Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Department of Pulmonology, Amsterdam University Medical Center, Location VU Medical Center, Amsterdam, The Netherlands.
Eur Respir J. 2024 Oct 31;64(4). doi: 10.1183/13993003.01128-2024. Print 2024 Oct.
Pulmonary hypertension (PH) remains a challenging condition to diagnose, classify and treat. Current approaches to the assessment of PH include echocardiography, ventilation/perfusion scintigraphy, cross-sectional imaging using computed tomography and magnetic resonance imaging, and right heart catheterisation. However, these approaches only provide an indirect readout of the primary pathology of the disease: abnormal vascular remodelling in the pulmonary circulation. With the advent of newer imaging techniques, there is a shift toward increased utilisation of noninvasive high-resolution modalities that offer a more comprehensive cardiopulmonary assessment and improved visualisation of the different components of the pulmonary circulation. In this review, we explore advances in imaging of the pulmonary vasculature and their potential clinical translation. These include advances in diagnosis and assessing treatment response, as well as strategies that allow reduced radiation exposure and implementation of artificial intelligence technology. These emerging modalities hold the promise of developing a deeper understanding of pulmonary vascular disease and the impact of comorbidities. They also have the potential to improve patient outcomes by reducing time to diagnosis, refining classification, monitoring treatment response and improving our understanding of disease mechanisms.
肺动脉高压（PH）的诊断、分类和治疗仍然具有挑战性。目前评估 PH 的方法包括超声心动图、通气/灌注闪烁显像、计算机断层扫描和磁共振成像的横断面成像，以及右心导管术。然而，这些方法仅提供了对疾病主要病理学的间接读数：肺循环中异常的血管重塑。随着新技术的出现，越来越多地使用非侵入性高分辨率模式，以提供更全面的心肺评估，并改善肺循环不同成分的可视化。在这篇综述中，我们探讨了肺血管成像的进展及其潜在的临床转化。这些进展包括诊断和评估治疗反应的进展，以及减少辐射暴露和实施人工智能技术的策略。这些新兴模式有望加深对肺血管疾病和合并症影响的理解。它们还有可能通过缩短诊断时间、改进分类、监测治疗反应以及提高对疾病机制的理解，来改善患者的预后。
