Black blood MRI has diagnostic and prognostic value in the assessment of patients with pulmonary hypertension

Eur Radiol. 2012 Mar;22(3):695-702. doi: 10.1007/s00330-011-2306-0. Epub 2011 Oct 13.


Objectives: Double inversion recovery (DIR) "black blood" MRI suppresses the signal from flowing blood, slow flowing blood causes incomplete suppression resulting in pulmonary blood flow artefact (PFA). This study examines the diagnostic utility and prognostic value of a PFA scoring system in a mixed cohort of patients with pulmonary hypertension (PH).

Methods: DIR-MRI images were reviewed for 233 patients referred with suspected PH who underwent right heart catheterisation (RHC) within 48 h of MR. The degree of PFA was visually scored in all patients from 0 to 5 (0 = absent, 1 = segmental, 2 = lobar, 3 = distal main, 4 = proximal main and 5 = trunk). Pulmonary artery (PA), aorta (Ao), and PA main branch diameters were measured from which PA/Ao ratios and mean PA branch diameters (MPAB) were calculated.

Results: PFA >1 demonstrated high sensitivity (86%) and specificity (85%) for the diagnosis PH in our mixed patient cohort. A good correlation was found with PFA and haemodynamic parameters, PVR (r = 0.70), mPAP (r = 0.65) and CI (r = -0.53). PFA predicted mortality (P = 0.005) during the mean follow-up for 19 months. PFA scoring demonstrated good inter-observer agreement (k = 0.83).

Conclusions: PFA scoring is of diagnostic and prognostic value in the assessment of patients with suspected PH. and is a predictor of mortality.

Key points: • A simple magnetic resonance method of assessing pulmonary blood flow is presented • This involves a qualitative scoring system of black blood pulmonary flow artefacts • This is simple to perform and seems reproducible in pulmonary hypertension patients • The degree of artefact correlates well with right heart catheter measurements • Prominent pulmonary flow artefact predicts mortality in patients with pulmonary hypertension.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analysis of Variance
  • Artifacts
  • Cardiac Catheterization
  • Chi-Square Distribution
  • Female
  • Hemodynamics
  • Humans
  • Hypertension, Pulmonary / diagnosis*
  • Image Interpretation, Computer-Assisted
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Prognosis
  • Pulmonary Circulation
  • ROC Curve
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity