Bildgebende Diagnostik bei pulmonaler Hypertonie

Die pulmonale Hypertonie (PH) ist ein häufiges und komplexes Krankheitsbild. Unabhängig von ihrer Ätiologie geht sie mit einer hohen Morbidität und Mortalität einher. Im multidisziplinären diagnostischen Algorithmus und Management der PH kommt dem Radiologen bei der frühzeitigen Diagnosestellung, der Subklassifikation und der Prognoseabschätzung eine wegweisende Rolle zu.

Abstract

Pulmonary hypertension (PH) is a disease with considerable morbidity and, depending on its severity, can be associated with a significantly increased mortality. Therefore, timely diagnostic confirmation and definitive clarification of the etiology are crucial to prevent disease progression as early as possible and to initiate targeted therapy. Defined by an increase in mean pulmonary arterial pressure, the final diagnosis can only be confirmed invasively via right heart catheterization. However, a broad series of typical non-invasive imaging findings can already provide clues to the presence of PH. Thus, the radiologist plays an important role in raising early suspicion of PH and, if necessary, to initiate further clarification. Basic knowledge of the typical image findings of the disease are therefore important for every radiologist.

Imaging also plays an important role in clarifying the underlying pathogenesis of PH. For a reliable subclassification, prognosis assessment and initiation of an adequate therapy, the examination and image findings of the different modalities used must be combined and ideally interpreted in an interdisciplinary manner. This should be done at a designated PH expert center.

Kernaussagen

• Die PH ist definiert als eine Erhöhung des mPAP > 20 mmHg. Klinisch werden 5 Krankheitsgruppen unterschieden. Unabhängig von der Ätiologie ist die PH mit einer hohen Morbidität und Mortalität assoziiert.

• Es gibt kein bildgebendes Kriterium, um die Diagnose einer PH sicher stellen zu können. Der Durchmesser des TP und der TP/A-Quotient sollten, angepasst an die klinische Vortestwahrscheinlichkeit, interpretiert werden. Multiparametrische Ansätze mit verschiedenen auf Basis von CT-Aufnahmen abgeleiteten Größen (TP-Durchmesser, Wanddicke des RVOT, Septumdeviation oder RV/LV-Quotient) bieten eine höhere diagnostische Genauigkeit.

• Die CT sollte bei allen Patienten mit Verdacht auf eine PH erwogen werden und kann wichtige Hinweise auf deren Ätiologie liefern.

• Die V/Q-Szintigrafie ist weiterhin der Goldstandard zum Screening auf eine CTEPH. Eine unauffällige Thoraxröntgenaufnahme und eine unauffällige V/Q-Szintigrafie schließen eine CTEPH faktisch aus.

• Die DECT erlaubt neben der morphologischen CT-Information die Beurteilung und Quantifizierung der Jodaufnahme des Lungenparenchyms als Surrogat für die pulmonale Perfusion. Als „One-Stop-Shop“-Untersuchung hat die DECT das Potenzial, multimodale Diagnostikansätze der PH zukünftig zu ersetzen.

• Die CMR ist der Goldstandard zur Beurteilung der rechtsventrikulären Volumina und Funktion bei Patienten mit PH und liefert für die Prognoseabschätzung der PAH wichtige Parameter (RVEF, SVI, RVESVI).

Schlüsselwörter

pulmonale Hypertonie

Key words

Pulmonary hypertension

Publication History

Article published online:
01 July 2024

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