Comparative assessment of diagnostic modalities in pulmonary hypertension (PH)
| Parameter | CMR | ECHO | CT (incl. CTA) | RHC |
| Initial diagnosis and confirmation | ++ (may suggest) | ++ (may suggest) | ++ (may suggest) | +++ (gold standard) |
| Aetiology | ++ | ++ | +++ (especially in CTEPH and ILD-related PH) | ++ (differentiates between various WHO groups) |
| Right ventricle variables | ||||
| Pressure | ++ | ++ | − | +++ |
| Ejection fraction | +++ (gold standard, stroke volume/end-diastolic volume) | ++ | +/−# | − |
| Strain | +++ | ++ | +/−# | − |
| Stroke volume | +++ (gold standard) | + | − | +++ |
| Mass | +++ (gold standard) | − | ++ | − |
| Right ventricular remodelling | +++ (gold standard) | ++ | ++ | − |
| Tricuspid regurgitation | ++ | +++ | − | + |
| Septal curvature | +++ | ++ | +/−# | − |
| Pericardial effusion | ++ | +++ | + | − |
| TAPSE | − | +++ | +/−# | − |
| Ventricular–arterial coupling (right ventricular end systolic elastance, arterial elastance) | +++ | − | +/−# | − |
| Right atrial variables | ||||
| Area/volume | ++ | ++ | + | − |
| Pressure | − | + | − | +++ |
| Pulmonary artery variables | ||||
| Pressure | ++ | ++ | − | +++ (gold standard) |
| RAC/pulsatility | +++ | + | +/−# | − |
| Distensibility | +++ | ++ | +/−# | + |
| Quantitative blood flow | +++ | − | − | − |
| Strengths | Gold standard for assessing ventricular mass and structure No radiation | Readily available Preferred imaging modality for first screening No radiation | Good for evaluation of aetiologies (especially CTEPH and ILD-related PH) | Gold standard for confirmation of PH |
| Limitations | Limited availability Significant operator/reader expertise required Poor evaluation of lung parenchyma | Limited role for confirmation/assessment of aetiology Limited evaluation of right ventricle and pulmonary artery morphology | Significant amount of radiation involved Poor modality to assess haemodynamics | Provides no information about the morphology and function of the right ventricle |
CMR: cardiovascular magnetic resonance; CT: computed tomography; CTA: computed tomography angiography; RHC: right-heart catheterisation; CTEPH: chronic thromboembolic pulmonary hypertension; ILD: interstitial lung disease; WHO: World Health Organization; TAPSE: tricuspid annular plane systolic excursion; RAC: relative area change; ECHO: echocardiography; ECG: electrocardiogram. #: CT/CTA can assess these variables if ECG-gating is employed.