Department of Diagnostic Radiology,Tohoku University Hospital.
Department of Advanced MRI Collaboration Research,Tohoku University Graduate School of Medicine.
Magn Reson Med Sci. 2022 Mar 1;21(2):309-318. doi: 10.2463/mrms.rev.2021-0111. Epub 2022 Feb 19.
Pulmonary hypertension (PH) is characterized by elevated pulmonary arterial pressure (PAP). Although right-heart catheterization is the gold standard method for the diagnosis of PH by definition, various less-invasive imaging tests have been used for screening, detection of underlying diseases-causing PH, and monitoring of diseases. Among them, 4D flow MRI is an emerging and unique imaging test that allows for comprehensive visualization of blood flow in the right heart and proximal pulmonary arteries. The characteristic blood flow pattern observed in patients with PH is vortical flow formation in the main pulmonary artery. Recent studies have proposed the use of these findings to determine not only the presence of PH but also estimate the mean PAP. Other applications of 4D flow MRI for PH include measurement of wall shear stress, helicity, and 3D flow balance in the pulmonary arteries. It is worth noting that 4D flow has also the potential for longitudinal follow-ups. In this review, the clinical definition of PH, summary of conventional imaging tests, characteristics of pulmonary arterial flow as shown by 4D flow MRI, and clinical application of 4D flow MRI in the management of patients with PH will be discussed.
肺动脉高压（PH）的特征是肺动脉压力（PAP）升高。尽管右心导管检查根据定义是诊断 PH 的金标准方法，但各种微创成像检查已被用于筛查、检测潜在的致病 PH 以及监测疾病。其中，4D 流 MRI 是一种新兴的独特成像检查方法，可全面可视化右心和近端肺动脉的血流。在 PH 患者中观察到的特征性血流模式是主肺动脉中涡流的形成。最近的研究提出，这些发现不仅可用于确定 PH 的存在，还可估计平均 PAP。4D 流 MRI 在 PH 中的其他应用包括测量肺动脉中的壁切应力、螺旋度和 3D 血流平衡。值得注意的是，4D 流也有可能进行纵向随访。在这篇综述中，将讨论 PH 的临床定义、常规成像检查的概述、4D 流 MRI 显示的肺动脉血流特征以及 4D 流 MRI 在 PH 患者管理中的临床应用。
