• Michinobu Nagao, Yuzo Yamasaki, Kohtaro Abe, Kazuya Hosokawa, Satoshi Kawanami, Takeshi Kamitani, Torahiko Yamanouchi, Hidetake Yabuuchi, Kenji Fukushima, and Hiroshi Honda.
• Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: nagao.michinobu@twmu.ac.jp.
• Eur J Radiol. 2017 Feb 1; 87: 99-104.

PurposeThe aims of this study were to propose a new quantitative method for pulmonary artery (PA) flow energetics using phase-contrast magnetic resonance imaging (PC-MRI), and to investigate how balloon pulmonary angioplasty (BPA) impacts energetics in chronic thromboembolic pulmonary hypertension (CTEPH).Materials And MethodsPC-MRI at 3-Teslar and with a flow sensitive gradient echo was used to examine energetics prior to and following BPA for 24 CTEPH patients. Stroke volume (m; ml) and mean velocity (V; mm/s) for the main pulmonary artery (PA), right PA, and left PA were calculated from a time-flow curve derived from PC-MRI. Based on the Bernoulli principle, PA energy was identified as 1/2mV2 (μj/kg), and energy loss was defined as the following equation "energy loss=main PA energy-(rt. PA energy+lt. PA energy)".ResultsRight PA energy was significantly greater post-BPA than pre-BPA (61±55 vs. 32±40μj/kg). There was no difference in main PA and left PA energies. Energy loss was significantly decreased post-BPA (18±97μj/kg) than pre-BPA (79±125μj/kg). An optimal cutoff of left PA energy of 45μj/kg pre-BPA can be used to predict patients with mPAP≥30mmHg after BPA, with an area under the curve of 0.91, 78% sensitivity, and 92% specificity.ConclusionAnalysis of PA energetics using phase-contrast MRI demonstrates that BPA improves energy loss in CTEPH. In addition, BPA responses can be predicted by PA energy status pre-treatment.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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