Regional ventilation in statically and dynamically hyperinflated dogs

Mild loss of lung aeration augments stretch in healthy lung regions

Inspiratory stretch by mechanical ventilation worsens lung injury. However, it is not clear whether and how the ventilator damages lungs in the absence of preexisting injury. We hypothesized that subtle loss of lung aeration during general anesthesia regionally augments ventilation and distension of ventilated air spaces. In eight supine anesthetized and intubated rats, hyperpolarized gas MRI was performed after a recruitment maneuver following 1 h of volume-controlled ventilation with zero positive end-expiratory pressure (ZEEP), FiO2 0.5, and tidal volume 10 ml/kg, and after a second recruitment maneuver. Regional fractional ventilation (FV), apparent diffusion coefficient (ADC) of (3)He (a measurement of ventilated peripheral air space dimensions), and gas volume were measured in lung quadrants of ventral and dorsal regions of the lungs. In six additional rats, computed tomography (CT) images were obtained at each time point. Ventilation with ZEEP decreased total lung gas volume and increased both FV and ADC in all studied regions. Increases in FV were more evident in the dorsal slices. In each lung quadrant, higher ADC was predicted by lower gas volume and by increased mean values (and heterogeneity) of FV distribution. CT scans documented 10% loss of whole-lung aeration and increased density in the dorsal lung, but no macroscopic atelectasis. Loss of pulmonary gas at ZEEP increased fractional ventilation and inspiratory dimensions of ventilated peripheral air spaces. Such regional changes could help explain a propensity for mechanical ventilation to contribute to lung injury in previously uninjured lungs.

Atlas-driven lung lobe segmentation in volumetric X-ray CT images

High-resolution X-ray computed tomography (CT) imaging is routinely used for clinical pulmonary applications. Since lung function varies regionally and because pulmonary disease is usually not uniformly distributed in the lungs, it is useful to study the lungs on a lobe-by-lobe basis. Thus, it is important to segment not only the lungs, but the lobar fissures as well. In this paper, we demonstrate the use of an anatomic pulmonary atlas, encoded with a priori information on the pulmonary anatomy, to automatically segment the oblique lobar fissures. Sixteen volumetric CT scans from 16 subjects are used to construct the pulmonary atlas. A ridgeness measure is applied to the original CT images to enhance the fissure contrast. Fissure detection is accomplished in two stages: an initial fissure search and a final fissure search. A fuzzy reasoning system is used in the fissure search to analyze information from three sources: the image intensity, an anatomic smoothness constraint, and the atlas-based search initialization. Our method has been tested on 22 volumetric thin-slice CT scans from 12 subjects, and the results are compared to manual tracings. Averaged across all 22 data sets, the RMS error between the automatically segmented and manually segmented fissures is 1.96 +/- 0.71 mm and the mean of the similarity indices between the manually defined and computer-defined lobe regions is 0.988. The results indicate a strong agreement between the automatic and manual lobe segmentations.