AUTHOR=Lasch Florian , Karch Annika , Koch Armin , Derlin Thorsten , Voskrebenzev Andreas , Alsady Tawfik Moher , Hoeper Marius M. , Gall Henning , Roller Fritz , Harth Sebastian , Steiner Dagmar , Krombach Gabriele , Ghofrani Hossein Ardeschir , Rengier Fabian , Heußel Claus Peter , Grünig Ekkehard , Beitzke Dietrich , Hacker Marcus , Lang Irene M. , Behr Jürgen , Bartenstein Peter , Dinkel Julien , Schmidt Kai-Helge , Kreitner Karl-Friedrich , Frauenfelder Thomas , Ulrich Silvia , Hamer Okka W. , Pfeifer Michael , Johns Christopher S. , Kiely David G. , Swift Andrew James , Wild Jim , Vogel-Claussen Jens TITLE=Comparison of MRI and VQ-SPECT as a Screening Test for Patients With Suspected CTEPH: CHANGE-MRI Study Design and Rationale JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=7 YEAR=2020 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2020.00051 DOI=10.3389/fcvm.2020.00051 ISSN=2297-055X ABSTRACT=

The diagnostic strategy for chronic thromboembolic pulmonary hypertension (CTEPH) is composed of two components required for a diagnosis of CTEPH: the presence of chronic pulmonary embolism and an elevated pulmonary artery pressure. The current guidelines require that ventilation–perfusion single-photon emission computed tomography (VQ-SPECT) is used for the first step diagnosis of chronic pulmonary embolism. However, VQ-SPECT exposes patients to ionizing radiation in a radiation sensitive population. The prospective, multicenter, comparative phase III diagnostic trial CTEPH diagnosis Europe - MRI (CHANGE-MRI, ClinicalTrials.gov identifier NCT02791282) aims to demonstrate whether functional lung MRI can serve as an equal rights alternative to VQ-SPECT in a diagnostic strategy for patients with suspected CTEPH. Positive findings are verified with catheter pulmonary angiography or computed tomography pulmonary angiography (gold standard). For comparing the imaging methods, a co-primary endpoint is used. (i) the proportion of patients with positive MRI in the group of patients who have a positive SPECT and gold standard diagnosis for chronic pulmonary embolism and (ii) the proportion of patients with positive MRI in the group of patients with negative SPECT and gold standard. The CHANGE-MRI trial will also investigate the performance of functional lung MRI without i.v. contrast agent as an index test and identify cardiac, hemodynamic, and pulmonary MRI-derived parameters to estimate pulmonary artery pressures and predict 6–12 month survival. Ultimately, this study will provide the necessary evidence for the discussion about changes in the recommendations on the diagnostic approach to CTEPH.