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Regional Pulmonary Perfusion in Patients with Acute Pulmonary Edema

¹ Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
² Department of Radiology, Washington University School of Medicine, St. Louis, Missouri

View larger version (73K): [in a new window]   FIGURE 1. Sample PET images from patient PH226 (Table 1) with pulmonary edema. (A) Transmission image. Scale is in arbitrary units, where higher numbers indicate greater attenuation of activity (i.e., greater tissue density). Scan is comparable with typical CT scan, except with approximately 1/10th the spatial resolution. Scan is used to identify lung regions (white outlines). (B) PBF image. Units are mL/min/100 mL lung. (C) Lung water concentration (LWC) image. Units are mL H2O/100 mL lung. Normal upper limits for LWC by these methods are approximately 25 mL H2O/100 mL lung. Note dorsal predominance of lung water accumulation. Also note general concordance between regional blood flow and lung water distributions (i.e., there is no appreciable perfusion redistribution away from regions of increased LWC [pulmonary edema]).

View larger version (15K): [in a new window]   FIGURE 2. Time-activity data after injection of H215O in patient PH226 (Table 1). Each point represents data from 3-s scan. Arrows point to first frame used to determine beginning of composite 18-s scan formed to estimate PBF from Equation 1. Note delay in activity reaching lung tissue region () from right ventricle (•). cps = counts per second.

View larger version (12K): [in a new window]   FIGURE 3. LWC in healthy (normal) subjects (Nl Subjs) (n = 12) and patients with ALI/ARDS (ALI) (n = 9) or non-ALI/ARDS (n = 7) pulmonary edema. *P < 0.05

View larger version (23K): [in a new window]   FIGURE 4. Regional distribution of LWC in healthy (normal) subjects (Nl Subjs) and patients with ALI/ARDS (ALI) or non-ALI/ARDS (non-ALI) pulmonary edema. Data are taken from PET images after sorting picture elements (pixels) into bins along ventral-to-dorsal axis. LWC in all bins from patients was significantly greater than that in healthy subjects.

View larger version (11K): [in a new window]   FIGURE 5. Mean PBF, which is proportional to cardiac output, as estimated from PET of healthy (normal) subjects (Nl Subjs) and patients with ALI/ARDS (ALI) or non-ALI/ARDS (non-ALI) pulmonary edema. No significant difference was found between the 2 groups.

View larger version (18K): [in a new window]   FIGURE 6. Regional distribution of fractional PBF in healthy (normal) subjects and patients with pulmonary edema (ALI and Non-ALI). Data are taken from PET images after sorting picture elements (pixels) into bins along ventral-to-dorsal axis. PBF data have been normalized for differences in cardiac output among individuals by dividing value for PBF in each pixel by mean PBF for same tomographic slice. For clarity of presentation, only mean values for PBF in pulmonary edema patients are shown. These values lie within ±1 SD of comparable values for healthy subjects (i.e., on average, distributions are not significantly different).

View larger version (16K): [in a new window]   FIGURE 7. Regional distribution of fractional PBF in healthy (normal) subjects and patients with pulmonary edema (ALI and non-ALI) versus LWC. Data represent combination of data from Figures 4 and 6. Each symbol represents 1 image bin. For clarity of presentation, only mean values are shown. Rightward shift of curves from pulmonary edema patients represents increase in LWC (i.e., pulmonary edema). However, PBF distributions within each LWC distribution are nearly identical (i.e., there is no perfusion redistribution in patients with pulmonary edema compared with pattern seen in healthy subjects).