本文采用的英格恩产品: 增强型ECL发光液
Accuracy of electrical impedance tomography to detect perfusion defects in pulmonary embolism
Affiliations
- 1 Laboratorio de Pneumologia LIM‑09, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil, SP.
- 2 Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
- 3 Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America.
- 4 Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, United States of America.
- 5 Department of Radiology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
- 6 Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, SP, Sao Paulo, Brazil.
- 7 Cardio-Pulmonary Department, Cardiovascular and Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
- 8 Cardio-Pulmonary Department, Interventional Cardiology Division, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
- 9 Unidade de Terapia Intensiva Adulto, Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, Brazil.
- 10 Institute of Physiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
- 11 Institute of Physiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic. joaobatistaborges8@gmail.com.
- 12 National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland. joaobatistaborges8@gmail.com.
- 13 Laboratorio de Pneumologia LIM‑09, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil, SP. marcelo.amato@fm.usp.br.
- 14 Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil. marcelo.amato@fm.usp.br.
- PMID: 42163364
- PMCID: PMC13224680
- DOI: 10.1186/s13054-026-06073-y
Abstract
Background: Timely detection of pulmonary embolism (PE) is crucial, particularly in critical settings where rapid confirmation or exclusion is required and computerized tomography pulmonary angiography (CTPA) poses safety challenges. We assessed the experimental and clinical accuracy of electrical impedance tomography (EIT)-ventilation-perfusion (V̇/Q̇) maps and a novel wasted-ventilation index for detecting PE.
Methods: Ten piglets underwent EIT-V̇/Q̇ mapping before and after proximal or distal pulmonary artery occlusions. EIT-perfusion maps were validated against dynamic contrast-enhanced CT (DCE-CT) and quantitative clot-burden analysis from whole-lung CTPA. To assess specificity, models of non-occlusive perfusion impairment were added (6 piglets). The wasted-ventilation index was refined across 114 piglet conditions (66 PE) and subsequently validated in 66 patients with acute respiratory failure (257 exams) and 10 patients with chronic thromboembolic disease (31 exams), totaling 288 EIT-exams.
Results: Strong positive correlations between estimates of regional perfusion obtained by EIT vs. DCE-CT or CTPA were found. Agreement showed mean bias of – 3.04 ± 3.02% between EIT and DCE-CT, and + 3.45 ± 2.81% between EIT and CTPA. The wasted-ventilation index performed with AUC = 0.989 in animals (P < 0.0001; sensitivity 96%, specificity 94%) and AUC = 0.923 in patients (P < 0.001; sensitivity 81%, specificity 94%). The index consistently decreased after thrombolysis.
Conclusions: The novel wasted-ventilation index showed high accuracy in detecting pulmonary arterial occlusions of varying severity, distinguishing them from other perfusion problems. Its agreement with CTPA, DCE-CT, and reference methods supports EIT-V̇/Q̇ mapping as a reliable diagnostic aid when conventional imaging is unfeasible or risky.
Keywords: Bedside monitoring; Critical care; Electrical impedance tomography; Pulmonary embolism; Pulmonary perfusion; Ventilation–perfusion mismatch.
