Imaging of pulmonary arterial hypertension

Introduction The investigation of pulmonary arterial hypertension (PAH) requires a rigorous aetiological assessment in which imaging modalities play an important role. Background The chest x-ray may show non-specific signs such as cardiomegaly and dilatation of the pulmonary arteries, and also allows examination of the lung parenchyma. Echocardiography is the essential screening tool and allows evaluation of left ventricular function. Pulmonary ventilation/perfusion scanning is essential to confirm post embolic PAH. Spiral CT has become an essential examination. It allows detailed study of the lung parenchyma, the pulmonary vessels and the cardiac chambers, and also helps determine the aetiology and complete the pre-treatment assessment. Magnetic resonance imaging allows calculation of several haemodynamic parameters and morphological study of the cardiac chambers and pulmonary vessels but requires further evaluation. Viewpoint The improvement in the quality of vascular images and the development of complementary MRI techniques may lead to increase of this modality in the study of PAH. Conclusion Imaging plays a fundamental role in the management of patients suffering from PAH.