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Qualitative und quantitative CT-Analysen beim akuten Lungenversagen

Qualitative and quantitative CT analysis of acute pulmonary failure

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Zusammenfassung

Die ersten computertomographischen Beschreibungen der Lungenmorphologie bei Patienten mit akutem Lungenversagen erschienen vor inzwischen 25 Jahren. Die Computertomographie (CT) hat das Verständnis pathophysiologischer Prozesse und therapeutischer Interventionen beim akuten Lungenversagen maßgeblich beeinflusst und sich von der Reservebildgebungsoption zum zentralen diagnostischen Baustein moderner Therapiekonzepte entwickelt. Der vorliegende Artikel soll einen Überblick über Indikationsstellung, Durchführung und Auswertung der CT bei Patienten mit akutem Lungenversagen geben. In der CT erfasste Veränderungen der Morphologie werden pathophysiologischen Eigenschaften der Lungenfunktion zugeordnet. Abschließend wird dargestellt, wie die CT zur Quantifizierung erkrankungs- oder beatmungsassoziierter Veränderungen der Lungenbelüftung eingesetzt werden kann.

Abstract

Since its first application in patients with acute lung injury 25 years ago, computed tomography (CT) has significantly influenced the understanding of the pathophysiology, diagnosis and management of acute lung injury and has become an important diagnostic modality for these patients. The aim of this article is to review important disease-specific aspects of CT acquisition and qualitative and quantitative analyses of CT data. Morphological changes seen on CT and associated functional alterations are discussed. Methods used for the quantification of lung aeration are described and their limitations outlined.

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Literatur

  1. Albaiceta GM, Taboada F, Parra D et al (2004) Tomographic study of the inflection points of the pressure-volume curve in acute lung injury. Am J Respir Crit Care Med 170:1066–1072

    Article  PubMed  Google Scholar 

  2. Amato MBP, Marini JJ (1998) Barotrauma, volutrauma, and the ventilation of acute lung injury. In: Marini JJ, Slutsky AS (eds) Physiological basis of ventilatory support, lung biology in health and disease. Dekker, New York, pp 1187–1245

  3. Anonymous (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 342:1301–1308

    Article  Google Scholar 

  4. Bikker IG, van Bommel J, Miranda DR et al (2008) End-expiratory lung volume during mechanical ventilation: a comparison with reference values and the effect of positive end-expiratory pressure in intensive care unit patients with different lung conditions. Crit Care 12:R145

    Article  PubMed  Google Scholar 

  5. Birnbaum BA, Hindman N, Lee J, Babb JS (2007) Multi-detector row CT attenuation measurements: assessment of intra- and interscanner variability with an anthropomorphic body CT phantom. Radiology 242:109–119

    Article  PubMed  Google Scholar 

  6. Bodenstein M, David M, Markstaller K (2009) Principles of electrical impedance tomography and its clinical application. Crit Care Med 37:713–724

    Article  PubMed  Google Scholar 

  7. Borges JB, Okamoto VN, Matos GF et al (2006) Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Crit Care Med 174:268–278

    Article  PubMed  Google Scholar 

  8. Bouhemad B, Richecoeur J, Lu Q et al (2003) Effects of contrast material on computed tomographic measurements of lung volumes in patients with acute lung injury. Crit Care 7:63–71

    Article  PubMed  Google Scholar 

  9. Caironi P, Langer T, Gattinoni L (2008) Acute lung injury/acute respiratory distress syndrome pathophysiology: what we have learned from computed tomography scanning. Curr Opin Crit Care 14:64–69

    Article  PubMed  Google Scholar 

  10. Cotes JE, Chinn DJ, Miller MR (2006) Lung function. Physiology, measurement and application in medicine. 6th edn. Blackwell, Oxford, pp 111

  11. Coxson HO, Mayo JR, Behzad H et al (1995) Measurement of lung expansion with computed tomography and comparison with quantitative histology. J Appl Physiol 79:1525–1530

    PubMed  CAS  Google Scholar 

  12. David M, Karmrodt J, Bletz C et al (2005) Analysis of atelectasis, ventilated, and hyperinflated lung during mechanical ventilation by dynamic CT. Chest 128:3757–3770

    Article  PubMed  Google Scholar 

  13. Dreyfuss D, Saumon G (1992) Barotrauma is volutrauma, but which volume is the one responsible? Intensive Care Med 18:139–141

    Article  PubMed  CAS  Google Scholar 

  14. Drummond GB (1998) Computed tomography and pulmonary measurements. Br J Anaesth 80:665–671

    PubMed  CAS  Google Scholar 

  15. Falke KJ, Pontoppidan H, Kumar A et al (1972) Ventilation with end-expiratory pressure in acute lung disease. J Clin Invest 51:2315–2323

    Article  PubMed  CAS  Google Scholar 

  16. Ferguson ND, Frutos-Vivar F, Esteban A et al (2005) Acute respiratory distress syndrome: underrecognition by clinicians and diagnostic accuracy of three clinical definitions. Crit Care Med 33:2228–2234

    Article  PubMed  Google Scholar 

  17. Gattinoni L, Caironi P, Pelosi P et al (2001) What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 164:1701–1711

    PubMed  CAS  Google Scholar 

  18. Gattinoni L, Pesenti A (2005) The concept of „baby lung“. Intensive Care Med 31:776–784

    Article  PubMed  Google Scholar 

  19. Gattinoni L, Caironi P, Cressoni M et al (2006) Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 354:1775–1786

    Article  PubMed  CAS  Google Scholar 

  20. Kalender WA (2005) Computed tomography – fundamentals, system technology, image quality, applications. Publicis, Erlangen, pp 30

  21. Ley-Zaporozhan J, Ley S, Unterhinninghofen R et al (2008) Quantification of lung volume at different tidal volumes and positive end-expiratory pressures in a porcine model by using retrospective respiratory gated 4D-computed tomography. Invest Radiol 43:461–469

    Article  PubMed  Google Scholar 

  22. Lu Q, Malbouisson LM, Mourgeon E et al (2001) Assessment of PEEP-induced reopening of collapsed lung regions in acute lung injury: are one or three CT sections representative of the entire lung? Intensive Care Med 27:1504–1510

    Article  PubMed  CAS  Google Scholar 

  23. Lundquist H, Hedenstierna G, Strandberg A et al (1995) CT-assessment of dependent lung densities in man during general anaesthesia. Acta Radiol 36:626–632

    Article  PubMed  CAS  Google Scholar 

  24. Madani A, De Maertelaer V, Zanen J, Gevenois PA (2007) Pulmonary emphysema: radiation dose and section thickness at multidetector CT quantification – comparison with macroscopic and microscopic morphometry. Radiology 243:250–257

    Article  PubMed  Google Scholar 

  25. Malbouisson LM, Muller JC, Constantin JM et al (2001) Computed tomography assessment of positive end-expiratory pressureinduced alveolar recruitment in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 163:1444–1450

    PubMed  CAS  Google Scholar 

  26. Miller PR, Croce MA, Bee TK et al (2001) ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients. J Trauma 51:223–228

    Article  PubMed  CAS  Google Scholar 

  27. Neumann P, Berglund JE, Andersson LG et al (2000) Effects of inverse ratio ventilation and positive end-expiratory pressure in oleic acid-induced lung injury. Am J Respir Crit Care Med 161:1537–1545

    PubMed  CAS  Google Scholar 

  28. Parr DG, Stoel BC, Stolk J et al (2004) Influence of calibration on densitometric studies of emphysema progression using computed tomography. Am J Respir Crit Care Med 170:883–990

    Article  PubMed  Google Scholar 

  29. Patroniti N, Bellani G, Maggioni E et al (2005) Measurement of pulmonary edema in patients with acute respiratory distress syndrome. Crit Care Med 33:2547–2554

    Article  PubMed  Google Scholar 

  30. Reske AW, Busse H, Amato MB et al (2008) Image reconstruction affects computer tomographic assessment of lung hyperinflation. Intensive Care Med 34:2044–2053

    Article  PubMed  Google Scholar 

  31. Reske AW, Reske AP, Seiwerts M et al (2008) Lung weights in mechanically ventilated trauma patients with normal lungs. Intensive Care Med 34 [suppl 1]:165, abstr 640

  32. Rommelsheim K, Lackner K, Westhofen P et al (1983) Das respiratorische Distress-Syndrom des Erwachsenen (ARDS) im Computertomogramm. Anasthesiol Intensivmed Notfallmed Schmerzther 18:59–64

    Article  CAS  Google Scholar 

  33. Rouby JJ, Puybasset L, Nieszkowska A, Lu Q (2003) Acute respiratory distress syndrome: lessons from computed tomography of the whole lung. Crit Care Med 31 [suppl]:S285–S295

    Google Scholar 

  34. Schuster DP (1995) What is acute lung injury? What is ARDS? Chest 107:1721–1726

    Article  PubMed  CAS  Google Scholar 

  35. Terragni PP, Rosboch G, Tealdi A et al (2007) Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 175:160–166

    Article  PubMed  CAS  Google Scholar 

  36. Tomashefski JF Jr (1990) Pulmonary pathology of the adult respiratory distress syndrome. Clin Chest Med 11:593–619

    PubMed  Google Scholar 

  37. Treggiari MM, Romand JA, Martin JB, Suter PM (2002) Air cysts and bronchiectasis prevail in nondependent areas in severe acute respiratory distress syndrome: a computed tomographic study of ventilator-associated changes. Crit Care Med 30:1747–1752

    Article  PubMed  Google Scholar 

  38. Uhlig S, Frerichs I (2008) Lungenprotektive Beatmung – Pathophysiologie und Diagnostik. Anasthesiol Intensivmed Notfallmed Schmerzther 6:438–445

    Google Scholar 

  39. Vieira SR, Puybasset L, Richecoeur J et al (1998) A lung computed tomographic assessment of positive end-expiratory pressureinduced lung overdistension. Am J Respir Crit Care Med 158:1571–1577

    PubMed  CAS  Google Scholar 

  40. Ware LB, Matthay MA (2000) The acute respiratory distress syndrome. N Engl J Med 342:1334–1349

    Article  PubMed  CAS  Google Scholar 

  41. Whitehead T, Slutsky AS (2002) The pulmonary physician in critical care 7: ventilator induced lung injury. Thorax 57:635–642

    Article  PubMed  CAS  Google Scholar 

  42. Winer-Muram HT, Steiner RM, Gurney JW et al (1998) Ventilator-associated pneumonia in patients with adult respiratory distress syndrome: CT evaluation. Radiology 208:193–199

    PubMed  CAS  Google Scholar 

  43. Zaporozhan J, Ley S, Eberhardt R et al (2005) Paired inspiratory/expiratory volumetric thin-slice CT scan for emphysema analysis: comparison of different quantitative evaluations and pulmonary function test. Chest 128:3212–3220

    Article  PubMed  Google Scholar 

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Danksagung

Herrn Professor Dr. med. T. Kahn, Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig AöR, danken wir herzlich für die Erlaubnis zur Benutzung der in seiner Klinik angefertigten CT-Bilder.

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  1. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    A.W. Reske

  2. Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland

    M. Seiwerts

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  1. A.W. Reske
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Correspondence to A.W. Reske.

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Reske, A., Seiwerts, M. Qualitative und quantitative CT-Analysen beim akuten Lungenversagen. Radiologe 49, 687–697 (2009). https://doi.org/10.1007/s00117-009-1878-z

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