Postmortem inflation and fixation of human lungs: A technique for pathological and radiological correlations

Wright, Brittany M; Slavin, G; Kreel, L.; Callan, K.; Sandin, Brenda

doi:10.1136/thx.29.2.189

Cited by 31 publications

(6 citation statements)

References 5 publications

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“…Based on previously reported methods (22, 23), the 15 resected specimens were ventilated under positive pressure of 12–25 cm H 2 O for 4–10 hours with 50% formalin vapor heated to 46°C, using a diaphragm pump with an electronically controlled circuit that provided a brief exhalation (< 1 sec) every 6–8 sec. The inflation-fixed specimens were cut into 1–2 cm-thick transverse slices, and 20 paraffin-embedded tissue blocks per resected lobe and 40 per whole lung were obtained in a random manner (avoiding any tumor tissue).…”

Section: Methodsmentioning

confidence: 99%

Effects of CT Section Thickness and Reconstruction Kernel on Emphysema Quantification

et al. 2010

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Rationale and Objectives CT section thickness and reconstruction kernel each influence CT measurements of emphysema. This study was performed to assess whether their effects are related to the magnitude of the measurement. Materials and Methods Low-radiation-dose multidetector CT was performed in 21 subjects representing a wide range of emphysema severity. Images were reconstructed using 20 different combinations of section thickness and reconstruction kernel. Emphysema index values were determined as the percentage of lung pixels having attenuation lower than multiple thresholds ranging from −960 HU to −890 HU. The index values obtained from the different thickness-kernel combinations were compared by repeated measures ANOVA and Bland-Altman plots of mean vs. difference, and correlated with quantitative histology (mean linear intercept, Lm) in a subset of resected lung specimens. Results The effects of section thickness and reconstruction kernel on the emphysema index were significant (p<0.001) and diminished as the index threshold was raised. The changes in index values due to changing the thickness-kernel combination were largest for subjects with intermediate index values (10–30%), and became progressively smaller for those with lower and higher index values. This pattern was consistent regardless of the thickness-kernel combinations compared and the HU threshold used. Correlations between the emphysema index values obtained with each thickness-kernel combination and Lm ranged from r=0.55–0.68 (p=0.007–0.03). Conclusion The effects of CT section thickness and kernel on emphysema index values varied systematically with the magnitude of the emphysema index. All reconstruction techniques provided significant correlations with quantitative histology.

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Section: Methodsmentioning

confidence: 99%

Effects of CT Section Thickness and Reconstruction Kernel on Emphysema Quantification

et al. 2010

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“…Quantitative histology measurements were obtained for a whole lung from four of the transplant patients and both of the unmatched donors, and for a lobe from four of the lobectomy patients. The lungs were fixed with heated formalin vapor using a method based on previously reported techniques (20, 21). In summary, each lung or lobe was ventilated under positive pressure of 12–20 cm H 2 O with 37% formalin vapor heated to 46°C for 4–10 hours, using a diaphragm pump with an electronically controlled circuit that provided a brief exhalation (<1 sec) every 6–8 seconds.…”

Section: Methodsmentioning

confidence: 99%

Effects of diffusion time on short‐range hyperpolarized ³He diffusivity measurements in emphysema

Gierada

Woods

Bierhals

et al. 2009

Magnetic Resonance Imaging

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Purpose:To characterize the effect of diffusion time on short-range hyperpolarized 3 He magnetic resonance imaging (MRI) diffusion measurements across a wide range of emphysema severity. Materials and Methods:3 He diffusion MRI was performed on 19 lungs or lobes resected from 18 subjects with varying degrees of emphysema using three diffusion times (1.6 msec, 5 msec, and 10 msec) at constant b value. Emphysema severity was quantified as the mean apparent diffusion coefficient (ADC) and as the percentage of pixels with ADC higher than multiple thresholds from 0.30 -0.55 cm 2 /sec (ADC index). Quantitative histology (mean linear intercept) was obtained in 10 of the lung specimens from 10 of the subjects. HYPERPOLARIZED3 He magnetic resonance imaging (MRI) depicts inhaled gas within the lungs. By applying diffusion-sensitizing gradients and measuring resultant changes in 3 He signal intensity, the restricted diffusion of 3 He within the airspaces of the lung can be quantified within each pixel as an apparent diffusion coefficient (ADC). Measuring the ADC over short diffusion times (milliseconds) has been used as a means of quantifying the increase in the size of lung airspaces, which defines emphysema. The 3 He ADC distinguishes individuals with and without emphysema (1,2), and is increased in many smokers with normal pulmonary function, suggesting that it is sensitive to the early stages of emphysema (3). Studies demonstrating that the ADC correlates with computed tomography (CT) measurements of lung attenuation (4,5) and with quantitative histologic measurements of airspace size (6 -8) further support its validity for quantifying emphysema. 3 He ADC measurements also appear to have good reproducibility (9 -11). Consequently, the 3 He ADC has

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“…Previous studies have shown that fixation of the lung in inflation with heated formalin vapor preserves its microscopic architecture 11,12,31. Good correlation between subjective emphysema grading of CT scans of inflation-fixed lungs and pathologic grade has been demonstrated 32.…”

Section: Discussionmentioning

confidence: 99%

“…The lungs were fixed in inflation for 4–10 hours with heated formalin vapor using a method based on previously reported techniques 10–12. This method prevents the collection of water the lung airspaces by continuous, externally-driven ventilation of the lung.…”

Section: Methodsmentioning

confidence: 99%

“…Fixation of the lung in inflation using heated formalin vapor is a means of obtaining a histologically10–12 and radiographically11,12 accurate representation of in vivo inflated state of the lung. To our knowledge, however, the quantitative CT imaging characteristics of inflation-fixed lungs and the ability to perform 3 He MR imaging with inflation-fixed lungs have not been assessed.…”

Section: Introductionmentioning

confidence: 99%

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Emphysema Quantification in Inflation-Fixed Lungs Using Low-Dose Computed Tomography and 3He Magnetic Resonance Imaging

Gierada¹,

Woods²,

Jacob³

et al. 2010

Journal of Computer Assisted Tomography

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Objective-To evaluate the use of inflation-fixed lung tissue for emphysema quantification with CT and 3 He MR diffusion imaging.Methods-Fourteen subjects representing a range of chronic obstructive pulmonary disease severity who underwent complete or lobar lung resection were studied. CT measurements of lung attenuation and MR measurements of the hyperpolarized 3 He apparent diffusion coefficient (ADC) in resected specimens fixed in inflation with heated formalin vapor were compared with measurements obtained before fixation.Results-The mean CT emphysema index was 56% ± 17% before and 58% ± 19% after fixation (P=0.77; R=0.76). Index differences correlated with differences in lung volume (R 2 =0.47). The mean 3 He ADC was 0.40 ± 0.15 cm 2 /sec before and 0.39 ± 0.14 cm 2 /sec after fixation (P=0.03, R=0.98). The CT emphysema index and the 3 He ADC were correlated before (R=0.89) and after fixation (R=0.79).Conclusion-Concordance of CT and 3 He MR imaging measurements in unfixed and inflationfixed lungs supports the use of inflation-fixed lungs for quantitative imaging studies in emphysema.

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Postmortem inflation and fixation of human lungs: A technique for pathological and radiological correlations

Cited by 31 publications

References 5 publications

Effects of CT Section Thickness and Reconstruction Kernel on Emphysema Quantification

Effects of CT Section Thickness and Reconstruction Kernel on Emphysema Quantification

Effects of diffusion time on short‐range hyperpolarized ³He diffusivity measurements in emphysema

Emphysema Quantification in Inflation-Fixed Lungs Using Low-Dose Computed Tomography and 3He Magnetic Resonance Imaging

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Postmortem inflation and fixation of human lungs: A technique for pathological and radiological correlations

Cited by 31 publications

References 5 publications

Effects of CT Section Thickness and Reconstruction Kernel on Emphysema Quantification

Effects of CT Section Thickness and Reconstruction Kernel on Emphysema Quantification

Effects of diffusion time on short‐range hyperpolarized 3He diffusivity measurements in emphysema

Emphysema Quantification in Inflation-Fixed Lungs Using Low-Dose Computed Tomography and 3He Magnetic Resonance Imaging

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Effects of diffusion time on short‐range hyperpolarized ³He diffusivity measurements in emphysema