循環器ジャーナル71巻4号

2023年10月発行

特集 変革期を迎えた肺高血圧症—次世代の病態理解，診断，治療とは？ Ⅰ.総論：肺高血圧症の診断と治療

肺高血圧症の鑑別に必要な画像検査—近年の進歩

著者： 上田仁¹

所属機関： ¹国立循環器病研究センター肺循環科

ページ範囲：P.490 - P.500

POINT
●PHのスクリーニングおよび病型診断において，画像検査は大きな役割を担っている．
●心エコー図検査は，PH診断のスクリーニングにおいてkeyとなる重要な検査である．
●PH診断後は，専門施設へ紹介し，専門施設での病型診断および治療が推奨されている．

参考文献

1）日本循環器学会，日本肺高血圧・肺循環学会，日本呼吸器学会，他．肺高血圧症治療ガイドライン（2017年改訂版）．2018

2）Humbert M, Kovacs G, Hoeper MM, et al. ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022 ; 43 : 3618-731.

3）Armstrong I, Billings C, Kiely DG, et al. The patient experience of pulmonary hypertension : a large cross-sectional study of UK patients. BMC Pulm Med 2019 ; 19 : 67.

4）Strange G, Gabbay E, Kermeen F, et al. Time from symptoms to definitive diagnosis of idiopathic pulmonary arterial hypertension : the delay study. Pulm Circ 2013 ; 3 : 89-94.

5）Kusunose K, Hirata Y, Tsuji T, et al. Deep Learning to Predict Elevated Pulmonary Artery Pressure in Patients with Suspected Pulmonary Hypertension Using Standard Chest X Ray. Sci Rep 2020 ; 10 : 19311.

6）Yamasaki Y, Abe K, Kamitani T, et al. Efficacy of Dynamic Chest Radiography for Chronic Thromboembolic Pulmonary Hypertension. Radiology 2023 ; 306 : e220908.

7）Harjola VP, Mebazaa A, Čelutkienė J, et al. Contemporary management of acute right ventricular failure : a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Fail 2016 ; 18 : 226-41.

8）日本循環器学会，日本小児循環器学会，日本心エコー図学会，他．2021年改訂版　循環器超音波検査の適応と判読ガイドライン．2021

9）Remy-Jardin M, Ryerson CJ, Schiebler ML, et al. Imaging of pulmonary hypertension in adults : a position paper from the Fleischner Society. Eur Respir J 2021 ; 57 : 2004455.

10）Tunariu N, Gibbs SJR, Win Z, et al. Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med 2007 ; 48 : 680-4.

11）He J, Fang W, Lv B, et al. Diagnosis of chronic thromboembolic pulmonary hypertension : comparison of ventilation/perfusion scanning and multidetector computed tomography pulmonary angiography with pulmonary angiography. Nucl Med Commun 2012 ; 33 : 459-63.

12）Nakazawa T, Watanabe Y, Hori Y, et al. Lung perfused blood volume images with dual-energy computed tomography for chronic thromboembolic pulmonary hypertension : correlation to scintigraphy with single-photon emission computed tomography. J Comput Assist Tomogr 2011 ; 35 : 590-5.

13）Fukui S, Ogo T, Morita Y, et al. Right ventricular reverse remodeling after balloon pulmonary angioplasty. Eur Respir J 2014 ; 43 : 1394-402.

14）Baggen VJ, Leiner T, Post MC, et al. Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension : a systematic review and meta-analysis. Eur Radiol 2016 ; 26 : 3771-80.

15）Sanz J, García-Alvarez A, Fernández-Friera L, et al. Right ventriculo-arterial coupling in pulmonary hypertension : a magnetic resonance study. Heart 2012 ; 98 : 238-43.

16）Freed BH, Gomberg-Maitland M, Chandra S, et al. Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension. J Cardiovasc Magn Reson 2012 ; 14 : 11.

17）Sigfridsson A, Haraldsson H, Ebbers T, et al. Single breath hold multiple slice DENSE MRI. Magn Reson Med 2010 ; 63 : 1411-4.

18）Freed BH, Collins JD, François CJ, et al. MR and CT Imaging for the Evaluation of Pulmonary Hypertension. JACC Cardiovasc Imaging 2016 ; 9 : 715-32.

19）Swift AJ, Rajaram S, Hurdman J, et al. Noninvasive estimation of PA pressure, flow, and resistance with CMR imaging : derivation and prospective validation study from the ASPIRE registry. JACC Cardiovasc Imaging 2013 ; 6 : 1036-47.

20）Ota H, Kamada H, Higuchi S, et al. Clinical Clinical Application of 4D Flow MR Imaging to Pulmonary Hypertension. Magn Reson Med Sci 2022 ; 21 : 309-18.