SPIRAL CT OF PULMONARY-HYPERTENSION AND CHRONIC THROMBOEMBOLISM

Pulmonary hypertension caused by chronic pulmonary embolism (PE) repre sents an uncommon, but severe and surgically curable complication of r ecurrent acute embolism. Because clinical signs might be silent or non specific, chronic PE requires imaging methods for diagnosis and treatm ent planning. Chest radiographic findings are usually nonspecific. Sci ntigraphy provides a high sensitivity for PE, but lacks anatomic resol ution and sufficient specificity. Pulmonary angiography, albeit accura te, is an invasive procedure associated with low but still considerabl e morbidity and mortality. Thus, noninvasive methods are required. Mos t reliably in the diagnosis of acute and chronic PE, fast computed tom ography (CT) techniques like spiral CT provide noninvasive means to de tect and differentiate organized mural thrombi, as well as perfusion a bnormalities and concomitant findings. Magnetic resonance imaging offe rs morphologic as well as functional information on lung perfusion and right heart function, but image quality needs improvement to be compa rable with spiral CT. Thus, although spiral CT is recommended as the s creening method for acute and chronic PE, magnetic resonance imaging m ight be the method of the future.