1
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Yamasaki Y, Kamitani T, Sagiyama K, Hino T, Kisanuki M, Tabata K, Isoda T, Kitamura Y, Abe K, Hosokawa K, Toyomura D, Moriyama S, Kawakubo M, Yabuuchi H, Ishigami K. Dynamic chest radiography for pulmonary vascular diseases: clinical applications and correlation with other imaging modalities. Jpn J Radiol 2024; 42:126-144. [PMID: 37626168 PMCID: PMC10811043 DOI: 10.1007/s11604-023-01483-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Dynamic chest radiography (DCR) is a novel functional radiographic imaging technique that can be used to visualize pulmonary perfusion without using contrast media. Although it has many advantages and clinical utility, most radiologists are unfamiliar with this technique because of its novelty. This review aims to (1) explain the basic principles of lung perfusion assessment using DCR, (2) discuss the advantages of DCR over other imaging modalities, and (3) review multiple specific clinical applications of DCR for pulmonary vascular diseases and compare them with other imaging modalities.
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Affiliation(s)
- Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takuya Hino
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Megumi Kisanuki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Department of Hematology, Oncology and Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kosuke Tabata
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takuro Isoda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yoshiyuki Kitamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuya Hosokawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Toyomura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shohei Moriyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masateru Kawakubo
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetake Yabuuchi
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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2
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Ugawa S, Akagi S, Ejiri K, Nakamura K, Ito H. Quantification of Lung Perfusion Blood Volume in Dual-Energy Computed Tomography in Patients with Pulmonary Hypertension. Life (Basel) 2022; 12:684. [PMID: 35629352 PMCID: PMC9143856 DOI: 10.3390/life12050684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Dual-energy computed tomography (DECT) is a promising technique for the assessment of the lung perfused blood volume (LPBV) in the lung parenchyma. This study was performed to compare the LPBV by DECT of patients with pulmonary hypertension (PH) and controls and to evaluate the association between the LPBV and the perfusion ratio derived by lung perfusion scintigraphy. This study involved 45 patients who underwent DECT (25 patients with PH and 20 controls). We measured the total LPBV and distribution of the LPBV in each lung. The total LPBV was significantly lower in the PH group than the control group (38 ± 9 vs. 45 ± 8 HU, p = 0.024). Significant differences were observed between the LPBV of the upper lung of the PH and control groups (34 ± 10 vs. 47 ± 10, p = 0.021 and 37 ± 10 vs. 47 ± 8, p < 0.001). A significant correlation was observed between the LPBV and the lung perfusion scintigraphy. A lower total LPBV and lower LPBV of the upper lung as detected by DECT might be specific findings of PH.
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Affiliation(s)
- Satoko Ugawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.U.); (K.E.); (K.N.); (H.I.)
- Department of Cardiology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Japan
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.U.); (K.E.); (K.N.); (H.I.)
| | - Kentaro Ejiri
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.U.); (K.E.); (K.N.); (H.I.)
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.U.); (K.E.); (K.N.); (H.I.)
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.U.); (K.E.); (K.N.); (H.I.)
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3
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Ebrahimi BS, Kumar H, Tawhai MH, Burrowes KS, Hoffman EA, Clark AR. Simulating Multi-Scale Pulmonary Vascular Function by Coupling Computational Fluid Dynamics With an Anatomic Network Model. FRONTIERS IN NETWORK PHYSIOLOGY 2022; 2:867551. [PMID: 36926101 PMCID: PMC10012968 DOI: 10.3389/fnetp.2022.867551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022]
Abstract
The function of the pulmonary circulation is truly multi-scale, with blood transported through vessels from centimeter to micron scale. There are scale-dependent mechanisms that govern the flow in the pulmonary vascular system. However, very few computational models of pulmonary hemodynamics capture the physics of pulmonary perfusion across the spatial scales of functional importance in the lung. Here we present a multi-scale model that incorporates the 3-dimensional (3D) complexities of pulmonary blood flow in the major vessels, coupled to an anatomically-based vascular network model incorporating the multiple contributing factors to capillary perfusion, including gravity. Using the model we demonstrate how we can predict the impact of vascular remodeling and occlusion on both macro-scale functional drivers (flow distribution between lungs, and wall shear stress) and micro-scale contributors to gas exchange. The model predicts interactions between 3D and 1D models that lead to a redistribution of blood between postures, both on a macro- and a micro-scale. This allows us to estimate the effect of posture on left and right pulmonary artery wall shear stress, with predictions varying by 0.75-1.35 dyne/cm2 between postures.
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Affiliation(s)
| | - Haribalan Kumar
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Merryn H Tawhai
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kelly S Burrowes
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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4
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Sharma M, Burns AT, Yap K, Prior DL. The role of imaging in pulmonary hypertension. Cardiovasc Diagn Ther 2021; 11:859-880. [PMID: 34295710 DOI: 10.21037/cdt-20-295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/17/2020] [Indexed: 01/10/2023]
Abstract
Pulmonary hypertension (PH) is a debilitating and potentially life threatening condition in which increased pressure in the pulmonary arteries may result from a variety of pathological processes. These can include disease primarily involving the pulmonary vasculature, but more commonly PH may result from left-sided heart disease, including valvular heart disease. Chronic thromboembolic pulmonary hypertension (CTEPH) is an important disease to identify because it may be amenable to surgical pulmonary artery endarterectomy or balloon pulmonary angioplasty. Parenchymal lung diseases are also widespread in the community. Any of these disease processes may result in adverse remodeling of the right ventricle and progressive right heart (RH) failure as a common final pathway. Because of the breadth of pathological processes which cause PH, multiple imaging modalities play vital roles in ensuring accurate diagnosis and classification, which will lead to application of the most appropriate therapy. Multimodality imaging may also provide important prognostic information and has a role in the assessment of response to therapies which ultimately dictate clinical outcomes. This review provides an overview of the wide variety of established imaging techniques currently in use, but also examines many of the novel imaging techniques which may be increasingly utilized in the future to guide comprehensive care of patients with PH.
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Affiliation(s)
- Meenal Sharma
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Andrew T Burns
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Kelvin Yap
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - David L Prior
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia.,Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), Melbourne, Australia
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5
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Harder EM, Vanderpool R, Rahaghi FN. Advanced Imaging in Pulmonary Vascular Disease. Clin Chest Med 2021; 42:101-112. [PMID: 33541604 DOI: 10.1016/j.ccm.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although the diagnosis of pulmonary hypertension requires invasive testing, imaging serves an important role in the screening, classification, and monitoring of patients with pulmonary vascular disease (PVD). The development of advanced imaging techniques has led to improvements in the understanding of disease pathophysiology, noninvasive assessment of hemodynamics, and stratification of patient risk. This article discusses the current role of advanced imaging and the emerging novel techniques for visualizing the lung parenchyma, mediastinum, and heart in PVD.
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Affiliation(s)
- Eileen M Harder
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA.
| | - Rebecca Vanderpool
- Division of Translational and Regenerative Medicine, Department of Medicine, University of Arizona, 1656 East Mabel Street, Tucson, AZ 85721, USA. https://twitter.com/rrvdpool
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA
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6
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Hopkins SR, Sá RC, Prisk GK, Elliott AR, Kim NH, Pazar BJ, Printz BF, El-Said HG, Davis CK, Theilmann RJ. Abnormal pulmonary perfusion heterogeneity in patients with Fontan circulation and pulmonary arterial hypertension. J Physiol 2020; 599:343-356. [PMID: 33026102 DOI: 10.1113/jp280348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/06/2020] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS The distribution of pulmonary perfusion is affected by gravity, vascular branching structure and active regulatory mechanisms, which may be disrupted by cardiopulmonary disease, but this is not well studied, particularly in rare conditions. We evaluated pulmonary perfusion in patients who had undergone Fontan procedure, patients with pulmonary arterial hypertension (PAH) and two groups of controls using a proton magnetic resonance imaging technique, arterial spin labelling to measure perfusion. Heterogeneity was assessed by the relative dispersion (SD/mean) and gravitational gradients. Gravitational gradients were similar between all groups, but heterogeneity was significantly increased in both patient groups compared to controls and persisted after removing contributions from large blood vessels and gravitational gradients. Patients with Fontan physiology and patients with PAH have increased pulmonary perfusion heterogeneity that is not explainable by differences in mean perfusion, gravitational gradients, or large vessel anatomy. This probably reflects vascular remodelling in PAH and possibly in Fontan physiology. ABSTRACT Many factors affect the distribution of pulmonary perfusion, which may be disrupted by cardiopulmonary disease, but this is not well studied, particularly in rare conditions. An example is following the Fontan procedure, where pulmonary perfusion is passive, and heterogeneity may be increased because of the underlying pathophysiology leading to Fontan palliation, remodelling, or increased gravitational gradients from low flow. Another is pulmonary arterial hypertension (PAH), where gravitational gradients may be reduced secondary to high pressures, but remodelling may increase perfusion heterogeneity. We evaluated regional pulmonary perfusion in Fontan patients (n = 5), healthy young controls (Fontan control, n = 5), patients with PAH (n = 6) and healthy older controls (PAH control) using proton magnetic resonance imaging. Regional perfusion was measured using arterial spin labelling. Heterogeneity was assessed by the relative dispersion (SD/mean) and gravitational gradients. Mean perfusion was similar (Fontan = 2.50 ± 1.02 ml min-1 ml-1 ; Fontan control = 3.09 ± 0.58, PAH = 3.63 ± 1.95; PAH control = 3.98 ± 0.91, P = 0.26), and the slopes of gravitational gradients were not different (Fontan = -0.23 ± 0.09 ml min-1 ml-1 cm-1 ; Fontan control = -0.29 ± 0.23, PAH = -0.27 ± 0.09, PAH control = -0.25 ± 0.18, P = 0.91) between groups. Perfusion relative dispersion was greater in both Fontan and PAH than controls (Fontan = 1.46 ± 0.18; Fontan control = 0.99 ± 0.21, P = 0.005; PAH = 1.22 ± 0.27, PAH control = 0.91 ± 0.12, P = 0.02) but similar between patient groups (P = 0.13). These findings persisted after removing contributions from large blood vessels and gravitational gradients (all P < 0.05). We conclude that patients with Fontan physiology and PAH have increased pulmonary perfusion heterogeneity that is not explained by differences in mean perfusion, gravitational gradients, or large vessel anatomy. This probably reflects the effects of remodelling in PAH and possibly in Fontan physiology.
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Affiliation(s)
- Susan R Hopkins
- Department of Radiology, University of California, San Diego, CA, USA.,Department of Medicine, University of California, San Diego, CA, USA
| | - Rui C Sá
- Department of Medicine, University of California, San Diego, CA, USA
| | - G Kim Prisk
- Department of Radiology, University of California, San Diego, CA, USA.,Department of Medicine, University of California, San Diego, CA, USA
| | - Ann R Elliott
- Department of Medicine, University of California, San Diego, CA, USA
| | - Nick H Kim
- Department of Medicine, University of California, San Diego, CA, USA
| | - Beni J Pazar
- Department of Radiology, University of California, San Diego, CA, USA
| | - Beth F Printz
- Department of Radiology, University of California, San Diego, CA, USA.,Rady Children's Hospital-San Diego, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego, CA, USA
| | - Howaida G El-Said
- Rady Children's Hospital-San Diego, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego, CA, USA
| | - Christopher K Davis
- Rady Children's Hospital-San Diego, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego, CA, USA
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7
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Bourhis D, Wagner L, Essayan M, Robin P, Le Pennec R, Salaun PY, Le Roux PY. Normal Dual Isotope V/Q SPECT Model for Monte-Carlo Studies. Front Med (Lausanne) 2020; 7:461. [PMID: 33015083 PMCID: PMC7461964 DOI: 10.3389/fmed.2020.00461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/10/2020] [Indexed: 02/03/2023] Open
Abstract
Background: There is currently no reliable or validated tool to delineate and quantify functional lung volumes with ventilation/perfusion (V/Q) SPECT/CT. The main challenges encountered include the physiological non-uniformity of lung function, such as the anterior-to-posterior gradient on perfusion images, and the lack of ground truth to assess the accuracy of delineation algorithms. In that respect, Monte-Carlo simulations would be an interesting tool. Thus, the aim of this study was to develop a realistic model of dual-isotope lung V/Q SPECT-CT Monte-Carlo simulations, integrating the anterior to posterior gradient on perfusion. Methods: Acquisitions and simulations parameters were set in accordance to nuclear medicine guidelines for V/Q lung SPECT-CT. Projections were acquired and simulated, then the reconstructions [with and without attenuation correction (AC)] were compared. A model was built from a patient's CT scan. To model the anterior to posterior gradient, the lungs were divided into sixteen coronal planes, where a rising radioactivity concentration was set. To assess the realism of simulations, they were compared to a normal co-registered normal cases database in terms of pixelwize Z-score map. Results: For ventilation images, mean (SD) Zscores on Zscore maps were −0.2 (0.7) and −0.2 (0.7) for AC and noAC images, respectively. For perfusion images, mean (SD) Zscores were −0.2 (0.6) and −0.1 (0.6) for AC and noAC images, respectively. Conclusion: We developed a model for dual isotopes lung V/Q SPECT-CT, integrating the anterior-to-posterior gradient on perfusion images. This model could be used to build a catalog of clinical scenarios, in order to test delineation methods of functional lung volumes.
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Affiliation(s)
- David Bourhis
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
| | - Laura Wagner
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Marine Essayan
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Philippe Robin
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
| | - Romain Le Pennec
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Pierre Yves Salaun
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
| | - Pierre Yves Le Roux
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
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8
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Bourhis D, Robin P, Essayan M, Abgral R, Querellou S, Tromeur C, Salaun PY, Le Roux PY. V/Q SPECT for the Assessment of Regional Lung Function: Generation of Normal Mean and Standard Deviation 3-D Maps. Front Med (Lausanne) 2020; 7:143. [PMID: 32411710 PMCID: PMC7198740 DOI: 10.3389/fmed.2020.00143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: V/Q SPECT/CT is attractive for regional lung function assessment, but accurate delineation and quantification of functional lung volumes remains a challenge. Physiological intra and inter patient non-uniformity of V/Q SPECT images make conventional delineation methods of functional lung volumes inaccurate. In that context it would be of interest to build statistical maps of normal V/Q SPECT to assess the physiological variability of radiotracers. The aim of this study was to generate normal mean and standard deviation maps of regional lung function as assessed with V/Q SPECT/CT, with (AC) and without (NoAC) attenuation correction. Methods: During a 13 month period, 73 consecutive patients referred for suspected acute pulmonary embolism, that had normal V/Q SPECT/CT based on the interpretation of 2 independent nuclear medicine physicians, were selected. Four set of images were reconstructed: perfusion and ventilation images, AC, and NoAC, respectively. Statistical maps were created as follows: all cases were registered to a reference scan using the CT data, first with a rigid then with a non-rigid method. SPECTs reconstructions were then co-registered and normalized, and mean and standard deviation voxel-wise maps were calculated. To assess the consistency of generated maps to lung physiology and the potential impact of non-rigid registration, visual analysis and quantitative comparison with non-registered data were performed in the whole series. Quantitative comparison was also conducted in two randomly sampled independent subsets. Results: Perfusion mean maps showed a continuous negative posterior to anterior gradient, majored on the AC mean map. Perfusion standard deviation maps showed higher variability in the periphery of the lungs, but especially in the posterior areas. The ventilation mean map showed a slightly positive posterior to anterior gradient on NoAC mean ventilation map, while the AC mean map showed no gradient. The NoAC ventilation SD map showed a higher variability in the periphery of the lungs as compared with AC SD map. No statistical difference in the posterior to anterior gradient measurements was found between the generated mean statistical maps and the non-registered data, either in the whole series or across the two independent datasets. Conclusion: We proposed a methodology to create statistical normal maps for V/Q SPECTs. Maps were consistent with the known physiological non-uniformity and showed the impact of attenuation correction on the posterior to anterior gradient. These maps could be used for a Z-score analysis, and a better segmentation of healthy uptake areas.
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Affiliation(s)
- David Bourhis
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
| | - Philippe Robin
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
| | - Marine Essayan
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Ronan Abgral
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
| | - Solène Querellou
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Cécile Tromeur
- EA3878 GETBO, Université de Bretagne Occidentale, Brest, France.,Service de Pneumologie, Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Pierre-Yves Salaun
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
| | - Pierre-Yves Le Roux
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.,EA3878 GETBO, Université de Bretagne Occidentale, Brest, France
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9
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Usefulness of ventilatory gas analysis for the non-invasive evaluation of the severity of chronic thromboembolic pulmonary hypertension. Int J Cardiol 2019; 296:149-154. [DOI: 10.1016/j.ijcard.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/28/2019] [Accepted: 07/05/2019] [Indexed: 01/01/2023]
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10
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Akizuki M, Sugimura K, Aoki T, Kakihana T, Tatebe S, Yamamoto S, Sato H, Satoh K, Shimokawa H, Kohzuki M. Non‐invasive screening using ventilatory gas analysis to distinguish between chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension. Respirology 2019; 25:427-434. [DOI: 10.1111/resp.13618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/25/2019] [Accepted: 05/22/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Mina Akizuki
- Department of Internal Medicine and Rehabilitation ScienceTohoku University Graduate School of Medicine Sendai Japan
| | - Koichiro Sugimura
- Department of Cardiovascular MedicineTohoku University Graduate School of Medicine Sendai Japan
| | - Tatsuo Aoki
- Department of Cardiovascular MedicineTohoku University Graduate School of Medicine Sendai Japan
| | - Takaaki Kakihana
- Department of Internal Medicine and Rehabilitation ScienceTohoku University Graduate School of Medicine Sendai Japan
| | - Shunsuke Tatebe
- Department of Cardiovascular MedicineTohoku University Graduate School of Medicine Sendai Japan
| | - Saori Yamamoto
- Department of Cardiovascular MedicineTohoku University Graduate School of Medicine Sendai Japan
| | - Haruka Sato
- Department of Cardiovascular MedicineTohoku University Graduate School of Medicine Sendai Japan
| | - Kimio Satoh
- Department of Cardiovascular MedicineTohoku University Graduate School of Medicine Sendai Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular MedicineTohoku University Graduate School of Medicine Sendai Japan
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation ScienceTohoku University Graduate School of Medicine Sendai Japan
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11
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Hur DJ, Sugeng L. Non-invasive Multimodality Cardiovascular Imaging of the Right Heart and Pulmonary Circulation in Pulmonary Hypertension. Front Cardiovasc Med 2019; 6:24. [PMID: 30931315 PMCID: PMC6427926 DOI: 10.3389/fcvm.2019.00024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/20/2019] [Indexed: 12/13/2022] Open
Abstract
Pulmonary hypertension (PH) is defined as resting mean pulmonary arterial pressure (mPAP) ≥25 millimeters of mercury (mmHg) via right heart (RH) catheterization (RHC), where increased afterload in the pulmonary arterial vasculature leads to alterations in RH structure and function. Mortality rates have remained high despite therapy, however non-invasive imaging holds the potential to expedite diagnosis and lead to earlier initiation of treatment, with the hope of improving prognosis. While historically the right ventricle (RV) had been considered a passive chamber with minimal role in the overall function of the heart, in recent years in the evaluation of PH and RH failure the anatomical and functional assessment of the RV has received increased attention regarding its performance and its relationship to other structures in the RH-pulmonary circulation. Today, the RV is the key determinant of patient survival. This review provides an overview and summary of non-invasive imaging methods to assess RV structure, function, flow, and tissue characterization in the setting of imaging's contribution to the diagnostic, severity stratification, prognostic risk, response of treatment management, and disease surveillance implications of PH's impact on RH dysfunction and clinical RH failure.
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Affiliation(s)
- David J Hur
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.,Division of Cardiology, Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.,Echocardiography Laboratory, Yale New Haven Hospital, New Haven, CT, United States
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12
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Simonneau G, Montani D, Celermajer DS, Denton CP, Gatzoulis MA, Krowka M, Williams PG, Souza R. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J 2019; 53:13993003.01913-2018. [PMID: 30545968 PMCID: PMC6351336 DOI: 10.1183/13993003.01913-2018] [Citation(s) in RCA: 2326] [Impact Index Per Article: 465.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 12/13/2022]
Abstract
Since the 1st World Symposium on Pulmonary Hypertension (WSPH) in 1973, pulmonary hypertension (PH) has been arbitrarily defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest, measured by right heart catheterisation. Recent data from normal subjects has shown that normal mPAP was 14.0±3.3 mmHg. Two standard deviations above this mean value would suggest mPAP >20 mmHg as above the upper limit of normal (above the 97.5th percentile). This definition is no longer arbitrary, but based on a scientific approach. However, this abnormal elevation of mPAP is not sufficient to define pulmonary vascular disease as it can be due to an increase in cardiac output or pulmonary arterial wedge pressure. Thus, this 6th WSPH Task Force proposes to include pulmonary vascular resistance ≥3 Wood Units in the definition of all forms of pre-capillary PH associated with mPAP >20 mmHg. Prospective trials are required to determine whether this PH population might benefit from specific management. Regarding clinical classification, the main Task Force changes were the inclusion in group 1 of a subgroup “pulmonary arterial hypertension (PAH) long-term responders to calcium channel blockers”, due to the specific prognostic and management of these patients, and a subgroup “PAH with overt features of venous/capillaries (pulmonary veno-occlusive disease/pulmonary capillary haemangiomatosis) involvement”, due to evidence suggesting a continuum between arterial, capillary and vein involvement in PAH. State of the art and research perspectives of haemodynamic definitions and clinical classification of pulmonary hypertensionhttp://ow.ly/TJeR30mgWKj
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Affiliation(s)
- Gérald Simonneau
- Université Paris-Sud, AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie, Département Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,INSERM UMR_S999, LabEx LERMIT, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - David Montani
- Université Paris-Sud, AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie, Département Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,INSERM UMR_S999, LabEx LERMIT, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - David S Celermajer
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christopher P Denton
- Centre for Rheumatology, Royal Free Campus, University College London, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Trust, and the National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Paul G Williams
- Center of Chest Disease and Critical Care, Milpark Hospital, Johannesburg, South Africa
| | - Rogerio Souza
- Pulmonary Circulation Unit, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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Bailey DL, Farrow CE, Lau EM. V/Q SPECT—Normal Values for Lobar Function and Comparison With CT Volumes. Semin Nucl Med 2019; 49:58-61. [DOI: 10.1053/j.semnuclmed.2018.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Frost A, Badesch D, Gibbs JSR, Gopalan D, Khanna D, Manes A, Oudiz R, Satoh T, Torres F, Torbicki A. Diagnosis of pulmonary hypertension. Eur Respir J 2019; 53:1801904. [PMID: 30545972 PMCID: PMC6351333 DOI: 10.1183/13993003.01904-2018] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 12/20/2022]
Abstract
A revised diagnostic algorithm provides guidelines for the diagnosis of patients with suspected pulmonary hypertension, both prior to and following referral to expert centres, and includes recommendations for expedited referral of high-risk or complicated patients and patients with confounding comorbidities. New recommendations for screening high-risk groups are given, and current diagnostic tools and emerging diagnostic technologies are reviewed.
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Affiliation(s)
- Adaani Frost
- Dept of Medicine, Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - David Badesch
- Divisions of Pulmonary Sciences and Critical Care Medicine, and Cardiology, University of Colorado, Denver, CO, USA
| | - J. Simon R. Gibbs
- National Heart and Lung Institute, Imperial College of London, London, UK
| | - Deepa Gopalan
- Dept of Radiology, Imperial College Healthcare NHS Trust and Imperial College London, Hammersmith Hospital, London, UK
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - Alessandra Manes
- Cardio-Thoracic and Vascular Dept, Sant'Orsola University Hospital, Bologna, Italy
| | - Ronald Oudiz
- LA Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Toru Satoh
- Division of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Fernando Torres
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Adam Torbicki
- Dept of Pulmonary Circulation and Cardidology, Medical Center for Postgraduate Education, ECZ-Otwock, Otwock, Poland
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Frost A, Badesch D, Gibbs JSR, Gopalan D, Khanna D, Manes A, Oudiz R, Satoh T, Torres F, Torbicki A. Diagnosis of pulmonary hypertension. Eur Respir J 2018. [PMID: 30545972 DOI: 10.1183/13993003.01904‐2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A revised diagnostic algorithm provides guidelines for the diagnosis of patients with suspected pulmonary hypertension, both prior to and following referral to expert centres, and includes recommendations for expedited referral of high-risk or complicated patients and patients with confounding comorbidities. New recommendations for screening high-risk groups are given, and current diagnostic tools and emerging diagnostic technologies are reviewed.
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Affiliation(s)
- Adaani Frost
- Dept of Medicine, Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - David Badesch
- Divisions of Pulmonary Sciences and Critical Care Medicine, and Cardiology, University of Colorado, Denver, CO, USA
| | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College of London, London, UK
| | - Deepa Gopalan
- Dept of Radiology, Imperial College Healthcare NHS Trust and Imperial College London, Hammersmith Hospital, London, UK
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - Alessandra Manes
- Cardio-Thoracic and Vascular Dept, Sant'Orsola University Hospital, Bologna, Italy
| | - Ronald Oudiz
- LA Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Toru Satoh
- Division of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Fernando Torres
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Adam Torbicki
- Dept of Pulmonary Circulation and Cardidology, Medical Center for Postgraduate Education, ECZ-Otwock, Otwock, Poland
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Abstract
Pulmonary hypertension (PH) is characterized by elevated pulmonary arterial pressure caused by a broad spectrum of congenital and acquired disease processes, which are currently divided into five groups based on the 2013 WHO classification. Imaging plays an important role in the evaluation and management of PH, including diagnosis, establishing etiology, quantification, prognostication and assessment of response to therapy. Multiple imaging modalities are available, including radiographs, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, echocardiography and invasive catheter angiography (ICA), each with their own advantages and disadvantages. In this article, we review the comprehensive role of imaging in the evaluation of PH.
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Affiliation(s)
- Harold Goerne
- IMSS Centro Medico Nacional De Occidente, Guadalajara, Jalisco, Mexico.,CID Imaging and Diagnostic Center, Guadalajara, Jalisco, Mexico
| | - Kiran Batra
- Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Prabhakar Rajiah
- Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA
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Velasco C, Mateo J, Santos A, Mota-Cobian A, Herranz F, Pellico J, Mota RA, España S, Ruiz-Cabello J. Assessment of regional pulmonary blood flow using 68Ga-DOTA PET. EJNMMI Res 2017; 7:7. [PMID: 28101850 PMCID: PMC5241570 DOI: 10.1186/s13550-017-0259-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/11/2017] [Indexed: 11/19/2022] Open
Abstract
Background In vivo determination of regional pulmonary blood flow (PBF) is a valuable tool for the evaluation of many lung diseases. In this study, the use of 68Ga-DOTA PET for the in vivo quantitative determination of regional PBF is proposed. This methodology was implemented and tested in healthy pigs and validated using fluorescent microspheres. The study was performed on young large white pigs (n = 4). To assess the reproducibility and consistency of the method, three PET scans were obtained for each animal. Each radiotracer injection was performed simultaneously to the injection of fluorescent microspheres. PBF images were generated applying a two-compartment exchange model over the dynamic PET images. PET and microspheres values were compared by regression analysis and Bland–Altman plot. Results The capability of the proposed technique to produce 3D regional PBF images was demonstrated. The correlation evaluation between 68Ga-DOTA PET and microspheres showed a good and significant correlation (r = 0.74, P < 0.001). Conclusions Assessment of PBF with the proposed technique allows combining the high quantitative accuracy of PET imaging with the use of 68Ga/68Ge generators. Thus, 68Ga-DOTA PET emerges as a potential inexpensive method for measuring PBF in clinical settings with an extended use. Electronic supplementary material The online version of this article (doi:10.1186/s13550-017-0259-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlos Velasco
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Jesus Mateo
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Arnoldo Santos
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain.,Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, 02114, Boston, MA, USA
| | - Adriana Mota-Cobian
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain
| | - Fernando Herranz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Juan Pellico
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Ruben A Mota
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,Charles River, Carrer dels Argenters, 7, 08290, Barcelona, Spain
| | - Samuel España
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain. .,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain.
| | - Jesus Ruiz-Cabello
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
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Abstract
Pulmonary hypertension (PH) is defined as resting mean pulmonary artery pressure ≥25 mmHg measured by right heart catheterization. PH is a progressive, life-threatening disease with a variety of etiologies. Swift and accurate diagnosis of PH and appropriate classification in etiologic group will allow for earlier treatment and improved outcomes. A number of imaging tools are utilized in the evaluation of PH, such as chest X-ray, computed tomography (CT), ventilation/perfusion (V/Q) scan, and cardiac magnetic resonance imaging. Newer imaging tools such as dual-energy CT and single-photon emission computed tomography/computed tomography V/Q scanning have also emerged; however, their place in the diagnostic evaluation of PH remains to be determined. In general, each imaging technique provides incremental information, with varying degrees of sensitivity and specificity, which helps suspect the presence and identify the etiology of PH. The present study aims to provide a comprehensive review of the utility, advantages, and shortcomings of the imaging modalities that may be used to evaluate patients with PH.
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Affiliation(s)
- Mona Ascha
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rahul D Renapurkar
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Overview of the Novel and Improved Pulmonary Ventilation-Perfusion Imaging Applications in the Era of SPECT/CT. AJR Am J Roentgenol 2016; 207:1307-1315. [PMID: 27726408 DOI: 10.2214/ajr.15.15071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE In this article, we describe the concepts of ventilation-perfusion planar, SPECT, and SPECT/CT and outline the advantages of integrated ventilation-perfusion SPECT/CT over planar imaging. We present an overview of the traditional and new applications of ventilation-perfusion scintigraphy. CONCLUSION SPECT/CT has improved the diagnostic accuracy of ventilation-perfusion imaging and opened the door for a new spectrum of applications.
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20
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Schoenfeld C, Cebotari S, Hinrichs J, Renne J, Kaireit T, Olsson KM, Voskrebenzev A, Gutberlet M, Hoeper MM, Welte T, Haverich A, Wacker F, Vogel-Claussen J. MR Imaging–derived Regional Pulmonary Parenchymal Perfusion and Cardiac Function for Monitoring Patients with Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy. Radiology 2016; 279:925-34. [DOI: 10.1148/radiol.2015150765] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Levac X, Harel F, Finnerty V, Nguyen QT, Letourneau M, Marcil S, Fournier A, Dupuis J. Evaluation of pulmonary perfusion by SPECT imaging using an endothelial cell tracer in supine humans and dogs. EJNMMI Res 2016; 6:43. [PMID: 27234509 PMCID: PMC4883022 DOI: 10.1186/s13550-016-0198-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/17/2016] [Indexed: 12/02/2022] Open
Abstract
Background Pulmonary perfusion is not spatially homogeneously distributed, and its variations could be of diagnostic value in lung vascular disease. PulmoBind is a ligand of the adrenomedullin receptor densely expressed in endothelial cells of lung capillaries. The aim of this study was to evaluate spatial distribution of human lung perfusion by using this novel molecular tracer of the pulmonary vascular endothelium. Methods Normal humans (n = 19) enrolled into the PulmoBind phase I trial were studied (Clinicaltrials.gov.NCT01539889). They were injected with 99mTc-PulmoBind for SPECT imaging. Results were compared with 99mTc-PulmoBind in quadruped mammals (dogs, n = 5). Imaging was performed in the supine position and distribution of activity was determined as a function of cumulative voxels along the different anatomical planes. Results PulmoBind uptake in humans was 58 ± 1 % (mean ± SEM) of the injected dose. Dorsal activity was 18.1 ± 2.1 % greater than ventral, and caudal activity was 25.7 ± 1.6 % greater than cranial. Lateral activity was only mildly higher than medial by 7.0 ± 1.0 %. In supine dogs, similar but higher PulmoBind gradients were present: dorsal 28.6 ± 2.5 %, caudal 34.1 ± 5.0 % and lateral 18.1 ± 2.0 %. Conclusions The perfused pulmonary circulation of supine humans, assessed by an adrenomedullin receptor ligand, is not homogeneously distributed with more prominent distribution in dorsal and caudal regions. It is qualitatively similar to a supine quadruped mammal confirming the presence of a microcirculatory gravitational perfusion gradient detectable with this tracer. Future studies are needed to determine if this novel endothelial cell tracer could be used to detect physiologic and pathologic variations of lung perfusion such as in pulmonary hypertension. Clinical trial ClinicalTrial.gov, NCT01539889
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Affiliation(s)
- Xavier Levac
- Research Center, Montreal Heart Institute, 5000, Belanger, Montreal, QC, H1T 1C8, Canada.,Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - François Harel
- Research Center, Montreal Heart Institute, 5000, Belanger, Montreal, QC, H1T 1C8, Canada.,Department of Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Vincent Finnerty
- Research Center, Montreal Heart Institute, 5000, Belanger, Montreal, QC, H1T 1C8, Canada
| | - Quang T Nguyen
- Research Center, Montreal Heart Institute, 5000, Belanger, Montreal, QC, H1T 1C8, Canada
| | | | - Sophie Marcil
- Research Center, Montreal Heart Institute, 5000, Belanger, Montreal, QC, H1T 1C8, Canada
| | | | - Jocelyn Dupuis
- Research Center, Montreal Heart Institute, 5000, Belanger, Montreal, QC, H1T 1C8, Canada. .,Department of Medicine, Université de Montréal, Montréal, Québec, Canada.
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22
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Schembri GP, Roach PJ, Bailey DL, Freeman L. Artifacts and Anatomical Variants Affecting Ventilation and Perfusion Lung Imaging. Semin Nucl Med 2015; 45:373-91. [DOI: 10.1053/j.semnuclmed.2015.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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23
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Ishii M, Hamedani H, Clapp JT, Kadlecek SJ, Xin Y, Gefter WB, Rossman MD, Rizi RR. Oxygen-weighted Hyperpolarized (3)He MR Imaging: A Short-term Reproducibility Study in Human Subjects. Radiology 2015; 277:247-58. [PMID: 26110668 DOI: 10.1148/radiol.2015142038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether hyperpolarized helium 3 magnetic resonance (MR) imaging to measure alveolar partial pressure of oxygen (Pao2) shows sufficient test-retest repeatability and between-cohort differences to be used as a reliable technique for detection of alterations in gas exchange in asymptomatic smokers. MATERIALS AND METHODS The protocol was approved by the local institutional review board and was HIPAA compliant. Informed consent was obtained from all subjects. Two sets of MR images were obtained 10 minutes apart in 25 subjects: 10 nonsmokers (five men, five women; mean ± standard deviation age, 50 years ± 6) and 15 smokers (seven women, eight men; mean age, 50 years ± 8). A mixed-effects model was developed to identify the regional repeatability of Pao2 measurements as an intraclass correlation coefficient. Ten smokers were matched with the 10 nonsmokers on the basis of signal-to-noise ratio (SNR). Three separate models were generated: one for nonsmokers, one for the SNR-matched smokers, and one for the five remaining smokers, who were imaged with a significantly higher SNR. RESULTS Short-term back-to-back regional reproducibility was assessed by using intraclass correlation coefficients, which were 0.67 and 0.65 for SNR case-matched nonsmokers and smokers, respectively. Repeatability was a strong function of SNR; a 50% increase in SNR in the remaining smokers improved the intraclass correlation coefficient to 0.82. Although repeatability was not significantly different between the SNR-matched cohorts (P = .44), the smoker group showed higher spatial and temporal variability in Pao2. CONCLUSION The short-term test-retest repeatability of hyperpolarized gas MR imaging of regional Pao2 was good. Asymptomatic smokers exhibited greater spatial and temporal variability in Pao2 than did the nonsmokers, which suggests that this parameter allows detection of small functional alterations associated with smoking.
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Affiliation(s)
- Masaru Ishii
- From the Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Md (M.I., R.R.R.); Department of Radiology (H.H., J.T.C., S.J.K., Y.X., W.G.), and Pulmonary, Allergy and Critical Care Division (M.D.R.), University of Pennsylvania, 308 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104
| | - Hooman Hamedani
- From the Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Md (M.I., R.R.R.); Department of Radiology (H.H., J.T.C., S.J.K., Y.X., W.G.), and Pulmonary, Allergy and Critical Care Division (M.D.R.), University of Pennsylvania, 308 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104
| | - Justin T Clapp
- From the Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Md (M.I., R.R.R.); Department of Radiology (H.H., J.T.C., S.J.K., Y.X., W.G.), and Pulmonary, Allergy and Critical Care Division (M.D.R.), University of Pennsylvania, 308 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104
| | - Stephen J Kadlecek
- From the Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Md (M.I., R.R.R.); Department of Radiology (H.H., J.T.C., S.J.K., Y.X., W.G.), and Pulmonary, Allergy and Critical Care Division (M.D.R.), University of Pennsylvania, 308 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104
| | - Yi Xin
- From the Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Md (M.I., R.R.R.); Department of Radiology (H.H., J.T.C., S.J.K., Y.X., W.G.), and Pulmonary, Allergy and Critical Care Division (M.D.R.), University of Pennsylvania, 308 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104
| | - Warren B Gefter
- From the Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Md (M.I., R.R.R.); Department of Radiology (H.H., J.T.C., S.J.K., Y.X., W.G.), and Pulmonary, Allergy and Critical Care Division (M.D.R.), University of Pennsylvania, 308 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104
| | - Milton D Rossman
- From the Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Md (M.I., R.R.R.); Department of Radiology (H.H., J.T.C., S.J.K., Y.X., W.G.), and Pulmonary, Allergy and Critical Care Division (M.D.R.), University of Pennsylvania, 308 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104
| | - Rahim R Rizi
- From the Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Md (M.I., R.R.R.); Department of Radiology (H.H., J.T.C., S.J.K., Y.X., W.G.), and Pulmonary, Allergy and Critical Care Division (M.D.R.), University of Pennsylvania, 308 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104
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Hamedani H, Shaghaghi H, Kadlecek SJ, Xin Y, Han B, Siddiqui S, Rajaei J, Ishii M, Rossman M, Rizi RR. Vertical gradients in regional alveolar oxygen tension in supine human lung imaged by hyperpolarized 3He MRI. NMR IN BIOMEDICINE 2014; 27:1439-50. [PMID: 25395184 PMCID: PMC5033039 DOI: 10.1002/nbm.3227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 09/22/2014] [Accepted: 09/22/2014] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to evaluate whether regional alveolar oxygen tension (P(A)O2) vertical gradients imaged with hyperpolarized (3)He can identify smoking-induced pulmonary alterations. These gradients are compared with common clinical measurements including pulmonary function tests (PFTs), the six minute walk test, and the St. George's Respiratory Questionnaire. 8 healthy non-smokers, 12 asymptomatic smokers, and 7 symptomatic subjects with chronic obstructive pulmonary disease (COPD) underwent two sets of back-to-back P(A)O2 imaging acquisitions in the supine position in two opposite directions (top to bottom and bottom to top), followed by clinically standard pulmonary tests. The whole-lung mean, standard deviation (DP(A)O2) and vertical gradients of P(A)O2 along the slices were extracted, and the results were compared with clinically derived metrics. Statistical tests were performed to analyze the differences between cohorts. The anterior-posterior vertical gradients and DP(A)O2 effectively differentiated all three cohorts (p < 0.05). The average vertical gradient P(A)O2 in healthy subjects was -1.03 ± 0.51 Torr/cm toward lower values in the posterior/dependent regions. The directional gradient was absent in smokers (0.36 ± 1.22 Torr/cm) and was in the opposite direction in COPD subjects (2.18 ± 1.54 Torr/cm). The vertical gradients correlated with smoking history (p = 0.004); body mass index (p = 0.037), PFT metrics (forced expiratory volume in 1 s, p = 0.025; residual volume/total lung capacity percent predicted, p = 0.033) and with distance walked in 6 min (p = 0.009). Regional P(A)O2 data indicate that cigarette smoke induces physiological alterations that are not being detected by the most widely used physiological tests.
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Affiliation(s)
- Hooman Hamedani
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Hoora Shaghaghi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Stephen J. Kadlecek
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Yi Xin
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Biao Han
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Sarmad Siddiqui
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Jennia Rajaei
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Masaru Ishii
- Departments of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Milton Rossman
- Department of Pulmonary and Critical Care, Johns Hopkins University of Pennsylvania, Philadelphia, PA, Baltimore, MD, United States
| | - Rahim R. Rizi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
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