Quantitative assessment of lung mechanical properties in ARDS using X-ray computed tomography

Jian Gao; Roberta Garberi; Emmanuel A. Akor; Gaetano Perchiazzi; David W. Kaczka

doi:10.1186/s40635-026-00946-w

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Quantitative assessment of lung mechanical properties in ARDS using X-ray computed tomography

Journal article

Open access

Peer reviewed

Quantitative assessment of lung mechanical properties in ARDS using X-ray computed tomography

Jian Gao, Roberta Garberi, Emmanuel A. Akor, Gaetano Perchiazzi and David W. Kaczka

Intensive care medicine experimental, Vol.14(1), 99

07/23/2026

DOI: 10.1186/s40635-026-00946-w

PMID: 42489760

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Abstract

Acute Respiratory Distress Syndrome (ARDS) is marked by spatial heterogeneity in lung structure and mechanical behavior, limiting the ability of global physiologic measurements to guide ventilatory management and prevent ventilator-induced lung injury (VILI). X-ray computed tomography (CT) has emerged as a central imaging modality for characterizing regional differences in lung aeration, deformation, and mechanical properties that underlie such heterogeneity. When combined with quantitative image processing, deformable image registration, and computational modeling, CT enables regional assessment of lung strain, recruitment, and computationally inferred estimates of regional mechanical stress in injured lungs. This review summarizes CT-based methods for the quantitative evaluation of lung mechanical properties in ARDS, including image acquisition, segmentation, aeration analysis, deformable registration, and biomechanical modeling. Experimental and translational evidence is discussed to illustrate how CT has advanced the mechanistic understanding of regional ventilation distribution and deformation patterns that contribute to VILI. Methodological limitations and translational challenges are also discussed. Emerging directions, such as portable, low-dose, and photon counting CT are considered in the context of critically ill patients and their potential use for bedside assessment of lung mechanics. Take-home Message In ARDS, lung structure and mechanics are highly heterogeneous, causing mechanical ventilation to generate uneven regional strains and stresses that are not captured by global respiratory mechanical measurements. Quantitative CT provides a regional view of lung aeration and deformation that helps explain the regional mechanisms underlying VILI. 140-character Tweet: CT imaging shows promise for quantifying regional lung mechanics in ARDS and potential risk factors for ventilator-induced lung injury.

Critical Care Medicine

Intensive

Medicine

Medicine & Public Health

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Details

Title: Subtitle: Quantitative assessment of lung mechanical properties in ARDS using X-ray computed tomography
Creators: Jian Gao - University of Iowa
Roberta Garberi - University of Iowa
Emmanuel A. Akor - University of Iowa
Gaetano Perchiazzi - Uppsala University
David W. Kaczka - University of Iowa
Resource Type: Journal article
Publication Details: Intensive care medicine experimental, Vol.14(1), 99
DOI: 10.1186/s40635-026-00946-w
PMID: 42489760
NLM abbreviation: Intensive Care Med Exp
ISSN: 2197-425X
eISSN: 2197-425X
Publisher: Springer International Publishing
Grant note: W81XWH-21-1-0507 / U.S. Department of Defense (http://dx.doi.org/10.13039/100000005) ALF-938050 and ALF-1028321 / Alvar Gullstrand Research Grant 20220681, 20230767, 20250936 / Swedish Heart and Lung Foundation T32 HL144461 / National Institutes of Health (http://dx.doi.org/10.13039/100000002)
Language: English
Date published: 07/23/2026
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Anesthesia
Record Identifier: 9985183674802771

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