Pulmonary blood flow remains fractal down to the level of gas exchange

Estimating perfusion using microCT to locate microspheres

The injection of microspheres into the blood stream has been a common method to measure the spatial distribution of blood flow (perfusion). A technique to conduct this kind of measurement in small animal organs is presented using silver-coated microspheres with a diameter of 16 microm and high-resolution computed tomography (microCT) to detect individual microspheres. Phantom experiments demonstrate the detectability of individual spheres. The distribution of microspheres within a rat heart is given as an example. Using non-destructive, three-dimensional imaging for microsphere detection avoids the cumbersome dissection of the organ into samples or slices and their subsequent registration. The detection of individual spheres allows high-resolution measurements of perfusion and arbitrary definition of regions of interest. These, in turn, allow for accurate statistical analysis of perfusion such as relative dispersion curves.

Quantification of regional ventilation from treatment planning CT

PURPOSE

We describe a method of quantifying regional ventilation from the radiotherapy treatment planning computed tomography (CT) images, with the goal of developing functional images for treatment planning and optimization.

METHODS AND MATERIALS

A series of exhalation breath-hold (eBH-CT) and inhalation breath-hold (iBH-CT) CT images obtained using a feedback-guided breath-hold technique for radiotherapy treatment planning was selected. The eBH-CT was mapped on a voxel-by-voxel basis to the iBH-CT using a deformable image registration algorithm. By using the average CT number over a 3 mm(3) region surrounding each pair of mapped voxels, the change in fraction of air per voxel (i.e., regional ventilation) was calculated. This methodology was applied to a series of 22 patients. The calculated total ventilation was compared to the change in contoured lung volumes between the exhalation and inhalation CTs (measured tidal volume).

RESULTS

A significant correlation was found between the calculated and measured tidal volumes for the left (R = 0.982) and right (R = 0.985), and for both lungs combined (R = 0.985). In the resulting images, the regional ventilation was highly variable and corresponded with the spatial distribution of differences in the CT values (Hounsfield units) between the eBH-CT and the iBH-CT images.

CONCLUSIONS

A method of quantifying regional ventilation from radiotherapy treatment planning CT data sets was demonstrated. The ventilation images can be used in plan optimization to minimize injury to functioning lung.

Blood transit time heterogeneity is associated to oxygen extraction in exercising human skeletal muscle

Capillary transit time and its heterogeneity have a marked impact on oxygen extraction in different tissues. Animal studies have shown that exercise shortens capillary transit time but the effects on capillary transit time heterogeneity have been controversial. We investigated whether exercise changes muscle blood transit time heterogeneity in humans in vivo and whether this heterogeneity correlates to muscle oxygen extraction. Muscle blood flow, blood volume, and oxygen uptake were measured during rest and low-intensity exercise in 12 healthy men using positron emission tomography (PET). Blood transit time was calculated from parametric PET images voxel by voxel by dividing blood volume with blood flow. Oxygen extraction was calculated by nonlinear fitting from dynamic 15O-O2 data. Relative dispersion (=SD/mean) was calculated as an index of heterogeneity of blood volume and blood transit time. As expected, exercise significantly shortened blood transit time and increased oxygen extraction. Furthermore, exercise decreased transit time heterogeneity (from 47 +/- 9% to 39 +/- 10%, P=0.07). Transit time heterogeneity correlated inversely to oxygen extraction in the exercising (r=-0.76, P=0.004) but not in the resting muscle (r=0.04, P=0.89). These results show that even low-intensity exercise shortens blood transit time markedly and decreases its heterogeneity in human skeletal muscle in vivo. Findings in correlation analyses suggest that less heterogeneous blood transit time associates to better muscle oxygen extraction during exercise. This may have effects on muscle oxygenation during exercise.

A fractal analysis of the radial distribution of bronchial capillaries around large airways

We analyzed published measurements of the bronchial circulation and airway wall (Anderson JC, Bernard SL, Luchtel DL, Babb AL, and Hlastala MP. Respir Physiol Neurobiol 132: 329-339, 2002) and determined that the radial distribution of bronchial capillary cross-sectional area was fractal. We limited our analysis to bronchial capillaries, diameter < or =10 mum, that resided between the epithelial basement membrane and adventitia-alveolar boundary, the airway wall tissue. Thirteen different radial distributions of capillary-to-tissue area were constructed simply by changing the number of annuli (i.e., the annular size) used to form each distribution. For the 13 distributions created, these annuli ranged in size from to of the size of the airway wall area. Radial distributions were excluded from the fractal analysis if the sectioning procedure resulted in an annulus with a radial thickness less than the diameter of a capillary. To determine the fractal dimension for a given airway, the coefficient of variation (CV) for each distribution was calculated, and ln(CV) was plotted against the logarithm of the relative piece area. For airways with diameter >2.4 mm, this relationship was linear, which indicated the radial distribution of bronchial capillary cross-sectional area was fractal with an average fractal dimension of 1.27. The radial distribution of bronchial capillary cross-sectional area was not fractal around airways with diameter <1.5 mm. We speculated on how the fractal nature of this circulation impacts the distribution of bronchial blood flow and the efficiency of mass transport during health and disease. A fractal analysis can be used as a tool to quantify and summarize investigations of the bronchial circulation.

Functional CT in lung with a conventional scanner: simulations and sampling considerations

Due to rapid transit times, motion artefacts from breathing and the low signal intensity, functional computed tomography (f-CT) studies in lung tissue remain challenging with conventional CT scanners. The purpose of this study is to examine the accuracy of parameter estimates when performing deconvolution analysis with signals from lung tissue. The effects of partial volume averaging in lung tissue, differing transit times, variable vascular and capillary responses, expected noise levels, differing sampling rate and durations were simulated on a computer. Deconvolution using singular-value decomposition (SVD) analysis was performed for realistic lung signals using published and measured values of the arterial input and noise levels. The accuracy, bias and variance of the estimated residue functions and their associated parameter estimates were evaluated. We find that f-CT signals may be measured and analysed using SVD and other deconvolution approaches. Functional CT signals in the lung may be analysed provided that the rise and fall of the tissue and input curves are well sampled (regardless of sampling rate) and noise levels in the lung ROI tissue are approximately 20 HU or less, even for regions of interest that are mostly occupied by air. Estimates of the mean tissue transit time (MTT) are insensitive to air volume. Other decovolution methods such as fast Fourier transform methods provide more accurate estimates of PBF, whereas SVD approaches provide more accurate estimates of pulmonary blood volume and MTT. F-CT of the lung with a conventional scanner should be possible, when the extra dose is not a consideration.

Physiological evaluation of a new quantitative SPECT method measuring regional ventilation and perfusion

We have developed a new quantitative single-photon-emission computed tomography (SPECT) method that uses (113m)In-labeled albumin macroaggregates and Technegas ((99m)Tc) to estimate the distributions of regional ventilation and perfusion for the whole lung. The multiple inert-gas elimination technique (MIGET) and whole lung respiratory gas exchange were used as physiological evaluations of the SPECT method. Regional ventilation and perfusion were estimated by SPECT in nine healthy volunteers during awake, spontaneous breathing. Radiotracers were administered with subjects sitting upright, and SPECT images were acquired with subjects supine. Whole lung gas exchange of MIGET gases and arterial Po(2) and Pco(2) gases was predicted from estimates of regional ventilation and perfusion. We found a good agreement between measured and SPECT-predicted exchange of MIGET and respiratory gases. Correlations (r(2)) between SPECT-predicted and measured inert-gas excretions and retentions were 0.99. The method offers a new tool for measuring regional ventilation and perfusion in humans.

Fractal properties of perfusion heterogeneity in optimized arterial trees: a model study

Regional blood flows in the heart muscle are remarkably heterogeneous. It is very likely that the most important factor for this heterogeneity is the metabolic need of the tissue rather than flow dispersion by the branching network of the coronary vasculature. To model the contribution of tissue needs to the observed flow heterogeneities we use arterial trees generated on the computer by constrained constructive optimization. This method allows to prescribe terminal flows as independent boundary conditions, rather than obtaining these flows by the dispersive effects of the tree structure. We study two specific cases: equal terminal flows (model 1) and terminal flows set proportional to the volumes of Voronoi polyhedra used as a model for blood supply regions of terminal segments (model 2). Model 1 predicts, depending on the number Nterm of end-points, fractal dimensions D of perfusion heterogeneities in the range 1.20 to 1.40 and positively correlated nearest-neighbor regional flows, in good agreement with experimental data of the normal heart. Although model 2 yields reasonable terminal flows well approximated by a lognormal distribution, it fails to predict D and nearest-neighbor correlation coefficients r1 of regional flows under normal physiologic conditions: model 2 gives D = 1.69 +/- 0.02 and r1 = -0.18 +/- 0.03 (n = 5), independent of Nterm and consistent with experimental data observed under coronary stenosis and under the reduction of coronary perfusion pressure. In conclusion, flow heterogeneity can be modeled by terminal positions compatible with an existing tree structure without resorting to the flow-dispersive effects of a specific branching tree model to assign terminal flows.

Branching tree model with fractal vascular resistance explains fractal perfusion heterogeneity

Perfusion heterogeneities in organs such as the heart obey a power law as a function of scale, a behavior termed "fractal." An explanation of why vascular systems produce such a specific perfusion pattern is still lacking. An intuitive branching tree model is presented that reveals how this behavior can be generated as a consequence of scale-independent branching asymmetry and fractal vessel resistance. Comparison of computer simulations to experimental data from the sheep heart shows that the values of the two free model parameters are realistic. Branching asymmetry within the model is defined by the relative tissue volume being fed by each branch. Vessel ordering for fractal analysis of morphology based on fed or drained tissue volumes is preferable to the commonly used Strahler system, which is shown to depend on branching asymmetry. Recently, noninvasive imaging techniques such as PET and MRI have been used to measure perfusion heterogeneity. The model allows a physiological interpretation of the measured fractal parameters, which could in turn be used to characterize vascular morphology and function.

Perfusion heterogeneity in rat lungs assessed from the distribution of 4-microm-diameter latex particles

Pulmonary vascular perfusion has been shown to follow a fractal distribution down to a resolution of 0.5 cm(3) (5E11 microm(3)). We wanted to know whether this distribution continued down to tissue volumes equivalent to that of an alveolus (2E5 microm(3)). To investigate this, we used confocal microscopy to analyze the spatial distribution of 4-microm-diameter fluorescent latex particles trapped within rat lung microvessels. Particle distributions were analyzed in tissue volumes that ranged from 1.7E2 to 2.8E8 microm(3). The analysis resulted in fractal plots that consisted of two slopes. The left slope, encompassing tissue volumes less than 7E5 microm(3), had a fractal dimension of 1.50 +/- 0.03 (random distribution). The right slope, encompassing tissue volumes greater than 7E5 microm(3), had a fractal dimension of 1.29 +/- 0.04 (nonrandom distribution). The break point at 7E5 microm(3) corresponds closely to a tissue volume equivalent to that of one alveolus. We conclude that perfusion distribution is random at tissue volumes less than that of an alveolus and nonrandom at tissue volumes greater than that of an alveolus.

Muscle fractal vascular branching pattern and microvascular perfusion heterogeneity in endurance-trained and untrained men

Less heterogeneous skeletal muscle perfusion has recently been reported in endurance-trained compared to untrained men at macrovascular level. The causes of this difference in perfusion heterogeneity are unknown as is whether the same difference is observed in microvasculature. We hypothesised that the difference could be caused by changes in muscle vascular branching pattern. Perfusion was measured in resting and exercising muscle in 14 endurance-trained and seven untrained men using [(15)O]water and positron emission tomography. Fractal dimension (D) of perfusion distribution was calculated as a measure of fractal characteristics of muscle vascular branching pattern. Perfusion heterogeneity in microvascular units (1 mm(3) samples) was estimated using the measured heterogeneity in voxels of positron emission tomography (PET) images (relative dispersion, RD = S.D./mean) and corresponding D values. D was similar between the groups (exercising muscle 1.11 +/- 0.07 and 1.14 +/- 0.06, resting muscle 1.12 +/- 0.06 and 1.14 +/- 0.03, trained and untrained, respectively). Trained men had lower perfusion (151 +/- 44 vs. 218 +/- 87 ml min(-1) kg(-1), P < 0.05) and macrovascular perfusion heterogeneity (relative dispersion 21 +/- 5 vs. 25 +/- 5 %, P < 0.05) in exercising muscle than untrained men. Furthermore, estimated perfusion heterogeneity in microvascular units in exercising muscle was also lower in trained men (33 +/- 7 vs.48 +/- 19 %, P < 0.05). These results show that fractal vascular branching pattern is similar in endurance-trained and untrained men but perfusion is less heterogeneous at both the macro- and the microvascular level in endurance-trained men. Thus, changes in fractal branching pattern do not explain the differences in perfusion heterogeneity between endurance-trained and untrained men.

Effect of position, nitric oxide, and almitrine on lung perfusion in a porcine model of acute lung injury

In a porcine model of oleic acid-induced lung injury, the effects of inhaled nitric oxide (iNO) and intravenous almitrine bismesylate (ivALM), which enhances the hypoxic pulmonary vasoconstriction on the distribution of regional pulmonary blood flow (PBF), were assessed. After injection of 0.12 ml/kg oleic acid, 20 anesthetized and mechanically ventilated piglets [weight of 25 +/- 2.6 (SD) kg] were randomly divided into four groups: supine position, prone position, and 10 ppm iNO for 40 min followed by 4 microg x kg(-1) x min(-1) ivALM for 40 min in supine position and in prone position. PBF was measured with positron emission tomography and H(2)15O. The redistribution of PBF was studied on a pixel-by-pixel basis. Positron emission tomography scans were performed before and then 120, 160, and 200 min after injury. With prone position alone, although PBF remained prevalent in the dorsal regions it was significantly redistributed toward the ventral regions (P < 0.001). A ventral redistribution of PBF was also obtained with iNO regardless of the position (P = 0.043). Adjunction of ivALM had no further effect on PBF redistribution. PP and iNO have an additive effect on ventral redistribution of PBF.

Determination of regional ventilation and perfusion in the lung using xenon and computed tomography

We propose a model to measure both regional ventilation (V) and perfusion (Q) in which the regional radiodensity (RD) in the lung during xenon (Xe) washin is a function of regional V (increasing RD) and Q (decreasing RD). We studied five anesthetized, paralyzed, mechanically ventilated, supine sheep. Four 2.5-mm-thick computed tomography (CT) images were simultaneously acquired immediately cephalad to the diaphragm at end inspiration for each breath during 3 min of Xe breathing. Observed changes in RD during Xe washin were used to determine regional V and Q. For 16 mm(3), Q displayed more variance than V: the coefficient of variance of Q (CV(Q)) = 1.58 +/- 0.23, the CV of V (CV(V)) = 0.46 +/- 0.07, and the ratio of CV(Q) to CV(V) = 3.5 +/- 1.1. CV(Q) (1.21 +/- 0.37) and the ratio of CV(Q) to CV(V) (2.4 +/- 1.2) were smaller at 1,000-mm(3) scale, but CV(V) (0.53 +/- 0.09) was not. V/Q distributions also displayed scale dependence: log SD of V and log SD of Q were 0.79 +/- 0.05 and 0.85 +/- 0.10 for 16-mm(3) and 0.69 +/- 0.20 and 0.67 +/- 0.10 for 1,000-mm(3) regions of lung, respectively. V and Q measurements made with CT and Xe also demonstrate vertically oriented and isogravitational heterogeneity, which are described using other methodologies. Sequential images acquired by CT during Xe breathing can be used to determine both regional V and Q noninvasively with high spatial resolution.

Physiology of pulmonary perfusion: new concepts

Regional pulmonary perfusion is spatially heterogeneous. The classic assumption has been that this is due to the influence of gravity. In the past decade, a new concept has emerged, stressing the fractal geometric properties of the pulmonary vascular tree. Studies that support the gravitational concept tend to have been elaborated using a lower resolution of measurement whereas experiments with high resolution measurements often yield results that contradict the gravitational hypothesis.