Noninvasive assessment of pulmonary hypertension: key insights to maximize chest computed tomography

According to the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines, a right heart catheterization-derived mean pulmonary arterial pressure (mPAP) > 20 mmHg at rest defines pulmonary hypertension (PH). As PH can ultimately lead to death, multidisciplinary early diagnosis, proper framework, and prompt management are crucial. ESC/ERS PH classification encompasses five groups, each sharing pathogenesis, hemodynamics, and management, i.e., group I, pulmonary arterial hypertension; II, left heart disease; III, lung disease and/or hypoxia; IV, chronic thromboembolic PH; and V, with unclear and/or multifactorial mechanisms. Chest CT is pivotal in PH grouping, comprehensively evaluating the lung, heart, pulmonary vessels, and mediastinum. In this review, we synoptically illustrate the chest CT findings of PH and provide a CT-based logical framework suggesting a PH group hypothesis. Improving knowledge of PH CT features and their combination empowers radiologists to contribute valuably to the PH multidisciplinary clinical discussion.