Pulmonary hypertension (PH) remains a challenging condition to diagnose, classify and treat. Current approaches to the assessment of PH include echocardiography, ventilation/perfusion scintigraphy, cross-sectional imaging using computed tomography and magnetic resonance imaging, and right heart catheterisation. However, these approaches only provide an indirect readout of the primary pathology of the disease: abnormal vascular remodelling in the pulmonary circulation. With the advent of newer imaging techniques, there is a shift toward increased utilisation of noninvasive high-resolution modalities that offer a more comprehensive cardiopulmonary assessment and improved visualisation of the different components of the pulmonary circulation. In this review, we explore advances in imaging of the pulmonary vasculature and their potential clinical translation. These include advances in diagnosis and assessing treatment response, as well as strategies that allow reduced radiation exposure and implementation of artificial intelligence technology. These emerging modalities hold the promise of developing a deeper understanding of pulmonary vascular disease and the impact of comorbidities. They also have the potential to improve patient outcomes by reducing time to diagnosis, refining classification, monitoring treatment response and improving our understanding of disease mechanisms.

肺动脉高压 （PH） 仍然是一种难以诊断、分类和治疗的疾病。目前评估 PH 的方法包括超声心动图、通气/灌注闪烁显像、使用计算机断层扫描和磁共振成像的横断面成像以及右心导管插入术。然而，这些方法仅提供了疾病主要病理的间接读数：肺循环中的异常血管重塑。随着更新的成像技术的出现，人们越来越多地使用无创高分辨率方法，这些方法提供更全面的心肺评估和改进的肺循环不同组成部分的可视化。在这篇综述中，我们探讨了肺血管系统成像的进展及其潜在的临床转化。其中包括诊断和评估治疗反应的进步，以及允许减少辐射暴露和人工智能技术实施的策略。这些新兴方式有望加深对肺血管疾病和合并症影响的理解。它们还有可能通过缩短诊断时间、完善分类、监测治疗反应和提高我们对疾病机制的理解来改善患者的预后。