肾脏肿瘤的MR动态增强扫描研究

目的:探讨MR动态增强扫描在肾脏肿瘤诊断和鉴别诊断中的价值。方法:对21例肾细胞癌、11例肾错构瘤和6例肾囊肿行MR常规检查及动态增强和延迟增强扫描,测量病灶的信号强度,绘制时间-对比增强率曲线并对动态增强的类型及血液动力学改变进行分析。结果:肾脏肿瘤动态增强后的时间-对比增强率曲线不同,富血供肾癌在早期强化并逐渐上升,但其时间-对比增强率曲线无明显峰值;乏血供肾癌早期轻度强化,缓慢上升至60s后趋于稳定;肾错构瘤早期即明显强化,于30s达到强化高峰后快速下降;肾囊肿则无明显强化。结论:通过定量分析肾脏肿瘤的信号强度,动态增强MRI可以提供肿瘤的血供信息,有助于肾脏肿瘤的诊断和鉴别诊断。     

增强MRI时间-信号增强率曲线对肾上腺肿瘤的鉴别价值

目的 :以肿瘤的时间 信号增强率曲线作为诊断标准 ,进一步证实Gd DTPA动态增强MRI检查技术对肾上腺肿瘤的鉴别诊断价值。方法 :3 6例共 41个肾上腺肿瘤 ,腺瘤 19例共 19个 ,非腺瘤 17例共 2 2个。所有肿瘤均先行常规SE序列T1 W和T2 W成像 ,选定肿瘤中心层面定位后 ,再利用屏气快速多层面破坏性梯度回波序列 (FMPSPGR)行轴位扫描 ,先平扫 ,再以同样条件行MRI动态增强检查 ,即静注Gd DTPA ,自注药后 0 .5min开始扫描 ,之后分别在 60min内共 17个时间点 ,以同等条件延时扫描 ,观察病变的增强程度 ,并分别测量其实质部分的信号值。计算肿瘤的信号比、最大信号增加比、增强率 ,再根据随时间延时肿瘤增强率的变化绘制曲线 ,比较肾上腺肿瘤间的时间 信号增强率曲线有无差异 ,并明确其对肾上腺肿瘤的鉴别诊断价值。结果 :Ⅰ型时间 信号增强率曲线具有高度特异性 ,只有大多数神经源性肿瘤符合此增强特点 ,对区分腺瘤与其它类型的非腺瘤无诊断价值 ;以Ⅲ型或Ⅳ型曲线为标准诊断恶性肿瘤的准确率均不高 ,有 5 0 %的恶性肿瘤无法确诊 ;而以Ⅱ型时间 信号增强率曲线为标准较前 3种曲线更有助于肾上腺肿瘤的鉴别诊断 ,即以早期增强 ,延时 9min内肿瘤增强率下降程度超过肿瘤最大增强率的 5 0 %为诊断腺瘤的标准 ,敏     

ROC曲线分析在肾上腺肿瘤的动态增强CT、MRI检查中的应用

目的 探讨应用受试者操作特性(ROC)曲线评价以肿瘤廓清率为标准利用动态增强CT、MRI检查鉴别肾上腺肿瘤的价值及其这两种检查方法的相关性.资料与方法 25例共28个肾上腺肿瘤均先行平扫及动态增强CT检查,之后再行平扫及动态增强MRI检查,以肿瘤的廓清率为鉴别标准,利用ROC曲线对所选取的诊断标准进行评价,通过ROC曲线下面积(AZ值)来确定所选择诊断标准的价值,并对这两种检查方法行相关性分析.结果 在延迟5～35 min时间点,以肿瘤的廓清率为标准对肾上腺肿瘤的鉴别诊断价值较大(AZ值均在0.7以上),两者之间差异无统计学意义(P＞0.05),再通过对两组变量,即两种检查方法中的廓清率进行分析,认为在延迟5～50 min时,两组变量对肾上腺肿瘤的鉴别诊断均具有高度相关性.结论 以肿瘤的廓清率为诊断标准,无论是利用动态增强CT还是动态增强MRI检查,均可提高肾上腺肿瘤的鉴别诊断水平,两种检查方法对于肾上腺肿瘤的鉴别诊断价值差异无统计学意义,且检查结果具有一致性.     

乳腺MRI动态增强对良恶性病变的鉴别价值

目的：探讨磁共振动态增强技术（DCE-MRI）对乳腺良恶性病变的鉴别诊断价值。方法：18例乳腺良性病变、16例恶性肿瘤及2例交界性病变患者行DCEMRI检查（平均年龄51．7岁）。对病变的边缘、形态、有无播散征、时间信号曲线、最大增强斜率（MSI）、信号增强率（SER）和信号增强幅度（SEE）等7项指标进行了良恶性组比较。结果：除了MSI以外,其余6项指标在良恶性组之间差异均有显著性意义。用病变形态、时间信号曲线及SEE等五项指标对36例乳腺病变综合评分结果显示：综合评分对诊断乳腺恶性肿瘤的灵敏度、特异度和准确性分别为93．8％、83．3％及88．2％。结论：结合DCE～MRI的病变形态学改变及动态增强表现对乳腺良恶性病变的鉴别有很好的诊断价值。     

颅咽管瘤的MRI诊断

目的：探讨MRI在诊断颅咽管瘤中的作用。材料和方法：取70例(男37，女33，平均年龄33．2岁，平均病程2年半)经手术和病理证实的颅咽管瘤患者术前MRI检查资料，其中25例加作Gd—DTPA增强MRI扫描，分析MRI表现特征及找出诊断与鉴别诊断要点。结果：本组术前MRI诊断定位正确率为：100％，定性正确率为80%，误诊率为20％，其MRI特征性表现为：(1)肿瘤形态以结节状．分叶状为主(本组为67％)，边界清楚．(2)肿囊信号多不均匀(本组为65％)，表现复杂．(3)Gd—DTPA增强多数肿瘤呈不均匀强化(本组56%)。结论：：MRI的多轴位成像及Gd—DTPA应用有助于颅咽管瘤的诊断与鉴别诊断．     

良、恶性乏脂质性肾上腺肿瘤的动态MRI检查

目的：探讨MRI动态增强检查技术对乏脂质性肾上腺肿瘤良、恶性的鉴别诊断价值。方法：经手术和临床证实的29例共33个乏脂质性肾上腺肿瘤行MRI平扫并于注药后1min、2min、3min、5min、7min和9min时间点行动态增强检查,分别观察病变的增强程度并获取乏脂质性肾上腺肿瘤的廓清率（Wash）和时间-信号强度曲线（T-S curve）,以评估良、恶性肿瘤间是否存在统计学差异。结果：T-S曲线分Ⅰ~Ⅴ五种类型。良性乏脂质性肿瘤的特征曲线为Ⅰ、Ⅱ型和Ⅳ型;恶性乏脂质性肿瘤的特征曲线为Ⅲ型和Ⅴ型（P=0.000）,肾上腺良性乏脂质性肿瘤的廓清率高于恶性肿瘤,两者之间差异有统计学意义（P=0.006）,在5min延迟点诊断价值较大,Wash≥23%提示为良性肿瘤。结论：MRI动态增强检查技术对乏脂质性肾上腺肿瘤良、恶性的鉴别诊断具有较高价值。     

幕上原始神经外胚层肿瘤的CT、MRI和病理分析

目的探讨幕上原始神经外胚层肿瘤（PNET）的CT及MRI特点，以提高影像学诊断的准确性。资料与方法分析经手术病理证实的8例PNET的CT及MRI表现。结果8例PNET分别位于幕上大脑半球的额顶、额颞、枕叶、胼胝体区，病灶普遍较大，多为偏实性肿瘤，边界清晰，瘤周水肿较轻，其中病灶内囊变4例，合并出血3例，肿瘤T1WI呈稍低信号，T2WI呈稍高信号4例，T1WI、T2WI呈混杂信号3例，2例DWI显示呈高信号。增强检查肿瘤可表现为不均一强化、不规则“印戒”样强化，2例显示沿室管膜播散。结论PNET影像学表现有一定特征，影像学表现结合临床症状有助于与其他肿瘤区分。     

鼻咽部血管纤维瘤的影像学诊断价值

目的：探讨鼻咽部血管纤维瘤影像学的价值。方法：回顾分析经手术病理证实的血管纤维瘤的CT、MRI、DSA特征，CT检查13例，MRI4例和DSA3例，同时完成2项或3项检查分别为4例和3例。结果：13例均显示出病变的部位及范围，CT平扫示软组织块为等密度或稍高密度。MRI示肿块T1WI呈等于或略高于肌肉信号，T2WI呈高信号。肿块增强扫描明显强化，CT强化密度曲线呈速升缓降型；MRI信号增强率升高。3例DSA显示供血情况以及营养血管的特征。结论：血管纤维瘤有特征性的CT和MRI表现，CT动态扫描、MRI增强率的表达及DSA有助于诊断和鉴别诊断。     

Gd-DTPA增强MRI诊断肺内结节

目的：研究Gd－DTPA增强MRI在孤立性肺结节鉴别诊断中的作用。材料和方法：对26例≤3cm的孤立肺内结节（肺癌16例，结核10例）进行了常规和动态Gd－DTPA增强MRI检查，测量病灶的增强程度，分析MRI表现并与病理对照。结果：16例肺癌在静脉注入Gd－DTPA后均有强化，表现为实体均匀（9例）和不均匀（7例）增强，而多数（8／10）结核球表现为环形增强。肺癌平均增强71％，与结核球（23％）有显著差异。肺癌结节的动态增强曲线也与结核球不同。结论：肺癌与结核球的MRI增强形态和增强程度不同，对鉴别诊断很有帮助。     

成人幕上原始神经外胚层肿瘤的MRI表现

目的:探讨成人幕上原始神经外胚层肿瘤(PNET)的MRI表现,提高对本病的诊断水平。方法:回顾分析10例经手术和病理证实的幕上PNET的MRI资料(其中3例为术后复发而再次手术的病例)。结果:病灶多数位于额叶及额顶叶,病灶普遍较大,病灶绝大多数信号不均匀,病灶内可见囊变/坏死(9例)、出血(3例)、钙化(2例)、流空小血管影(5例),增强后病灶呈明显不均匀强化(9例),2例显示肿瘤脑脊液通路播散,1例显示肿瘤侵犯上矢状窦和颅骨。结论:PNET的MRI表现无特异性,一些MR特征对本病的诊断有一定的帮助,最后的确诊依赖于病理学诊断。     

Non-contrast-enhanced MR angiography of the thoracic aorta using cardiac and navigator-gated magnetization-prepared three-dimensional steady-state free precession

PURPOSE: To assess the usefulness of non-contrast-enhanced MR angiography using cardiac and navigator-gated magnetization-prepared three-dimensional (3D) steady-state free precession (SSFP) imaging for the diagnosis of diseases of the thoracic aorta. MATERIALS AND METHODS: Twenty-two patients with diseases of the thoracic aorta were examined using a 1.5 Tesla unit. Non-contrast-enhanced MR angiography was done using parasagittal 3D SSFP combined with cardiac-gating and k-space weighted navigator-gating techniques, using T2-prepared and fat-suppression pulses. Imaging quality and the diagnostic capability of this technique were compared with the imaging quality of 2D SSFP or contrast-enhanced 3D MR angiography and with final diagnoses. RESULTS: Non-contrast-enhanced 3D MR angiography provided signal-to-noise and contrast-to-noise ratios of the thoracic aorta comparable to non-contrast-enhanced 2D or contrast-enhanced 3D MR angiography (P > 0.17). This imaging technique gave accurate diagnoses in 19 of the 22 patients. CONCLUSION: Non-contrast-enhanced MR angiography using cardiac and navigator-gated magnetization-prepared 3D SSFP technique was useful for the diagnosis of diseases of the thoracic aorta.     

Transcatheter Dynamic Contrast-Enhanced MR Lymphangiography for Nontraumatic Lymphatic Disorders: Technical Feasibility and Imaging Findings

This study aimed to evaluate the feasibility and added value of transcatheter dynamic contrast-enhanced magnetic resonance (MR) lymphangiography for nontraumatic lymphatic disorders. Five patients (2 males and 3 females; median age, 16.0 years; range, 3–74 years) who underwent both intranodal and transcatheter dynamic contrast-enhanced MR lymphangiography for suspected nontraumatic lymphatic leakages from June 2017 to January 2020 were included in this retrospective study. The imaging findings of both dynamic contrast-enhanced MR lymphangiography techniques were assessed for the presence of chylolymphatic reflux or direct sign of leakage. Intranodal dynamic contrast-enhanced MR lymphangiography demonstrated chylolymphatic reflux into the thoracic area in 2 patients (40%) but no direct evidence of leakage in any of the 5 patients. Transcatheter dynamic contrast-enhanced MR lymphangiography revealed chylolymphatic reflux and extravasation of the contrast agent in all 5 patients (100%). In conclusion, transcatheter dynamic contrast-enhanced MR lymphangiography may reveal additional signs of reflux and extravasation even when the findings of intranodal dynamic contrast-enhanced MR lymphangiography are negative.     

Value of dynamic contrast-enhanced MR imaging in diagnosing and classifying peripheral vascular malformations

OBJECTIVE: Our purpose was to evaluate prospectively whether MR imaging, including dynamic contrast-enhanced MR imaging, could be used to categorize peripheral vascular malformations and especially to identify venous malformations that do not need angiography for treatment. SUBJECTS AND METHODS: In this blinded prospective study, two observers independently correlated MR imaging findings of 27 patients having peripheral vascular malformations with those of diagnostic angiography and additional venography. MR diagnosis of the category, based on a combination of conventional and dynamic contrast-enhanced MR parameters, was compared with the angiographic diagnosis using gamma statistics. Sensitivity and specificity of conventional MR imaging and dynamic contrast-enhanced MR imaging in differentiating venous from nonvenous malformations were determined. RESULTS: Excellent agreement between the two observers in determining MR categories (gamma = 0.99) existed. Agreement between MR categories and angiographic categories was high for both observers (gamma = 0.97 and 0.92). Sensitivity of conventional MR imaging in differentiating venous and nonvenous malformations was 100%, whereas specificity was 24-33%. Specificity increased to 95% by adding dynamic contrast-enhanced MR imaging, but sensitivity decreased to 83%. CONCLUSION: Conventional and dynamic contrast-enhanced MR parameters can be used in combination to categorize vascular malformations. Dynamic contrast-enhanced MR imaging allows diagnosis of venous malformations with high specificity.     

Soft-tissue tumors: value of static and dynamic gadopentetate dimeglumine-enhanced MR imaging in prediction of malignancy

PURPOSE: To prospectively evaluate static and dynamic gadopentetate dimeglumine-enhanced magnetic resonance (MR) imaging relative to nonenhanced MR imaging in differentiation of benign from malignant soft-tissue lesions and to evaluate which MR imaging parameters are most predictive of malignancy, with associated interobserver variability. MATERIALS AND METHODS: One hundred forty consecutive patients (78 male patients [median age, 51 years], 62 female patients [median age, 53 years]) with a soft-tissue mass underwent nonenhanced static and dynamic contrast material-enhanced MR imaging. Diagnosis was based on histologic findings in surgical specimens (86 of 140), findings at core-needle biopsy (43 of 140), or results of all imaging procedures with clinical follow-up (11 of 140). Multivariate logistic regression analysis was used to identify the best combination of MR imaging parameters that might be predictive of malignancy. Subjective overall performance of two observers was evaluated with receiver operating characteristic analysis. RESULTS: For subjective overall diagnosis, area under the receiver operating characteristic curve, a measure for diagnostic accuracy, was significantly larger for combined nonenhanced and contrast-enhanced MR imaging than it was for nonenhanced MR imaging alone, with no significant difference between observers. Multivariate analysis of all lesions revealed that combined nonenhanced static and dynamic contrast-enhanced MR imaging parameters were significantly superior to nonenhanced MR imaging parameters alone and to nonenhanced MR imaging parameters combined with static contrast-enhanced MR imaging parameters in prediction of malignancy. The most discriminating parameters were presence of liquefaction, start of dynamic enhancement (time interval between start of arterial and tumor enhancement), and lesion size (diameter). Results for extremity lesions were the same, with one exception: With dynamic contrast-enhanced MR imaging parameters, diagnostic performance of one observer did not improve. CONCLUSION: Static and dynamic contrast-enhanced MR imaging, when added to nonenhanced MR imaging, improved differentiation between benign and malignant soft-tissue lesions.     

Dynamic contrast-enhanced breath-hold MR imaging of thoracic malignancy using cardiac compensation

The purpose of this paper was to evaluate the use of dynamic gadopentetate dimeglumine-enhanced, breath-hold spoiled gradient-recalled (SPGR) MR imaging with cardiac compensation (CMON) compared to spin-echo MR imaging in patients with thoracic malignancy. We retrospectively reviewed MR images from 29 patients with thoracic tumors. MR imaging included axial electrocardiogram (ECG)-gated T1-weighted, fast spin echo (FSE) T2-weighted, and contrast-enhanced breath-hold fast multiplanar SPGR imaging with CMON, which selects the phase-encoding gradient based on the phase within the cardiac cycle. Images were reviewed for lung masses, mediastinal or hilar tumor, disease of the pleura, chest wall, and bones, and vascular compression or occlusion. Contrast-enhanced fast multiplanar SPGR imaging with CMON produces images of the chest that are free of respiratory artifact and have diminished vascular pulsation artifact. ECG-gated T1-weighted images were preferred for depicting mediastinal and hilar tumor. The gadopentetate dimeglumine-enhanced fast multiplanar SPGR images were useful for depicting chest wall tumor, vascular compression or thrombosis, osseous metastases, and in distinguishing a central tumor mass from peripheral lung consolidation. Pleural tumor was depicted best on the FSE T2-weighted images and the contrast-enhanced SPGR images. As an adjunct to spin echo T1-weighted and T2-weighted imaging, contrast-enhanced fast multiplanar SPGR imaging with CMON is useful in the evaluation of thoracic malignancy.     

Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging

PURPOSE: To prospectively determine the accuracies of T2-weighted magnetic resonance (MR) imaging, dynamic contrast material-enhanced MR imaging, and quantitative three-dimensional (3D) proton MR spectroscopic imaging of the entire prostate for prostate cancer localization, with whole-mount histopathologic section findings as the reference standard. MATERIALS AND METHODS: This study was approved by the institutional review board, and informed consent was obtained from all patients. Thirty-four consecutive men with a mean age of 60 years and a mean prostate-specific antigen level of 8 ng/mL were examined. The median biopsy Gleason score was 6. T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, and 3D MR spectroscopic imaging were performed, and on the basis of the image data, two readers with different levels of experience recorded the location of the suspicious peripheral zone and central gland tumor nodules on each of 14 standardized regions of interest (ROIs) in the prostate. The degree of diagnostic confidence for each ROI was recorded on a five-point scale. Localization accuracy and ROI-based receiver operating characteristic (ROC) curves were calculated. RESULTS: For both readers, areas under the ROC curve for T2-weighted MR, dynamic contrast-enhanced MR, and 3D MR spectroscopic imaging were 0.68, 0.91, and 0.80, respectively. Reader accuracy in tumor localization with dynamic contrast-enhanced imaging was significantly better than that with quantitative spectroscopic imaging (P < .01). Reader accuracy in tumor localization with both dynamic contrast-enhanced imaging and spectroscopic imaging was significantly better than that with T2-weighted imaging (P < .01). CONCLUSION: Compared with use of T2-weighted MR imaging, use of dynamic contrast-enhanced MR imaging and 3D MR spectroscopic imaging facilitated significantly improved accuracy in prostate cancer localization.     

Enhanced cervical MRI in identifying intracranial dural arteriovenous fistulae with spinal perimedullary venous drainage

Diagnosis of an intracranial dural arteriovenous fistula (DAVF) with spinal perimedullary venous drainage is challenging because the presenting symptoms are usually related to dysfunction of the spine, not of the brain. Repeated spinal angiograms are usually performed before the diagnosis is finally made by cerebral angiography. We report two cases of intracranial DAVFs with spinal perimedullary venous drainage. In both cases contrast-enhanced cervical MRI demonstrated dilated lower brainstem and upper spinal veins, which, we believe, is a good indicator of the existence of such drainage. We suggest that, in cases with perimedullary serpentine enhancement on thoracic or lumbar MR images, additional Gd-enhanced cervical spinal MR imaging should be performed. The simple process of tracing the veins upwards may avoid a lot of unnecessary examinations and delay in the diagnosis. Received: 3 July 1997 Accepted: 6 August 1997     

恶性血液肿瘤脊柱骨髓弥漫性浸润的动态对比增强MR灌注成像

目的 评价动态对比增强MR灌注成像对恶性血液肿瘤脊柱骨髓弥漫性浸润性病变的诊断价值. 资料与方法 经骨髓组织活检确诊的恶性血液肿瘤26例和20例正常对照者行腰椎动态对比增强MR灌注成像检查.计算峰值增强百分率(Emax)、增强斜率(ES)和到达峰值时间(TTP). 结果 脊柱骨髓弥漫性恶性浸润组与正常对照组间的Emax、ES和TTP均具有显著差异(P<0.01).骨髓轻度浸润和中度浸润之间的Emax、ES和TTP均具有显著差异(P<0.05).骨髓轻度浸润和重度浸润之间的Emax、ES和TTP均具有显著差异(P<0.01).骨髓中度浸润和重度浸润之间的Emax、ES和TTP无显著差异(P>0.05).Emax、ES和骨髓浸润程度之间具有正相关性(P<0.01),TTP和骨髓浸润程度之间具有负相关性(P<0.01). 结论 动态对比增强MR灌注成像可以判断恶性血液肿瘤是否出现脊柱骨髓弥漫性浸润,灌注参数可以反映骨髓肿瘤细胞浸润程度.     

Postoperative evaluation for disseminated medulloblastoma involving the spine: contrast-enhanced MR findings, CSF cytologic analysis, timing of disease occurrence, and patient outcomes

BACKGROUND AND PURPOSE: Postoperative MR imaging is routinely performed for staging of medulloblastoma because of frequent tumor dissemination along CSF pathways. The goals of this study were to: 1) determine the timing of disease occurrence and contrast-enhanced MR imaging features of disseminated medulloblastoma involving the spine and their relationship to patient outcomes; and 2) compare the diagnostic accuracy of MR imaging findings with CSF cytologic analysis. METHODS: Medical records, pathologic reports, and unenhanced and contrast-enhanced postoperative MR images of the spine and head from 112 patients who had resection of medulloblastoma were retrospectively reviewed. MR images of the spine were evaluated for abnormal contrast enhancement in the meninges and vertebral bone marrow. MR images of the head were evaluated for recurrent or residual intracranial tumor. Imaging data were correlated with available CSF cytologic results and patient outcomes. RESULTS: Twelve patients (11%) had tumor within the spinal leptomeninges depicted on MR images at the time of diagnosis. Twenty-five patients (22%) had disseminated disease in the spine (leptomeninges, n = 22; vertebral marrow, n = 1; or both locations, n = 2) on MR images 2 months to 5.5 years (mean, 2 years) after initial surgery and earlier negative imaging examinations. Eleven other patients (10%) had recurrent intracranial medulloblastoma without spinal involvement seen with MR imaging. Spinal MR imaging had a sensitivity of 83% in the detection of disseminated tumor, whereas contemporaneous CSF cytologic analysis had a sensitivity of 60%. The sensitivity of CSF cytologic analysis increased to 78% with acquisition of multiple subsequent samples, although diagnosis would have been delayed by more than 6 months compared with diagnosis by spinal MR imaging in six patients. Spinal MR imaging was found to have greater overall diagnostic accuracy than CSF cytologic analysis in the early detection of disseminated tumor (P = .03). Spinal MR imaging confirmed disseminated tumor when contemporaneous CSF cytologic findings were negative in 13 patients, whereas the opposite situation occurred in only two patients. False-positive results for spinal MR imaging and CSF cytologic analysis occurred when these examinations were obtained earlier than 2 weeks after surgery. The 5-year survival probability for patients with spinal tumor was 0.24 +/- 0.08 versus 0.68 +/- 0.05 for the entire study group. CONCLUSION: Spinal MR imaging was found to have greater diagnostic accuracy than CSF cytologic analysis in the early detection of disseminated medulloblastoma. CSF cytologic analysis infrequently confirmed disseminated tumor when spinal MR imaging results were negative. Delaying spinal MR imaging and CSF cytologic analysis by more than 2 weeks after surgery can reduce false-positive results for both methods. The presence of disseminated medulloblastoma in the spine seen with MR imaging is associated with a poor prognosis.     

Chronic thromboembolic pulmonary hypertension — assessment by magnetic resonance imaging

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe disease that has been ignored for a long time. However, with the development of improved therapeutic modalities, cardiologists and thoracic surgeons have shown increasing interest in the diagnostic work-up of this entity. The diagnosis and management of chronic thromboembolic pulmonary hypertension require a multidisciplinary approach involving the specialties of pulmonary medicine, cardiology, radiology, anesthesiology and thoracic surgery. With this approach, pulmonary endarterectomy (PEA) can be performed with an acceptable mortality rate. This review article describes the developments in magnetic resonance (MR) imaging techniques for the diagnosis of chronic thromboembolic pulmonary hypertension. Techniques include contrast-enhanced MR angiography (ce-MRA), MR perfusion imaging, phase-contrast imaging of the great vessels, cine imaging of the heart and combined perfusion-ventilation MR imaging with hyperpolarized noble gases. It is anticipated that MR imaging will play a central role in the initial diagnosis and follow-up of patients with CTEPH. This article is dedicated to Manfred Thelen, MD, Professor of Radiology, our teacher in clinical radiology. This study was supported by the Deutsche Forschungsgemeinschaft (grant FOR 474/1).