Utility of digital perfusion images of the lung in mitral stenosis: the pathophysiological significance of the distribution of pulmonary perfusion
Tanaka, T.; Kato, K.; Kawagoe, Y.; Kimata, S.; Kondo, M.; Hirosawa, K.
Journal of Cardiology 18(1): 179-187
1988
ISSN/ISBN: 0914-5087 PMID: 3265438 Document Number: 317194
The relationship between pulmonary hemodynamics (cardiac index; CI and the mean pulmonary artery wedge pressure; mPw) and the redistribution of pulmonary perfusion were studied in 300 patients with mitral stenosis using computerized Tc99m-MAA perfusion images (digital perfusion images: DPI), which consisted of isocount areas. Various types of DPI were obtained and were classified in six grades according to patterns of 100-70% of the isocount area in the right anterior DPI, i.e. grade-0 (normal), grade-1 (increased perfusion in the upper zone), grade-2 (uniform distribution), grade-3 (disappearance of the basal hyperperfusion area), grade-4 (apical hyperperfusion area) and grade-5 (decrease of perfusion at the lower zone). The mPw was thought to be one of the factors determining distribution. Thus, it was not adequate to estimate the mPw from DPI. In patients with the mPw less than 20 mmHg, an increase in perfusion at the upper zone and disappearance of the basal hyperperfusion might be noted, however, the mPw more than 20 mmHg was necessary to cause an apical hyperperfusion area. The predictive values of grades 0 and 1 for the mPw less than 20 mmHg were 70% (54/77) and those of grades 4 and 5 for the mPw less than 20 mmHg and the mPw less than 25 mmHg were 86% (110/128) and 56% (71/128), respectively.