深入了解急性呼吸窘迫综合征：高级影像学技术的作用。
Looking closer at acute respiratory distress syndrome: the role of advanced imaging techniques.
机构信息
aDepartment of Medicine and Surgery, University of Milan-Bicocca bDepartment of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy cMultidisciplinary Intensive Care Unit, Department of Anesthesia and Critical Care, Pitie-Salpêtrière Hospital, Assistance Publique Hopitaux de Paris, University School of Medicine Pierre and Marie Curie, UPMC (University Paris-6), Paris dIntensive Care Unit, Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont Université, Université d'Auvergne, France eDipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico and Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
出版信息
Curr Opin Crit Care. 2017 Feb;23(1):30-37. doi: 10.1097/MCC.0000000000000380.
PURPOSE OF REVIEW
Advanced imaging techniques have provided invaluable insights in understanding of acute respiratory distress syndrome (ARDS) and the effect of therapeutic strategies, thanks to the possibility of gaining regional information and moving from simple 'anatomical' information to in-vivo functional imaging.
RECENT FINDINGS
Computed tomography (CT) led to the understanding of several ARDS mechanisms and interaction with mechanical ventilation. It is nowadays frequently part of routine diagnostic workup, often leading to treatment changes. Moreover, CT is a reference for novel techniques both in clinical and preclinical studies. Bedside transthoracic lung ultrasound allows semiquantitative regional analysis of lung aeration, identifies ARDS lung morphology and response to therapeutic maneuvers. Electrical impedance tomography is a radiation-free, functional, bedside, imaging modality which allows a real-time monitoring of regional ventilation. Finally, positron emission tomography (PET) is a functional imaging technique that allows to trace physiologic processes, by administration of a radioactive molecule. PET with FDG has been applied to patients with ARDS, thanks to its ability to track the inflammatory cells activity.
SUMMARY
Progresses in lung imaging are key to individualize therapy, diagnosis, and pathophysiological mechanism at play in any patient at any specified time, helping to move toward personalized medicine for ARDS.
目的综述
高级影像学技术通过提供区域性信息，从单纯的“解剖学”信息转变为体内功能成像，为理解急性呼吸窘迫综合征（ARDS）和治疗策略的效果提供了宝贵的见解。
最近的发现
计算机断层扫描（CT）有助于了解几种 ARDS 发病机制和与机械通气的相互作用。如今，它经常作为常规诊断的一部分，经常导致治疗方式的改变。此外，CT 是临床和临床前研究中新型技术的参考标准。床边经胸肺超声允许对肺充气进行半定量的区域性分析，识别 ARDS 肺形态和对治疗措施的反应。电阻抗断层成像（EIT）是一种无辐射的、功能性的、床边成像方式，可实时监测区域性通气。最后，正电子发射断层扫描（PET）是一种功能成像技术，通过放射性分子的给药来追踪生理过程。FDG-PET 已应用于 ARDS 患者，因为它能够追踪炎症细胞的活性。
总结
肺部成像的进展是实现个体化治疗、诊断和发病机制的关键，有助于在任何特定时间对任何患者进行个体化治疗，为 ARDS 迈向个体化医学奠定了基础。
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