CT Chest While CT can document the position of the diaphragm with multiplanar imaging and in theory can provide dynamic information, there are no data to support its use in the analysis of diaphragmatic dysfunction. MRI Chest Although not widely practiced, cine dynamic MRI sequences allow for the direct visualization of diaphragm motion [88]. This can result in comprehensive analysis of both the diaphragm and chest wall muscle movement in neuromuscular diseases [89]. US Chest US findings have been found to be concordant with fluoroscopic imaging of diaphragm motion, with reproducible results [90]. Diaphragmatic excursion amplitude, thickness, and contraction can be evaluated, and paralysis may be identified as paradoxical movement during respiration [91]. There is high sensitivity and specificity for the diagnosis of neuromuscular disorders of the diaphragm [92-95]. The extent of diaphragm motion in various conditions, including neuromuscular diseases, COPD, and ILD, correlates with respiratory symptoms and lung function [96-100]. Summary of Recommendations Variant 1: For patients with chronic dyspnea of unclear etiology, it is usually appropriate to initially evaluate with chest radiography, which may reveal a wide variety of abnormalities and guide further imaging decisions. Variant 2: The appropriate initial imaging study for patients with chronic dyspnea with suspected COPD is usually a chest radiograph, which can evaluate for comorbidities, complications, and alternative diagnoses. Variant 3: A chest radiograph is usually appropriate for the initial imaging of patients with chronic dyspnea and suspected central airways disease. Alternatively, CT without IV contrast is also usually appropriate, particularly for the detection of airway collapse, stenosis, or tumor. Variant 4: CT without IV contrast is usually appropriate for the initial imaging of patients with chronic dyspnea and suspected ILD, especially if the patient has a disease that predisposes to ILD.
Chronic Dyspnea Noncardiovascular Origin. CT Chest While CT can document the position of the diaphragm with multiplanar imaging and in theory can provide dynamic information, there are no data to support its use in the analysis of diaphragmatic dysfunction. MRI Chest Although not widely practiced, cine dynamic MRI sequences allow for the direct visualization of diaphragm motion [88]. This can result in comprehensive analysis of both the diaphragm and chest wall muscle movement in neuromuscular diseases [89]. US Chest US findings have been found to be concordant with fluoroscopic imaging of diaphragm motion, with reproducible results [90]. Diaphragmatic excursion amplitude, thickness, and contraction can be evaluated, and paralysis may be identified as paradoxical movement during respiration [91]. There is high sensitivity and specificity for the diagnosis of neuromuscular disorders of the diaphragm [92-95]. The extent of diaphragm motion in various conditions, including neuromuscular diseases, COPD, and ILD, correlates with respiratory symptoms and lung function [96-100]. Summary of Recommendations Variant 1: For patients with chronic dyspnea of unclear etiology, it is usually appropriate to initially evaluate with chest radiography, which may reveal a wide variety of abnormalities and guide further imaging decisions. Variant 2: The appropriate initial imaging study for patients with chronic dyspnea with suspected COPD is usually a chest radiograph, which can evaluate for comorbidities, complications, and alternative diagnoses. Variant 3: A chest radiograph is usually appropriate for the initial imaging of patients with chronic dyspnea and suspected central airways disease. Alternatively, CT without IV contrast is also usually appropriate, particularly for the detection of airway collapse, stenosis, or tumor. Variant 4: CT without IV contrast is usually appropriate for the initial imaging of patients with chronic dyspnea and suspected ILD, especially if the patient has a disease that predisposes to ILD.