RESUMEN
Pulmonary arterial hypertension (PAH) is a disease of the small vessels in which there is a substantial increase in pulmonary vascular resistance leading to right ventricle failure and death. Invasive haemodynamic evaluation is mandatory not only for diagnosis confirmation but also to address prognosis and eligibility for the use of calcium-channel blockers through an acute vasodilator challenge. Noninvasive surrogate response markers to the acute vasodilator test have been sought. In the present study, the relationship between pulmonary artery distensibility, assessed using magnetic resonance imaging (MRI), and response to acute vasodilator tests was investigated. In total, 19 patients diagnosed with idiopathic PAH without any specific treatment were evaluated. Within a 48-h window after pulmonary artery catheterisation, patients underwent cardiac MRI. Cardiac index, calculated after the determination (invasively and noninvasively) of cardiac output, showed excellent correlation, as did right atrial pressure and right ventricle ejection fraction. Pulmonary artery distensibility was significantly higher in responders. A receiver operating characteristic curve analysis has shown that 10% distensibility was able to differentiate responders from nonresponders with 100% sensitivity and 56% specificity. The present findings suggest that magnetic resonance imaging and pulmonary artery distensibility may be useful noninvasive tools for the evaluation of patients with pulmonary hypertension.
Asunto(s)
Hipertensión Pulmonar/fisiopatología , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Cinemagnética , Vasodilatación/fisiología , Administración por Inhalación , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Gasto Cardíaco/fisiología , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Óxido Nítrico , Proyectos Piloto , Estudios Prospectivos , Arteria Pulmonar/fisiopatología , Presión Esfenoidal Pulmonar/fisiología , Volumen Sistólico/fisiología , Disfunción Ventricular Derecha/fisiopatologíaRESUMEN
Pleural and pulmonary asbestos-related diseases range from benign conditions, like pleural effusion and pleural plaques, to some neoplasias, such as lung cancer and malignant mesothelioma. Pleural effusion is the earliest finding after asbestos exposure, but the imaging findings are not specific. Diffuse pleural thickening involves the visceral pleura and pleural plaques are considered to be hallmarks of exposure. Asbestosis is the pulmonary fibrosis due to asbestos. Rounded atelectasis is a peripheral lung collapse in these individuals, generally related to pleural disease. Some neoplasias, like lung carcinoma and pleural mesothelioma, are more prevalent in asbestos-exposed subjects. The aim of this essay is to illustrate the main imaging findings of asbestos-related diseases.
Asunto(s)
Amianto/efectos adversos , Asbestosis/diagnóstico por imagen , Enfermedades Pleurales/diagnóstico por imagen , Enfermedades Pleurales/etiología , Humanos , RadiografíaRESUMEN
Pleural plaques (PP) are considered to be hallmarks of asbestos exposure. They constitute focal thickenings of the pleura and are commonly seen in patients without lung disease. They can involve parietal, diaphragmatic and mediastinal pleura. Chest x-ray is frequently used for PP diagnosis, but computed tomography, especially when used the high-resolution technique, is the imaging exam with the greatest sensibility and specificity. PP are almost always asymptomatic, but there are some controversial about their relationship with asbestos exposure indexes, pulmonary functional alterations and risk of neoplasias.