肺动脉高压 CTPA

PART 01 Definition
肺高压(Pulmonary hypertension,PH) :是一组由异源性疾病和不
同发病机制引起的以肺血管阻力持续增高为特征的临床病理生理综合征。
右心导管术是金标准（有创），海平面状态下、静息时，肺动脉平均压 ≥25mmHg。
PART 02 Classification
Pulmonary hypertension resulting from heart disease (group 2) implies an increase in pulmonary arterial pressure due to backward transmission of pressure elevation (postcapillary pulmonary hypertension) and is defined as a mean pulmonary arterial pressure of 20 mmHg or more and a pulmonary wedge pressure greater than 15 mmHg.
Diagram shows the imaging work-up of patients with PH
Diagram shows the imaging algorithm used for patients with suspected PH
Chest Radiography
Chest radiography is usually the initial imaging study performed. The classic radiographic findings of pulmonary hypertension are evident only late in the disease process. Such late findings include:
PART 04
Diagnosis and Assessment of Pulmonary Hypertension
In patients with suspected PH, the diagnostic approach includes four stages: Suspicion Detection Classification Functional evaluation
1. central pulmonary arterial dilatation;
2. pruning of the peBiblioteka Baiduipheral arteries;
3. increased diameter (15 mm in women and 16 mm in men) of the right interlobar artery;
4. reduced retrosternal air space on lateral views, a result of right ventricular dilatation.
Multidetector CTPA（vascular, cardiac, and parenchymal）
• Vascular Signs
than 1:1 at the midventricular level on axial images) 4. Decreased right ventricular ejection fraction 5. Dilatation of the inferior vena cava and hepatic veins 6. Pericardial effusion
Multidetector CTPA（vascular, cardiac, and parenchymal）
• Cardiac Signs
1. Right ventricular hypertrophy(wall thickness of more than 4 mm) 2. Straightening or leftward bowing of the interventricular septum 3. Right ventricular dilatation (right ventricle–to–left ventricle diameter ratio of more
第4届世界PH研讨会对PH的分类
①动脉性肺动脉高压
特发性/遗传性/药物和毒物诱导/与疾病相关 性（结缔组织疾病、HIV感染、门脉高压、先 天性心脏病、血吸虫病和慢性溶血性贫血）、 新生儿持续性肺动脉高压、肺静脉闭塞病、肺 毛细血管瘤样增生症
②与左心疾病相关的肺高压
③与肺疾病和/或低氧相关的肺高压 ④慢性血栓栓塞性肺高压(CTEPH) ⑤多种机制和/或不明机制引起的肺 高压
Chronic Thromboembolic Disease
Chronic Thromboembolic Disease
Primary Pulmonary Artery Sarcoma
Takayasu Arteritis
Fibrosing mediastinitis
实验室检查
项目
意义
BNP,NT-pro-BNP;肌钙蛋白T(TnT),肌钙蛋 白I(TnI);尿酸
血液系统疾病（骨髓增生性疾病，脾脏切除术 ）、系统性疾病（结节病，肺朗格汉斯细胞组 织细胞增生症，淋巴管肌瘤病，多发性神经纤 维瘤，血管炎）、代谢性疾病（糖原贮积病， 高雪氏病，甲状腺疾病）、其他（肿瘤阻塞， 纤维性纵隔炎，透析治疗的慢性肾衰竭）
Pulmonary arterial hypertension is restricted to those with a
PART 03
Pathophysiology and Clinical Course
The clinical course of PH is divided into three phases: Asymptomatic compensated Symptomatic decompensating Advanced decompensated
ANA,ENA,ANCA,RF,RA相关抗体
PAH评估 筛查风湿免疫病
D-Dimmer；抗磷脂抗体、抗心磷脂抗体、 筛查肺栓塞 狼疮抗凝物
血气分析
了解血氧水平
甲状腺功能
了解有无甲亢
乙肝标记物、HIV抗体
了解有无乙肝与AIDS
基因检查
遗传性肺动脉高压
治疗：
• 氧疗 • 抗凝治疗 • 钙通道阻滞剂 • 靶向药物治疗 • 介入治疗和手术治疗
Multidetector CTPA（vascular, cardiac, and parenchymal）
• Parenchymal Signs
Centrilobular ground-glass nodules are a feature of pulmonary hypertension and are especially common in patients with idiopathic pulmonary arterial hypertension. Also can be seen in patients with pulmonary capillary hemangiomatosis.
Cardiac MR Imaging
• Morphologic cardiac findings
1. Right ventricular dilatation and hypertrophy 2. Flattening of the interventricular septum or leftward bowing 3. Right ventricular morphologic changes ranging from a normal
谢谢聆听
Cardiac MR Imaging
• Delayed Contrast Enhancement
A delayed contrast enhancement pattern with a midwall distribution at the right ventricular septal insertion that points into the interventricular septum and is more prominent at the base of the heart has been described in patients with chronic pulmonary hypertension from varying causes.
Pulmonary Hypertension:
How the Radiologist can help
杜倩妮 2019.08
目录
CONTENTS
01. Definition 02. Classification 03. Pathophysiology and
Clinical Course
04.
Diagnosis and Assessment of Pulmonary Hypertension
hemodynamic profile in which high pulmonary pressure is a result of elevated precapillary pulmonary resistance and normal pulmonary venous pressure and is measured as a pulmonary wedge pressure of 15 mmHg or less, a hemodynamic profile that is shared by groups 3, 4, and 5 in the Dana Point classification system.
1. The main pulmonary artery with a diameter of 29 mm or more (positive predictive value of 97%, sensitivity of 87%, and specificity of 89%)
2. A segmental artery–to-bronchus diameter ratio of 1:1 or more in three or four lobes (specificity of 100%)
3. The main pulmonary arterial diameter larger than that of the ascending aorta(positive predictive value of 96% and specificity of 92%, especially in patients younger than 50 years old)
crescent shape to a more concentric form 4. Right atrial enlargement 5. Tricuspid regurgitation
Cardiac MR Imaging
• Cine Imaging
Assess left and right ventricular volume, mass and function Assess wall motion abnormalities
Long-standing Leftto-Right Shunt
Pulmonary Capillary Hemangiomatosis and Veno-occlusive Disease
Pulmonary Veno-occlusive Disease
Chronic Thromboembolic Disease