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01-05-2014 | Original

Low-dose chest computed tomography for quantitative and visual anatomical analysis in patients with acute respiratory distress syndrome

Authors: Davide Chiumello, Thomas Langer, Vittoria Vecchi, Simone Luoni, Andrea Colombo, Matteo Brioni, Sara Froio, Irene Cigada, Silvia Coppola, Alessandro Protti, Marco Lazzerini, Luciano Gattinoni

Published in: Intensive Care Medicine | Issue 5/2014

Abstract

Purpose

Chest computed tomography (CT) is a fundamental tool for the characterization of acute respiratory distress syndrome (ARDS). Its frequent use is, however, hindered by the associated radiation exposure. The aim of the present study was to evaluate, in patients with ARDS, the accuracy of quantitative and visual anatomical lung analysis performed on low-dose CT. We hypothesized that low-dose CT would provide accurate quantitative and visual anatomical results.

Methods

Chest CT was performed in 45 ARDS patients in static conditions at set airway pressures of 45 and 15 or 45 and 5 cmH₂O. During each pause, two consecutive scans were obtained at two different tube current–time products (mAs). In 24 patients 110 mAs was coupled with 60 mAs; in 21 patients 110 was coupled with 30 mAs. All other CT parameters were kept unaltered. Quantitative and visual anatomical results obtained at different mAs were compared via Bland–Altman analysis.

Results

Good agreements were observed between 110 and 60 mAs and between 110 and 30 mAs both for quantitative and visual anatomical results (all biases below 1.5 %). Estimated mean effective dose at 110, 60, and 30 mAs corresponded to 5.3 ± 1.6, 2.8 ± 0.8, and 1.4 ± 0.3 mSv, respectively.

Conclusions

In patients with ARDS a reduction of mAs up to 30 (70 % effective dose reduction) can be achieved without significant effect on quantitative and visual anatomical results. Low-dose chest CT, with related quantitative and visual anatomical analysis, could be a valuable tool to characterize and potentially monitor lung disease in patients with ARDS.

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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 14:64–69PubMedCrossRef

Chiumello D, Froio S, Bouhemad B, Camporota L, Coppola S (2013) Clinical review: lung imaging in acute respiratory distress syndrome patients—an update. Crit Care 17:243PubMedCrossRef

Cortes I, Penuelas O, Esteban A (2012) Acute respiratory distress syndrome: evaluation and management. Minerva Anestesiol 78:343–357PubMed

Gattinoni L, Pesenti A, Carlesso E (2013) Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure: impact and clinical fallout through the following 20 years. Intensive Care Med 39:1909–1915PubMedCrossRef

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

Lu Q (2013) How to assess positive end-expiratory pressure-induced alveolar recruitment? Minerva Anestesiol 79:83–91PubMed

Constantin JM, Futier E (2013) Lung imaging in patients with acute respiratory distress syndrome: from an understanding of pathophysiology to bedside monitoring. Minerva Anestesiol 79:176–184PubMed

Parmentier-Decrucq E, Poissy J, Favory R, Nseir S, Onimus T, Guerry MJ et al (2013) Adverse events during intrahospital transport of critically ill patients: incidence and risk factors. Ann Intensive Care 3:10PubMedCentralPubMedCrossRef

Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505PubMedCentralPubMedCrossRef

10.

Sodickson A, Baeyens PF, Andriole KP, Prevedello LM, Nawfel RD, Hanson R et al (2009) Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 251:175–184PubMedCrossRef

11.

Rohner DJ, Bennett S, Samaratunga C, Jewell ES, Smith JP, Gaskill-Shipley M et al (2013) Cumulative total effective whole-body radiation dose in critically ill patients. Chest 144:1481–1486PubMedCrossRef

12.

Naidich DP, Marshall CH, Gribbin C, Arams RS, McCauley DI (1990) Low-dose CT of the lungs: preliminary observations. Radiology 175:729–731PubMed

13.

Dinkel HP, Sonnenschein M, Hoppe H, Vock P (2003) Low-dose multislice CT of the thorax in follow-up of malignant lymphoma and extrapulmonary primary tumors. Eur Radiol 13:1241–1249PubMed

14.

Itoh S, Ikeda M, Arahata S, Kodaira T, Isomura T, Kato T et al (2000) Lung cancer screening: minimum tube current required for helical CT. Radiology 215:175–183PubMedCrossRef

15.

Ravenel JG, Scalzetti EM, Huda W, Garrisi W (2001) Radiation exposure and image quality in chest CT examinations. AJR Am J Roentgenol 177:279–284PubMedCrossRef

16.

Yamada T, Ono S, Tsuboi M, Saito H, Sato A, Matsuhashi T et al (2004) Low-dose CT of the thorax in cancer follow-up. Eur J Radiol 51:169–174PubMedCrossRef

17.

Lee KS, Primack SL, Staples CA, Mayo JR, Aldrich JE, Muller NL (1994) Chronic infiltrative lung disease: comparison of diagnostic accuracies of radiography and low- and conventional-dose thin-section CT. Radiology 191:669–673PubMed

18.

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:S285–S295PubMedCrossRef

19.

Caironi P, Cressoni M, Chiumello D, Ranieri M, Quintel M, Russo SG et al (2010) Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med 181:578–586PubMedCrossRef

20.

Crotti S, Mascheroni D, Caironi P, Pelosi P, Ronzoni G, Mondino M et al (2001) Recruitment and derecruitment during acute respiratory failure: a clinical study. Am J Respir Crit Care Med 164:131–140PubMedCrossRef

21.

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

22.

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

23.

Chiumello D, Marino A, Cressoni M, Mietto C, Berto V, Gallazzi E et al (2013) Pleural effusion in patients with acute lung injury: a CT scan study. Crit Care Med 41:935–944PubMedCrossRef

24.

De Prost N, Dreyfuss D (2012) How to prevent ventilator-induced lung injury? Minerva Anestesiol 78:1054–1066PubMed

25.

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 243:250–257PubMedCrossRef

26.

Nishio M, Matsumoto S, Ohno Y, Sugihara N, Inokawa H, Yoshikawa T et al (2012) Emphysema quantification by low-dose CT: potential impact of adaptive iterative dose reduction using 3D processing. AJR Am J Roentgenol 199:595–601PubMedCrossRef

27.

Vecchi V, Langer T, Bellomi M, Rampinelli C, Chung KK, Cancio LC et al (2013) Low-dose CT for quantitative analysis in acute respiratory distress syndrome. Crit Care 17:R183PubMedCrossRef

28.

Reske AW, Reske AP, Gast HA, Seiwerts M, Beda A, Gottschaldt U et al (2010) Extrapolation from ten sections can make CT-based quantification of lung aeration more practicable. Intensive Care Med 36:1836–1844PubMedCrossRef

29.

Chiumello D, Marino A, Brioni M, Menga F, Cigada I, Lazzerini M et al (2013) Visual anatomical lung CT scan assessment of lung recruitability. Intensive Care Med 39:66–73PubMedCrossRef

30.

Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R et al (2012) The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 38:1573–1582PubMedCrossRef

31.

Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E et al (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533PubMed

32.

Kalra MK, Maher MM, Toth TL, Schmidt B, Westerman BL, Morgan HT et al (2004) Techniques and applications of automatic tube current modulation for CT. Radiology 233:649–657PubMedCrossRef

33.

Kubo T, Lin PJ, Stiller W, Takahashi M, Kauczor HU, Ohno Y et al (2008) Radiation dose reduction in chest CT: a review. AJR Am J Roentgenol 190:335–343PubMedCrossRef

34.

Sarma A, Heilbrun ME, Conner KE, Stevens SM, Woller SC, Elliott CG (2012) Radiation and chest CT scan examinations: what do we know? Chest 142:750–760PubMedCrossRef

35.

Austin JH, Muller NL, Friedman PJ, Hansell DM, Naidich DP, Remy-Jardin M et al (1996) Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology 200:327–331PubMed

36.

Gutierrez FR, Rossi S, Bhalla S (2006) Thorax: techniques and normal anatomy. In: Lee JKT, Sagel SS, Stanley RJ, Heiken JP (eds) Computed body tomography with MRI correlation, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 255–310

37.

Huda W, Magill D, He W (2011) CT effective dose per dose length product using ICRP 103 weighting factors. Med Phys 38:1261–1265PubMedCrossRef

38.

Wintermark M, Maeder P, Verdun FR, Thiran JP, Valley JF, Schnyder P et al (2000) Using 80 kVp versus 120 kVp in perfusion CT measurement of regional cerebral blood flow. AJNR Am J Neuroradiol 21:1881–1884PubMed

39.

Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedCrossRef

40.

Critchley LA, Critchley JA (1999) A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 15:85–91PubMedCrossRef

41.

Hanneman SK (2008) Design, analysis, and interpretation of method-comparison studies. AACN Adv Crit Care 19:223–234PubMedCentralPubMedCrossRef

42.

Lin LI (1989) A concordance correlation coefficient to evaluate reproducibility. Biometrics 45:255–268PubMedCrossRef

43.

Yuan R, Mayo JR, Hogg JC, Pare PD, McWilliams AM, Lam S et al (2007) The effects of radiation dose and CT manufacturer on measurements of lung densitometry. Chest 132:617–623PubMedCrossRef

44.

Katsura M, Matsuda I, Akahane M, Sato J, Akai H, Yasaka K et al (2012) Model-based iterative reconstruction technique for radiation dose reduction in chest CT: comparison with the adaptive statistical iterative reconstruction technique. Eur Radiol 22:1613–1623PubMedCrossRef

Title: Low-dose chest computed tomography for quantitative and visual anatomical analysis in patients with acute respiratory distress syndrome
Authors: Davide Chiumello
Thomas Langer
Vittoria Vecchi
Simone Luoni
Andrea Colombo
Matteo Brioni
Sara Froio
Irene Cigada
Silvia Coppola
Alessandro Protti
Marco Lazzerini
Luciano Gattinoni
Publication date: 01-05-2014
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 5/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3264-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Low-dose chest computed tomography for quantitative and visual anatomical analysis in patients with acute respiratory distress syndrome

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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