ABSTRACT

Pulmonary arterial hypertension following chronic pulmonary thromboembolism (PTE) is an unusual pathology and it has a deadly prognostic in the short term. In the present study, we evaluate, in a prospective and blind way, the sensitiveness, the specificity and the diagnosis precision of the magnetic resonance image (MRI) in the diagnosis of pulmonary vascular obstruction of the central and peripheral type,in the pulmonary arterial hypertension following unsolved pulmonary thromboembolism. We evaluated in patients suffering from severe pulmonary arterial hypertension (PAH) from diverse etiologies the pulmonary angiography (PA) as the golden standard for the diagnosis of PTE, comparing it with the MRI. We studied 29 patients (13 women and 7 men) ranging from 24 to 70 years old. The mean arterial pulmonary pressure was of 55.4 ± 13.9mmHg. In 55% of the patients, the presence of chronic PTE was demonstrated through pulmonary angiography, in the rest, the cause of PAH was diverse, as follows: primary PAH, PAH following congenital cardiopathy and PAH following left ventricle break. In 11 of the cases the pulmonary angiography demonstrated the presence of thrombus, in 9 patients with both locations (central and peripheral), and in one of them with central location and in other one with peripheral location. In the rest of the patients (9), the angiography did not demonstrate any thrombus occlusions. The MRI suggested the presence of PTE in both locations in 11 of the cases, no case reported central isolated location, 6 cases presented exclusive peripheral location and in only 3 cases there was suggested no vascular thrombus presence. We obtain as a result a 100% sensitiveness and a specificity of 90% in PTE of central location (p < 0.001 Fisher Exact) and a sensitiveness of 100% and a specificity of just 33% in PTE of peripheral location (p = NS). We conclude that MRI is an excellent alternative to pulmonary angiography when diagnosing central vascular obstructions in unsolved thromboembolism.

KEYWORDS

Unsolved pulmonary thromboembolism, pulmonary arterial hypertension, magnetic resonance image, pulmonary angiography, pulmonary thromboendarterectomy.

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