Does hyperexpansion of the native lung adversely affect outcome after single lung transplantation for emphysema? Preliminary findings.

RATIONALE AND OBJECTIVES: The authors evaluated the effect of the native emphysematous lung on graft function after single lung transplantation. MATERIALS AND METHODS: Thirty-two patients who underwent single lung transplantation were examined with radiography preoperatively for degree of emphysema and postoperatively for hyperexpansion of the native lung. All patients underwent ventilation-perfusion scanning before transplantation and ventilation scanning after transplantation. Pulmonary function tests and measurement of arterial partial pressure of oxygen were also measured before and after surgery. The postoperative course was graded on a subjective scale. RESULTS: Hyperexpansion of the native lung was seen in 16 of the 32 patients in the postoperative period. On the basis of serial measurements of forced expiratory volume in 1 minute, these patients fared poorly in the postoperative period compared with patients without hyperexpansion. Pulmonary blood flow to the native lung, as measured with perfusion scintigraphy, paradoxically increased in 11 patients after transplantation. Nine of these 11 patients demonstrated hyperinflation of the native lung, suggesting that graft compression adversely affects blood flow to the transplanted lung. CONCLUSION: Hyperexpansion of the native lung after single lung transplantation for emphysema may have a deleterious effect on graft function and possibly on clinical outcome.

Radiologic diagnosis of extrathoracic metastases to the lung.

Because many types of cancers metastasize to the lungs, early detection may affect both tumor staging and treatment planning. On the other hand, it is also important to refrain from subjecting patients to procedures that are unnecessary because of the low likelihood of positive yield. The radiologic modalities of greatest benefit in screening for pulmonary metastases are the standard chest radiograph and thoracic computed tomography (CT). Other modalities that may be of value in answering specific questions are positron emission tomography (PET) and magnetic resonance imaging (MRI). Factors that help determine which tests will be most useful in demonstrating pulmonary metastasis from extrathoracic primary tumors include the mechanisms of hematogenous tumor spread, the likelihood of distant metastasis vs spread to nearby nodal groups, and the probability of distant metastasis in the absence of local invasion.

The General Electric-Association of University Radiologists Radiology Research Academic Fellowship (GERRAF). An industry-academic collaboration to improve clinical research in radiology.

The association of GE Medical Systems and the AUR represents a unique collaboration between academic radiology and industry that bears important potential for elevating the quality of clinical research in radiology and developing a cadre of high-quality radiologist researchers for the future. The establishment of the GERRAF is especially timely given the new imperatives of the rapidly changing health care environment, with its emphasis on expenditure reduction. The ultimate goals of GERRAF are to develop research leaders for radiology that will provide guidance for appropriate clinical practice, better train future researchers, and secure the role of radiologists in caring for patients.

Activities of the Conjoint Committee. Enhancement of diagnostic radiologic research and education.

Even though we have made much progress over the last decade, much still needs to be done. I am personally very pleased with the excellent management and authority of my coauthor, Joe Frank, in assuming the Acting Directorship of our DRRP. You will be hearing more from him in the immediate future about this research program, and he will be accessible to all of you, both individually and at our national meetings. We must continue to recruit representatives to fill responsible positions at the NIH, including Director for the DRRP at the National Cancer Institute. Further funding for equipment and personnel within the Diagnostic Radiology Research Laboratory also will be necessary. We are anticipating that the annual laboratory budget will increase further, but to provide additional resources, the Conjoint Committee plans to take an active role in encouraging foundations, corporations, and member societies to assist further with this effort. Most of the other disciplines within medicine--in fact, many individuals in your own medical school within other departments--have spent time at the NIH. It is this high-quality experience, in an environment that can provide both the research background and the cultivated personal relationships and interactions, that will foster a long-term research career. Clearly, the complementary role of both the intramural and extramural programs will allow diagnostic radiology to achieve excellence and true respect in the total research community of the Academy. Many people have been responsible for our success, and I have already mentioned a few.(ABSTRACT TRUNCATED AT 250 WORDS)

Fostering research by radiologists: recommendations of the 1991 Summit meeting.

At the annual Radiology Summit Meeting sponsored by the Intersociety Commission of the American College of Radiology, leaders of U.S. and Canadian radiologic organizations met in part to discuss ways to improve radiology research. Support by radiology departments and radiologic organizations is currently not sufficient to improve the research of the specialty. Five issues of central importance to improving research are (a) the need for a definition of radiology research, (b) a lack of financial resources, (c) a lack of mentors, (d) hesitancy to embark on a research career, and (e) conflicts between clinicians and researchers. The adoption of 31 recommendations regarding these five issues was urged.

Sarcoidosis: correlation of pulmonary parenchymal pattern at CT with results of pulmonary function tests.

The appearances of the lungs on radiographs and computed tomographic (CT) scans were correlated with degree of uptake on gallium scans and results of pulmonary function tests (PFTs) in 27 patients with sarcoidosis. CT scans were evaluated both qualitatively and quantitatively. Patients were divided into five categories on the basis of the pattern of abnormality at CT: 1 = normal (n = 4); 2 = segmental air-space disease (n = 4); 3 = spherical (alveolar) masslike opacities (n = 4); 4 = multiple, discrete, small nodules (n = 6); and 5 = distortion of parenchymal structures (fibrotic end-stage sarcoidosis) (n = 9). The percentage of the volume judged to be abnormal (CT grade) was correlated with PFT results for each CT and radiographic category. CT grades were also correlated with gallium scanning results and percentage of lymphocytes recovered from bronchoalveolar lavage (BAL). Patients in CT categories 1 and 2 had normal lung function, those in category 3 had mild functional impairment, and those in categories 4 and 5 showed moderate to severe dysfunction. The overall CT grade correlated well with PFT results expressed as a percentage of the predicted value. In five patients, CT scans showed extensive parenchymal disease not seen on radiographs. CT grades did not correlate with the results of gallium scanning or BAL lymphocytes. The authors conclude that patterns of parenchymal sarcoidosis seen at CT correlate with the PFT results and can be used to indicate respiratory impairment.

Work in progress: in vitro analysis of pleural fluid analogs by proton magnetic resonance. Preliminary studies at 1.5T.

To test the potential of 1.5 Tesla magnetic resonance imaging (MRI) for assessing the protein concentration of pleural effusions, five pleural fluid analogs (saline + 0, 2, 4, 6, 8 g albumin/100 mL) and, for comparison, four saline dilutions of whole blood were evaluated in vitro. The relaxation rates (1/T1, 1/T2) of albumin solutions were determined by 1.5 T spectroscopy (MRS) and correlated with albumin concentration (1/T1:slope 0.02, r + 0.89, P less than .05; 1/T2: slope 0.16, r = 0.997, P less than .001). MRI studies of these solutions showed no significant correlation with 1/T1, but 1/T2 showed a positive correlation with albumin concentration (r = 0.98, P less than .01). Both MRI relaxation rates were significantly correlated with blood concentration, and slopes were greater than for albumin solutions. These preliminary studies, demonstrating differences in correlation between relaxation rates and the concentration of albumin and blood, suggest that MRI has the potential for differentiating pleural effusions of different chemical composition.