Computed tomography studies of lung mechanics.
Computed tomography studies of lung mechanics.
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DOI：
10.1513/pats.200603-086ms
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发表时间：
2005-01-01
期刊：
影响因子：
--
通讯作者：
Reinhardt, Joseph M
中科院分区：
文献类型：
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作者：
Simon, Brett A;Christensen, Gary E;Reinhardt, Joseph M
随着多排计算机断层扫描（MDCT）的进步，现在可以在10秒或更短的时间内对肺部进行成像，并准确提取肺部、肺叶和气道树到第五代至第七代支气管，并对肺密度、纹理、通气和灌注进行区域表征。这些方法现在被用于健康和疾病中的肺的表型，并深入了解病理过程的病因。本文概述了这些方法的应用，特别强调慢性阻塞性肺疾病。我们展示了我们的方法用于评估局部通气和灌注的用途，并展示了早期数据，这些数据显示，在绵羊模型中，局部完整的缺氧肺血管收缩剂（HPV）反应，在存在炎症的情况下，局部HPV明显受到抑制。我们提出的假设是，在肺气肿受试者中，导致实质破坏的一个主要因素是当局部缺氧与局部炎症事件（细支气管炎或肺泡灌洗）相关时，HPV缺乏局部钝化。如果维持足够的血流到发炎的肺区域对于炎症事件的非破坏性解决是至关重要的，那么HPV在炎症区域中持续的病理状况可能在肺尖中具有最大的影响，其中在直立的身体姿势中血流已经减少。肺力学的研究已经从肺压力和体积关系的全局描述发展到高分辨率，动态区域力学性能和位移的三维定量测量。X射线计算机断层扫描（CT）成像是理想的适合在完整的主题，因为它的高空间和时间分辨率，相关的功能数据与解剖细节，增加体积数据采集，和CT密度和肺空气含量之间的独特关系的局部肺力学的研究。本文综述了CT测量原理和局限性的研究区域力学的概述，回顾了一些早期的工作，设置阶段的现代成像方法和影响急性肺损伤患者的理解和管理，并提出了不断发展的新方法的分析和应用动态容积肺图像数据。
With advances in multidetector-row computed tomography (MDCT), it is now possible to image the lung in 10 s or less and accurately extract the lungs, lobes, and airway tree to the fifth- through seventh-generation bronchi and to regionally characterize lung density, texture, ventilation, and perfusion. These methods are now being used to phenotype the lung in health and disease and to gain insights into the etiology of pathologic processes. This article outlines the application of these methodologies with specific emphasis on chronic obstructive pulmonary disease. We demonstrate the use of our methods for assessing regional ventilation and perfusion and demonstrate early data that show, in a sheep model, a regionally intact hypoxic pulmonary vasoconstrictor (HPV) response with an apparent inhibition of HPV regionally in the presence of inflammation. We present the hypothesis that, in subjects with pulmonary emphysema, one major contributing factor leading to parenchymal destruction is the lack of a regional blunting of HPV when the regional hypoxia is related to regional inflammatory events (bronchiolitis or alveolar flooding). If maintaining adequate blood flow to inflamed lung regions is critical to the nondestructive resolution of inflammatory events, the pathologic condition whereby HPV is sustained in regions of inflammation would likely have its greatest effect in the lung apices where blood flow is already reduced in the upright body posture.The study of lung mechanics has progressed from global descriptions of lung pressure and volume relationships to the high-resolution, three-dimensional, quantitative measurement of dynamic regional mechanical properties and displacements. X-ray computed tomography (CT) imaging is ideally suited to the study of regional lung mechanics in intact subjects because of its high spatial and temporal resolution, correlation of functional data with anatomic detail, increasing volumetric data acquisition, and the unique relationship between CT density and lung air content. This review presents an overview of CT measurement principles and limitations for the study of regional mechanics, reviews some of the early work that set the stage for modern imaging approaches and impacted the understanding and management of patients with acute lung injury, and presents evolving novel approaches for the analysis and application of dynamic volumetric lung image data.