Journal of Applied Physiology
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J Appl Physiol 82: 1163-1176, 1997;
8750-7587/97 $5.00
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Journal of Applied Physiology
Vol. 82, No. 4, pp. 1163-1176, April 1997
GAS EXCHANGE, MECHANICS, AND AIRWAYS

Contributions of pulmonary perfusion and ventilation to heterogeneity in VA/Q measured by PET

Steven Treppo, Srboljub M. Mijailovich, and José G. Venegas

Department of Anesthesia, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02114

Received 22 March 1995; accepted in final form 12 November 1996.

Treppo, Steven, Srboljub M. Mijailovich, and José G. Venegas. Contributions of pulmonary perfusion and ventilation to heterogeneity in VA/Q measured by PET. J. Appl. Physiol. 82(4): 1163-1176, 1997. To estimate the contributions of the heterogeneity in regional perfusion (Q) and alveolar ventilation (VA) to that of ventilation-perfusion ratio (VA/Q), we have refined positron emission tomography (PET) techniques to image local distributions of Q and VA per unit of gas volume content (sQ and sVA, respectively) and VA/Q in dogs. sVA was assessed in two ways: 1) the washout of 13NN tracer after equilibration by rebreathing (sVAi), and 2) the ratio of an apneic image after a bolus intravenous infusion of 13NN-saline solution to an image collected during a steady-state intravenous infusion of the same solution (sVAp). sVAp was systematically higher than sVAi in all animals, and there was a high spatial correlation between sQ and sVAp in both body positions (mean correlation was 0.69 prone and 0.81 supine) suggesting that ventilation to well-perfused units was higher than to those poorly perfused. In the prone position, the spatial distributions of sQ, sVAp, and VA/Q were fairly uniform with no significant gravitational gradients; however, in the supine position, these variables were significantly more heterogeneous, mostly because of significant gravitational gradients (15, 5.5, and -10%/cm, respectively) accounting for 73, 33, and 66% of the corresponding coefficient of variation (CV)2 values. We conclude that, in the prone position, gravitational forces in blood and lung tissues are largely balanced out by dorsoventral differences in lung structure. In the supine position, effects of gravity and structure become additive, resulting in substantial gravitational gradients in sQ and sVAp, with the higher heterogeneity in VA/Q caused by a gravitational gradient in sQ, only partially compensated by that in sVA.

positron emission tomography; body position; gas exchange; regional ventilation-perfusion ratio; dog; pulmonary heterogeneity; functional imaging

0161-7567/97 $5.00 Copyright © 1997 the American Physiological Society




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