Phenotyping Pulmonary Hypertension with CT and MR Imaging: Pulmonary Vessel and Right Ventricular Analysis

The thesis titled "Phenotyping Pulmonary Hypertension with CT and MR Imaging: Pulmonary Vessel and Right Ventricular Analysis" presents a body of work in clinical diagnostic and interventional radiology that aims to investigate the use of computed tomography (CT) imaging to analyse pulmonary blood vessels and magnetic resonance imaging (MRI) to evaluate the right ventricle in patients with pulmonary hypertension respectively, in addition to invasive interventional procedures such as right heart catheterisation. The work focuses on two subgroups of patients with pulmonary hypertension: those with chronic lung disease (CLD) and those with chronic thromboembolic pulmonary disease (CTEPH).’’ Pulmonary hypertension is a condition characterised by high blood pressure in the pulmonary arteries, which can lead to heart failure and other serious complications. Both CLD and CTEPH can cause or contribute to the development of pulmonary hypertension and both conditions have a direct impact on pulmonary blood vessels. The thesis aims to use CT and MRI to better understand the impact of these conditions on the pulmonary vessels and the right ventricle, and to identify potential biomarkers or other indicators that could be used to diagnose and manage pulmonary hypertension in these patients. The thesis discusses the results of the studies and the implications of these findings for the diagnosis and treatment of pulmonary hypertension in patients with CLD and CTEPH. It also describes the limitations and suggests potential directions for future research in this area. In the thesis, I aimed to investigate the utility of computed tomography (CT) imaging and magnetic resonance imaging (MRI) in the diagnosis and phenotyping of patients with PH due to CLD and CTEPH. My results show that CT pulmonary vessel analysis and cardiac MRI assessment of RV function can support the diagnosis and phenotyping of patients with PH due to CLD and CTEPH. Specifically, a lower volume of small pulmonary arteries on CT is associated with more severe PH and MRI has been shown to be an effective tool for assessing disease severity in PH in addition to assessment of therapy response. These imaging modalities can provide valuable information about the severity and morphological and functional changes in the right ventricle, as well as the presence and extent of underlying pulmonary vascular changes in CLD or CTEPH. Our findings suggest that CT and MRI can be valuable tools for the diagnosis and management of PH in these patient populations. Further research is needed to confirm and expand on these findings, and to identify potential biomarkers or other indicators that could be used to diagnose and manage PH in these patients.