advantages. Recent advances in cardiovascular MRI (CMR) technology have led to the development of dedicated techniques for non-invasive assessment of cardiovascular structure and function, including haemodynamical parameters in the pulmonary circulation, which are superior in their identification of pulmonary arterial right ventricular morphological changes. These advantages make CMR a very attractive modality for diagnosing, following and providing prognoses for PAH patients. In this review, we highlight the developments in the use of CMR for the diagnosis, assessment and monitoring of patients with PAH. These remarkable improvements in image acquisition, physiological imaging and contrast techniques place CMR in a prime position for defining this disease. In the coming decade, it is anticipated that continued improvements in CMR image acquisition, spatial and temporal resolution and analytical techniques will result in improved understanding of PAH pathophysiology, diagnosis and prognostic variables, as well as the replacement of the most, if not all, invasive procedures currently applied routinely to the evaluation of PAH.
目前有多种成像技术用于评估肺动脉高压（PAH），包括超声心动图、X线、心电图（ECG）、计算机断层扫描和磁共振成像（MRI）。所有这些检查方式都有其固有的优缺点，这些优缺点受物理原理的制约，从而决定了它们的临床应用价值。鉴于PAH是一种进行性疾病，其特征是肺循环血压异常升高，导致广泛的血管重塑和肺血管阻力增加，因此一种能够概括描绘该疾病多个方面的特定特征的技术具有明显优势。心血管MRI（CMR）技术的最新进展已促使开发出用于非侵入性评估心血管结构和功能的专门技术，包括肺循环中的血流动力学参数，这些技术在识别肺动脉和右心室形态变化方面更具优势。这些优势使CMR成为诊断、随访PAH患者并提供预后信息的极具吸引力的检查方式。在本综述中，我们重点介绍了CMR在PAH患者诊断、评估和监测中的应用进展。图像采集、生理成像和造影技术的这些显著改进使CMR在定义这种疾病方面处于首要地位。在未来十年，预计CMR图像采集、空间和时间分辨率以及分析技术的持续改进将有助于加深对PAH病理生理学、诊断和预后变量的理解，同时也将取代目前常规用于评估PAH的大多数（如果不是全部）侵入性检查。
