Renapurkar Rahul D, Shrikanthan Sankaran, Heresi Gustavo A, Lau Charles T, Gopalan Deepa
*Section of Thoracic Imaging †Cardiovascular Imaging Laboratory ‡Section of Nuclear Medicine, Imaging Institute §Section of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH ∥Department of Radiology, VA Palo Alto Health Care System, Palo Alto, CA ¶Department of Radiology, Imperial College Hospitals, London, UK.
J Thorac Imaging. 2017 Mar;32(2):71-88. doi: 10.1097/RTI.0000000000000256.
Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable causes of pulmonary hypertension and is definitively treated with pulmonary thromboendartectomy. CTEPH can be overlooked, as its symptoms are nonspecific and can be mimicked by a wide range of diseases that can cause pulmonary hypertension. Early diagnosis of CTEPH and prompt evaluation for surgical candidacy are paramount factors in determining future outcomes. Imaging plays a central role in the diagnosis of CTEPH and patient selection for pulmonary thromboendartectomy and balloon pulmonary angioplasty. Currently, various imaging tools are used in concert, with techniques such as computed tomography (CT) and conventional pulmonary angiography providing detailed structural information, tests such as ventilation-perfusion (V/Q) scanning providing functional data, and magnetic resonance imaging providing a combination of morphologic and functional information. Emerging techniques such as dual-energy CT and single photon emission computed tomography-CT V/Q scanning promise to provide both anatomic and functional information in a single test and may change the way we image these patients in the near future. In this review, we discuss the roles of various imaging techniques and discuss their merits, limitations, and relative strengths in depicting the structural and functional changes of CTEPH. We also explore newer imaging techniques and the potential value they may offer.
慢性血栓栓塞性肺动脉高压（CTEPH）是肺动脉高压潜在可治愈的病因之一，明确的治疗方法是肺动脉血栓内膜剥脱术。CTEPH可能会被忽视，因为其症状不具特异性，且可被多种能导致肺动脉高压的疾病所模仿。CTEPH的早期诊断以及对手术候选资格的及时评估是决定未来预后的关键因素。影像学在CTEPH的诊断以及肺动脉血栓内膜剥脱术和球囊肺动脉成形术的患者选择中起着核心作用。目前，各种影像学工具协同使用，如计算机断层扫描（CT）和传统肺动脉造影等技术提供详细的结构信息，通气-灌注（V/Q）扫描等检查提供功能数据，磁共振成像提供形态学和功能信息的组合。双能量CT和单光子发射计算机断层扫描-CT V/Q扫描等新兴技术有望在一次检查中同时提供解剖学和功能信息，可能在不久的将来改变我们对这些患者的成像方式。在本综述中，我们讨论了各种成像技术的作用，并探讨了它们在描绘CTEPH的结构和功能变化方面的优点、局限性和相对优势。我们还探讨了更新的成像技术及其可能提供的潜在价值。
