Pulmonary density distribution in experimental and clinical cardiogenic pulmonary edema evaluated by computed transmission tomography

Slutsky, Robert A.; Peck, Wallace W.; Higgins, Charles B.; Mancini, G.B. John

doi:10.1016/0002-8703(84)90632-x

Cited by 11 publications

(5 citation statements)

References 20 publications

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“…'5 Others again have strapped pots or tubes of water to the chest in man, to provide explicit evidence that the calculated density of reference objects within the field of view but outside the body were correct, or could be used to correct in vivo values appropriately. '6 17 The present findings extend and support these previous observations. Comparing our estimates of lung density in man with previous work is not easy for two reasons: other workers have used various degrees of lung inflation and various exclusions of hilar tissues and bronchial and vascular trees.…”

Section: Discussionsupporting

confidence: 91%

Estimation of regional gas and tissue volumes of the lung in supine man using computed tomography.

Denison¹,

Morgan²,

Millar³

1986

Thorax

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This study was intended to discover how well computed tomography could recover the volume and weight of lung like foams in a body like shell, and then how well it could recover the volume and weight of the lungs in supine man. Model thoraces were made with various loaves of bread submerged in water. Computed tomography scans recovered the volume of the model lungs (true volume range 250-12 500 ml) within + 0-2 (SD 68) ml and their weights (true range 72-3125 g) within + 30 (78) g. Scans also recovered successive injections of 50 ml of water, within + 5 ml. Scans in 12 healthy supine men recovered their vital capacities, total lung capacities (TLC), and predicted tissue volumes with comparable accuracy. At total lung capacity the mean tissue volume of single lungs was 431 (64) ml and at residual volume (RV) it was 427 (63) ml. Tissue volume was then used to match inspiratory and expiratory slices and calculate regional ventilation. Throughout the mid 90% of lung the RV/TLC ratio was fairly constant-mean 21% (5%). New methods of presenting such regional data graphically and automatically are also described. This paper describes a study of estimates of regional gas and tissue volumes in the lungs of healthy people based on computed tomography. A conventional posteroanterior radiograph is an image generated by x rays travelling in straight lines. Its magnification is accurate and determined by simple geometry, from which the size of the lungs can be calculated reliably.' -The density information it contains, however, condenses three dimensions into two and cannot be used to calculate lung mass. By contrast, a computed tomograph purports to be an accurate map of position and density. It is, however, a fabricated image whose reconstruction rests on several assumptions, which make it vulnerable to error, particularly in the lung.The primary information for the tomograph is collected in the form of banks of numerical data, describing the x ray intensities falling on each of very many minute sensors as a function of time. Each sensor is read every several milliseconds for a few seconds. Firstly, this information is scanned for, and filtered from, "obvious noise." Secondly, it is corrected for the phenomenon of beam hardening (the absorption of rays of lower energy by radiodense material). This will be especially complex where there Address for reprint requests: Professor DM Denison, BromptonHospital, London SW3 6HP.Accepted 21 January 1986 are steep radiodensity gradients, as in the thorax. Thirdly, the image is reconstructed by effectively throwing back and overlaying the assumed densities of a vast number of single beams (back projection). Some workers have foreseen that if the computed image is correct it offers accurate estimates of regional gas and tissue volumes in the lung.4 Other investigators have shown that the technique provides good estimates of solid organ volume and mass in the abdomen (and in one pulmonary nodule).56 We cannot, however, directly transfer these findings to the lung. Its foam lik...

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Section: Discussionsupporting

confidence: 91%

Estimation of regional gas and tissue volumes of the lung in supine man using computed tomography.

Denison¹,

Morgan²,

Millar³

1986

Thorax

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“…The decreased accuracy in the lower lobes is likely related to atelectasis either due to gravity or adjacent pleural effusions. Previous studies have documented that while there is no cranio-caudal gradient of lung density measurements, the dependent portions of the lungs demonstrated higher attenuation values in normal subjects without pulmonary edema [8,10]. This has been postulated to be attributed to the gravitational effects on the lower lobes causing compression of the lung parenchyma in addition to increase in lung blood volume with subsequent increases in lung density.…”

Section: Discussionmentioning

confidence: 98%

Simple quantitative chest CT for pulmonary edema

Barile

Hida

Hammer

et al. 2020

European Journal of Radiology Open

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To determine the accuracy of quantitative CT to diagnose pulmonary edema compared to qualitative CT and CXR and to determine a threshold Hounsfield unit (HU) measurement for pulmonary edema on CT examinations. Method: Electronic medical records were searched for patients with a billing diagnosis of heart failure and a Chest CT and CXR performed within three hours between 1/1/2016 to 10/1/2016, yielding 100 patients. CXR and CT examinations were scored for the presence and severity of edema, using a 0-5 scale, and CT HU measurements were obtained in each lobe. Polyserial correlation coefficients evaluated the association between CT HUs and CXR scores, and receiver operating characteristic (ROC) curve analysis determined a cutoff CT HU value for identification of pulmonary edema. Results: Correlation between CT HU and CXR score was moderately strong (r = 0.585− 0.685) with CT HU measurements demonstrating good to excellent accuracy in differentiating between no edema (grade 0) and mild to severe edema (grades 1-5) in every lobe, with AUCs ranging between 0.869 and 0.995. The left upper lobe demonstrated the highest accuracy, using a cutoff value of -825 HU (AUC of 0.995, sensitivity = 100 % and specificity = 95.1 %). Additionally, qualitative CT evaluation was less sensitive (84 %) than portable CXR in identifying pulmonary edema. However, quantitative CT evaluation was as sensitive as portable CXR (100 %) and highly specific (95 %). Conclusions: Quantitative CT enables the identification of pulmonary edema with high accuracy and demonstrates a greater sensitivity than qualitative CT in assessment of pulmonary edema.

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“…Then, Slutsky et al used the same method to relate density changes to the alteration in left ventricular filling pressure. The results showed the ratio of pulmonary density in the anterior and posterior segments (A/P) is related with heart failure (17). The dependent lung is always denser; this is attributed to the effect of gravity on the lower lobes (32).…”

Section: Discussionmentioning

confidence: 98%

“…The imaging features of the lungs related to hydrostatic changes and other signs were evaluated and recorded, including small ill-defined opacities, interlobular septal thickening, ground-glass attenuation, airspace consolidation, and pleural effusion (Figure 1) (15). For quantitative analysis, we used the sector method to measure the density of a peripheral area of lung parenchyma (16,17). We manually drew regions of interest (ROIs) on the axial images in 12 regions, including the right and left upper lobes, left lingula and right middle lobe, and left and right lower lobes (size, 2 cm × 1 cm), and recorded CT Hounsfield unit (HU) of every ROI.…”

Section: Measurements and Outcomementioning

confidence: 99%

Evaluating cardiac function with chest computed tomography in acute ischemic stroke: feasibility and correlation with short-term outcome

Bao,

Wang,

Zhang

et al. 2023

Front. Neurol.

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BackgroundThe outcomes of patients with acute ischemic stroke (AIS) are related to cardiac function. Cardiac insufficiency can manifest as hydrostatic changes in the lungs. Computed tomography (CT) of the chest is commonly used for screening pulmonary abnormalities and provides an opportunity to assess cardiac function.PurposeTo evaluate the correlation between hydrostatic lung manifestations on chest CT and cardiac function with its potential to predict the short-term outcome of AIS patients.MethodsWe retrospectively analyzed AIS patients who had undergone chest CT at admission and echocardiogram within 48 h. Morphological and quantitative hydrostatic changes and left ventricular dimensions were assessed using chest CT. Improvement in the National Institutes of Health Stroke Scale (NIHSS) score on the seventh day determined short-term outcomes. Multivariate analysis examined the correspondence between hydrostatic lung manifestations, left ventricular dimension, and left ventricle ejection fraction (LVEF) on echocardiography, and the correlation between hydrostatic changes and short-term outcomes.ResultsWe included 204 patients from January to December 2021. With the progression of hydrostatic changes on chest CT, the LVEF on echocardiography gradually decreased (p < 0.05). Of the 204, 53 patients (26%) with varying degrees of hypostatic lung manifestations had less improvement in the NIHSS score (p < 0.05). The density ratio of the anterior/posterior lung on CT showed a significant negative correlation with improvement in the NIHSS score (r = −5.518, p < 0.05). Additionally, patients with a baseline NIHSS ≥4 with left ventricular enlargement had significantly lower LVEF than that of patients with normal NIHSS scores.ConclusionHydrostatic lung changes on chest CT can be used as an indicator of cardiac function and as a preliminary reference for short-term outcome in AIS patients.

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Pulmonary density distribution in experimental and clinical cardiogenic pulmonary edema evaluated by computed transmission tomography

Cited by 11 publications

References 20 publications

Estimation of regional gas and tissue volumes of the lung in supine man using computed tomography.

Estimation of regional gas and tissue volumes of the lung in supine man using computed tomography.

Simple quantitative chest CT for pulmonary edema

Evaluating cardiac function with chest computed tomography in acute ischemic stroke: feasibility and correlation with short-term outcome

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