New Frontiers in Functional and Molecular Imaging of the Acutely Injured Lung: Pathophysiological Insights and Research Applications

Abstract

This review focuses on the advances in the understanding of the pathophysiology of ventilator-induced and acute lung injury that have been afforded by technological development of imaging methods over the last decades. Examples of such advances include the establishment of regional lung mechanical strain as a determinant of ventilator-induced lung injury, the relationship between alveolar recruitment and overdistension, the regional vs. diffuse nature of pulmonary involvement in acute respiratory distress syndrome (ARDS), the identification of the physiological determinants of the response to recruitment interventions, and the pathophysiological significance of metabolic alterations in the acutely injured lung. Taken together, these advances portray multimodality imaging as the next frontier to both advance knowledge of the pathophysiology of these conditions and to tailor treatment to the individual patient’s condition.

Monitoring Lung Injury Severity and Ventilation Intensity during Mechanical Ventilation

“…Tomographic lung imaging (e.g., including CT, positron emission tomography [PET], and electrical impedance tomography [EIT]), magnetic resonance imaging (MRI), and lung ultrasound (LUS) provide useful data to improve strategies to prevent VILI. 241 242 As lung monitoring by lung imaging is not specifically part of this chapter, we refer—for the reader—to the most updated guidelines or leading reports detailing the potential of lung imaging in the diagnostics and in the evaluation of the lung injury severity through CT, 143 PET, 243 EIT, 244 MRI, 245 246 and LUS. 247 248…”