title: Imaging in acute respiratory distress syndrome.
abstract: OBJECTIVE
  Imaging has become increasingly important across medical specialties for diagnostic, monitoring, and investigative purposes in acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  This review addresses the use of imaging techniques for the diagnosis and management of ARDS as well as gaining knowledge about its pathogenesis and pathophysiology. The techniques described in this article are computed tomography, positron emission tomography, and two easily accessible imaging techniques available at the bedside-ultrasound and electrical impedance tomography (EIT).
  
  
  RESULTS
  The use of computed tomography has provided new insights into ARDS pathophysiology, demonstrating that ARDS does not homogeneously affect the lung parenchyma and that lung injury severity is widely distributed in the ARDS population. Positron emission tomography is a functional imaging technique whose value resides in adding incremental insights to morphological imaging. It can quantify regional perfusion, ventilation, aeration, lung vascular permeability, edema, and inflammation. Lung ultrasound and EIT are radiation-free, noninvasive tools available at the bedside. Lung ultrasound can provide useful information on ARDS diagnosis when x-rays or CT scan are not available. EIT is a useful tool to monitor lung ventilation and to assess the regional distribution of perfusion.
  
  
  CONCLUSIONS
  The future of imaging in critical care will probably develop in two main directions: easily accessible imaging techniques that can be used at the bedside and sophisticated imaging methods that will be used to aid in difficult diagnostic cases or to advance our understanding of the pathogenesis and pathophysiology of an array of critical illnesses.
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. antonio.pesenti@unimi.it.|Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy. antonio.pesenti@unimi.it.
authors.forename: Antonio
authors.identifier: http://orcid.org/0000-0003-2593-729X
authors.initials: A
authors.lastname: Pesenti
authors.affiliation: Department of Anesthesiology, Washington University and General Anesthesiology, Barnes Jewish Hospital, St. Louis, USA.
authors.forename: Guido
authors.initials: G
authors.lastname: Musch
authors.affiliation: Medical ICU, Hospital Ambroise-Pare, Paris-West University, Nanterre, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lichtenstein
authors.affiliation: Anesthesia and Intensive Care, Emergency Department, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.|Anesthesia, Intensive Care and Pain Therapy, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mojoli
authors.affiliation: Respiratory Intensive Care Unit, University of Sao Paulo School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Marcelo B P
authors.initials: MBP
authors.lastname: Amato
authors.affiliation: Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy.
authors.forename: Gilda
authors.initials: G
authors.lastname: Cinnella
authors.affiliation: Department of Anesthesiology, Emergency and Intensive Care Medicine, Georg-August University of Göttingen, Göttingen, Germany.
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
authors.affiliation: Department of Anesthesiology, Emergency and Intensive Care Medicine, Georg-August University of Göttingen, Göttingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Quintel
mesh_terms: D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006801:Humans; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Acute respiratory distress syndrome; Computed tomography; Electrical impedance tomography; Lung ultrasound; Positron emission tomography