From the Guidelines
Cardio pulmonary MRI is the recommended diagnostic tool for evaluating pulmonary veno-occlusive disease (PVOD), as it provides a comprehensive assessment of both cardiac and pulmonary vascular structures, allowing for accurate measurement of right ventricular function, pulmonary artery distensibility, and detection of pulmonary venous obstruction 1.
Key Components of Cardio Pulmonary MRI for PVOD
- Cine imaging for ventricular function
- Late gadolinium enhancement for fibrosis detection
- Pulmonary angiography sequences
- T1-weighted black blood imaging
- Steady-state free precession cine sequences
- Phase-contrast imaging of pulmonary vessels
- Contrast-enhanced MR angiography using gadolinium-based contrast agents at standard doses (0.1-0.2 mmol/kg)
MRI Findings Suggestive of PVOD
- Centrilobular ground-glass opacities
- Septal thickening
- Lymph node enlargement
- Signs of pulmonary hypertension such as right ventricular enlargement and dysfunction
Advantages of Cardio Pulmonary MRI
- Non-invasive approach
- No radiation exposure
- Allows for serial examinations to monitor disease progression and treatment response
- Provides functional and anatomical information
Limitations of Cardio Pulmonary MRI
- Availability and expertise requirements may limit widespread use
- Motion and respiratory artifacts may degrade image quality
- Contraindications to MRI include presence of specific ferromagnetic and/or conducting implants, and allergy to gadolinium or renal dysfunction 1
From the Research
Cardio Pulmonary MRI in PVOD
- There are no specific studies provided that directly discuss the use of Cardio Pulmonary MRI in PVOD.
- However, the provided studies discuss the diagnosis and management of PVOD, highlighting the importance of distinguishing it from pulmonary arterial hypertension (PAH) due to differences in treatment response and prognosis 2, 3, 4, 5, 6.
- Diagnostic approaches for PVOD include high-resolution computed tomography (HRCT) of the chest, arterial blood gases, pulmonary function tests, and bronchoalveolar lavage 2, 4.
- The studies suggest that PVOD is characterized by a poor prognosis, with lung transplantation being the treatment of choice, and cautious use of specific PAH therapy in some patients 2, 3, 4, 5, 6.
- Further research is needed to explore the role of Cardio Pulmonary MRI in the diagnosis and management of PVOD, as the current evidence does not provide sufficient information on this topic.
Key Features of PVOD
- Higher male/female ratio and higher tobacco exposure compared to PAH 2, 4
- Lower arterial oxygen tension at rest, lower diffusing capacity of the lung for carbon monoxide, and lower oxygen saturation nadir during the 6-min walk test 2, 4
- Characteristic HRCT findings include centrilobular ground-glass opacities, septal lines, and lymph node enlargement 2, 3, 4, 5
- Poor response to PAH-approved drugs, which can lead to pulmonary edema and clinical deterioration 2, 3, 4, 5, 6