Regional changes in extravascular lung water detected by positron emission tomography

Regional measurements of extravascular lung water (rEVLW) were made with positron emission tomography (PET) and 15O-labeled radionuclides. The label used to measure the total lung water (TLW) content fully equilibrated with TLW prior to scanning in both dogs with normal and low cardiac outputs, and nearly so in areas of lung made edematous by oleic acid injury (the TLW values used were 97% of maximum values). Regional EVLW measurements made by PET (EVLW-PET) and gravimetric techniques in both normal and edematous lung were closely correlated (r = 0.93), and EVLW-PET increased from an average of 0.20 to 0.37 mlH2O/ml lung (P less than 0.05) after regional lung injury. PET measurements of regional blood volume always decreased [from an average of 0.12 to 0.09 ml blood/ml lung (P less than 0.05)] after cardiac output was lowered by hemorrhage in a separate set of animals. Total EVLW (by thermodye indicator dilution) did not change. Likewise, regional EVLW remained constant in areas below the left atrium but decreased in areas above the left atrium. We conclude that PET measurements are accurate, noninvasive, and reproducible and that regional changes may be detected even when measurements of total EVLW by other methods may fail to change significantly.