Ghani Hakim, Weir-McCall Jonathan R, Ruggiero Alessandro, Pepke-Zaba Joanna
National Pulmonary Hypertension Centre, Royal Papworth Hospital, UK.
Institute of Heart and Lung Research, University of Cambridge, Cambridge, UK.
Int J Cardiol Congenit Heart Dis. 2024 Aug 10;17:100536. doi: 10.1016/j.ijcchd.2024.100536. eCollection 2024 Sep.
Chronic thromboembolic pulmonary disease (CTEPD) with or without pulmonary hypertension (PH) occurs when thromboemboli in pulmonary arteries fail to resolve completely. Pulmonary artery obstructions due to chronic thrombi and secondary microvasculopathy can increase pulmonary arterial pressure and resistance leading to chronic thromboembolic PH (CTEPH). Mechanical interventions and/or PH medications can improve cardiopulmonary haemodynamic, alleviate symptoms, and decrease mortality risk. Imaging is pivotal throughout the CTEPD management journey, spanning diagnosis, treatment planning, and assessing treatment outcome. With just computed tomography (CT) pulmonary angiogram and right heart catheterisation, an experienced multidisciplinary team can determine surgical candidacy in most cases. Dual energy CT, lung subtraction iodine mapping CT, and dynamic contrast-enhanced magnetic resonance imaging (MRI) offer comparable sensitivities with ventilation-perfusion scintigraphy in diagnosing CTEPD. Pulmonary angiogram with digital subtraction angiography although considered the gold standard for assessing thrombi extent and vasculature morphology is now mostly used to assess targets for balloon pulmonary angioplasty. Advancements in CT modalities and innovative MRI metrics offer better insight into CTEPD management but are limited by the availability of technology and expertise. Learning from current artificial intelligence application in medical imaging, there is promise in tapping the wealth of data provided by CTEPD imaging through automating cardiopulmonary and vascular morphology analysis.
慢性血栓栓塞性肺疾病（CTEPD）伴或不伴肺动脉高压（PH），是在肺动脉内的血栓栓子不能完全溶解时发生的。由于慢性血栓和继发性微血管病变导致的肺动脉阻塞可使肺动脉压力和阻力增加，进而导致慢性血栓栓塞性肺动脉高压（CTEPH）。机械干预和/或肺动脉高压药物可改善心肺血流动力学、缓解症状并降低死亡风险。在CTEPD的整个管理过程中，影像学检查至关重要，涵盖诊断、治疗计划制定以及评估治疗效果。仅通过计算机断层扫描（CT）肺动脉造影和右心导管检查，一个经验丰富的多学科团队在大多数情况下就能确定手术适应症。双能CT、肺减影碘图CT和动态对比增强磁共振成像（MRI）在诊断CTEPD方面与通气-灌注闪烁扫描具有相当的敏感性。尽管数字减影血管造影肺动脉造影被认为是评估血栓范围和血管形态的金标准，但现在大多用于评估球囊肺动脉成形术的靶点。CT技术的进步和创新的MRI指标能更好地指导CTEPD的管理，但受技术和专业知识可用性的限制。借鉴当前人工智能在医学成像中的应用，通过对心肺和血管形态分析进行自动化处理，利用CTEPD成像提供的大量数据有望取得进展。
