27 May 2021

Novel imaging approaches in pulmonary hypertension patients

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Agenda

  • Martine Remy // Update from the Fleischner Society Task Force for imaging in pulmonary hypertension
  • Jocelyn Dupuis // Molecular imaging of pulmonary vascular disease using microvascular endothelial cell ligands
  • Jens Vogel-Claussen // MRI to assess pulmonary vascular changes and PH progression
  • Sudarshan Rajagopal // Xenon magnetic resonance imaging signatures of PH
  • Karin Tran-Lundmark // Synchrotron-based phase contrast micro-CT imaging of pulmonary vascular disease in human tissue and animal models. 

Summary

The 5th webinar of the PVRI 2021 web series focused on the role of imaging in pulmonary hypertension (PH). The talks in the webinar covered both the current state-of-the-art in PH imaging, and promising developing imaging modalities.

The first talk by Martine Remy (University Centre of Lille, France) provided an update from Fleischner Society Task force for imaging in pulmonary hypertension. It provided an overview of the modalities used, and listed several recommendations for imaging. Dr Remy focused on the first two main questions in this talk - (1) is non-invasive imaging capable of identifying PH?; and (2) what is the role of imaging in establishing the cause of PH? It is highly recommended to read the accompanying update paper, as it is full of insights into the role of imaging within PH. There was a question about the use of RV/LV ratio on CT and whether it alone can help diagnose PH. Dr Remy highlighted that it is important in all cases to look at the patient holistically and assess the pre-test probability of the disease in such circumstances. Another question was about what can be done to minimise delay in diagnosis of chronic pulmonary embolism (PE). Dr Remy felt this could be tackled with two approaches. First is increasing education and knowledge amongst clinicians and radiologists. Secondly, newly developing AI algorithms and machine learning approaches could help assess and alert clinicians for Chronic PE. She also highlighted how AI in the future can be used to help detect features challenging on visual assessment.

The second talk by Dr Jocelyn Dupuis (Montreal Heart Institute, Canada) looked at a promising receptor ligand called ‘Pulmobind’, used in SPECT-CT. The novel ligand enabled dynamic and quantitative lung imaging. There was some discussion about the role of negative (where uptake corresponds to having a disease) or positive tracers (visa versa). Pulmobind is a negative tracer, which looks to correspond with severity.  

The third talk by Dr Jens Vogel-Claussen (Hannover Medical School, Germany) looked at the role of Magnetic resonance imaging (MRI) in Chronic thromboembolic pulmonary hypertension (CTEPH). The talk described the advances that MR imaging has made over the last few years, and how it has become part of the routine practice in Dr Vogel-Claussen’s centre. There was a question about the role of CT vs MR imaging in these patients. The panel felt both had their merits, and it is important for physicians and radiologists to work well together to understand the imaging modality of choice.

The fourth talk by Sudarshan Rajagopal (Duke University Medical Centre, USA) looked at functional lung imaging using hyperpolarised xenon gas imaging. He described how patients with PAH have a unique signature compared to those with other phenotypes, such as lung and heart disease. There was panel discussion on how there is a need to help quantify the impact the extent of lung disease has on PH. Dr Rajagopal felt that the largest impact of Xe imaging may be in the evaluation of patients with unexplained dyspnoea, as it provided important information on lung gas exchange and function beyond currently available modalities. However, he highlighted that this is a developing field that requires more data and further studies.

The final talk by Dr Karin Tran-Lundmark (Lund University, Sweden) covered the use of synchrotron-based phase contrast micro-CT to analyse the pulmonary vascular tree. The method enabled analysis of multiple rare conditions from various biobanks. The talk described how this form of 3D imaging is particularly helpful in answering questions about the localisation of lesions and contained multiple visual illustrations. There was discussion about the etiology of plexiform lesions and whether this work could be expanded to other phenotypes of PH. 

Summary by Krit Dwivedi, Wellcome Trust Clinical Research Training Fellow, Academic Radiology, University of Sheffield, Sheffield, UK


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