Pulmoner Hipertansiyonda Görüntüleme
Özet
Pulmoner hipertansiyon (PH), sağ ventrikül (RV) üzerinde artan basınç ve direnç yüküyle karakterize, tanı ve sınıflandırmasında sağ kalp kateterizasyonunun altın standart olduğu hemodinamik bir durumdur. Bu kitap bölümünde, PH’nin klinik yönetiminde hayati rol oynayan bilgisayarlı tomografi (BT), bilgisayarlı tomografi anjiyografi (BTA), ventilasyon/perfüzyon (V/Q) sintigrafisi ve kardiyak manyetik rezonans görüntüleme (KMRG) yöntemleri; teknik özellikleri, karakteristik bulguları ve tanısal performansları açısından incelenmiştir. BT ve BTA; ana pulmoner arter genişlemesi, RV dilatasyonu gibi morfolojik değişikliklerin yanı sıra parankimal patolojilerin ve pulmoner veno-oklüzif hastalık ipuçlarının saptanmasında temel yöntemlerdir. Kronik tromboembolik pulmoner hipertansiyon (KTEPH) tanısında ve cerrahi planlamada vasküler yapıların BT ile değerlendirilmesi kritik öneme sahiptir. V/Q sintigrafisi, özellikle SPECT/BT tekniğiyle, yüksek negatif prediktif değeri sayesinde KTEPH için ilk basamak tarama yöntemi olarak benzersiz bir konuma sahiptir. KMRG ise iyonizan radyasyon içermeden RV hacimleri, fonksiyonları ve kütlesinin değerlendirilmesinde, ayrıca prognoz ve tedavi yanıtının izlenmesinde referans yöntem kabul edilmektedir. Görüntüleme yöntemlerinin hiçbiri pulmoner arter basıncını doğrudan ve kantitatif olarak ölçemese de, bu yöntemlerin multidisipliner bir yaklaşım içinde entegre edilmesi optimal hasta yönetimi için vazgeçilmezdir.
Pulmonary hypertension (PH) is a hemodynamic condition characterized by an increased pressure and resistance load on the right ventricle (RV), in which right heart catheterization is the gold standard for diagnosis and classification. In this book chapter, computed tomography (CT), computed tomography angiography (CTA), ventilation/perfusion (V/Q) scintigraphy, and cardiac magnetic resonance imaging (CMRI), which play a vital role in the clinical management of PH, are reviewed in terms of their technical features, characteristic findings, and diagnostic performance. CT and CTA are fundamental methods for detecting morphological changes such as main pulmonary artery dilatation and RV dilatation, as well as parenchymal pathologies and clues suggestive of pulmonary veno-occlusive disease. Evaluation of vascular structures with CT is of critical importance in the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) and in surgical planning. V/Q scintigraphy, particularly with the SPECT/CT technique, holds a unique position as the first-line screening method for CTEPH owing to its high negative predictive value. CMRI, without involving ionizing radiation, is considered the reference method for assessing RV volumes, function, and mass, as well as for monitoring prognosis and treatment response. Although none of these imaging modalities can directly and quantitatively measure pulmonary artery pressure, integrating them within a multidisciplinary approach is indispensable for optimal patient management.
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