The aim of the study was to determine the size and location of homogeneous inflamed/ noninflamed and inhomogeneous inflamed/noninflamed lung compartments and their association with acute respiratory distress syndrome (ARDS) severity. In total, 20 ARDS patients underwent 5 and 45 cmH2O computed tomography (CT) scans to measure lung recruitability. [18F]2-fluoro-2-deoxy-D-glucose ([18F]FDG) uptake and lung inhomogeneities were quantified with a positron emission tomography-CT scan at 10 cmH2O. We defined four compartments with normal/abnormal [18F]FDG uptake and lung homogeneity. The homogeneous compartment with normal [18F]FDG uptake was primarily composed of well-inflated tissue (80±16%), double-sized in nondependent lung (32±27% versus 16±17%, p<0.0001) and decreased in size from mild, moderate to severe ARDS (33±14%, 26±20% and 5±9% of the total lung volume, respectively, p=0.05). The homogeneous compartment with high [18F]FDG uptake was similarly distributed between the dependent and nondependent lung. The inhomogeneous compartment with normal [18F]FDG uptake represented 4% of the lung volume. The inhomogeneous compartment with high [18F]FDG uptake was preferentially located in the dependent lung (21±10% versus 12±10%, p<0.0001), mostly at the open/closed interfaces and related to recruitability (r2=0.53, p<0.001). The homogeneous lung compartment with normal inflation and [18F]FDG uptake decreases with ARDS severity, while the inhomogeneous poorly/not inflated compartment increases. Most of the lung inhomogeneities are inflamed. A minor fraction of healthy tissue remains in severe ARDS.
Lung inhomogeneities, inflation and [18F]2-fluoro-2-deoxy-D-glucose uptake rate in acute respiratory distress syndrome / M. Cressoni, D. Chiumello, C. Chiurazzi, M. Brioni, I. Algieri, M. Gotti, K. Nikolla, D. Massari, A. Cammaroto, A. Colombo, P. Cadringher, E. Carlesso, R. Benti, R. Casati, F. Zito, L. Gattinoni. - In: EUROPEAN RESPIRATORY JOURNAL. - ISSN 0903-1936. - 47:1(2016 Jan), pp. 233-242.
|Titolo:||Lung inhomogeneities, inflation and [18F]2-fluoro-2-deoxy-D-glucose uptake rate in acute respiratory distress syndrome|
CHIUMELLO, DAVIDE ALBERTO (Secondo)
GATTINONI, LUCIANO (Ultimo)
|Parole Chiave:||Adult; Aged; Aged, 80 and over; Female; Fluorodeoxyglucose F18; Humans; Lung; Male; Middle Aged; Multimodal Imaging; Pneumonia; Radiopharmaceuticals; Respiratory Distress Syndrome, Adult; Sepsis; Tomography, X-Ray Computed; Wounds and Injuries; Pulmonary and Respiratory Medicine|
|Settore Scientifico Disciplinare:||Settore MED/41 - Anestesiologia|
|Data di pubblicazione:||gen-2016|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1183/13993003.00885-2015|
|Appare nelle tipologie:||01 - Articolo su periodico|