© 2005. The Children’s Hospital of Philadelphia. Proprietary and confidential. Do not copy.

The Effects of Secondhand Smoke in the Lung

- Hyperpolarized Helium Diffusion MRI

Chengbo Wang, PhD1, T. A. Altes, MD1,2,

G. W. Miller, PhD2, E. E. de Lange, MD2, K. Ruppert, PhD1,2,

J. F. Mata, PhD2, G. D. Cates, Jr, PhD3, J. P. Mugler, III, PhD2,4

1Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA

2Radiology, 3Physics, 4Biomedical Engineering, University of Virginia, Charlottesville, VA

Active Cigarette Smoking

15-30% of smokers develop chronic obstructive pulmonary disease (COPD)

• High morbidity & mortality

4th leading cause of death

30 Million (10%) Americans have COPD (estimated)

• Total estimated cost: $32 Billion for the US in 2002

Secondhand cigarette smoking

• Causes coronary heart disease and lung cancer

• Evidence suggests but not sufficient to prove secondhand smoke causes COPD before our study

The 2006 U.S. Surgeon General's Report on The Health Consequences of Involuntary Exposure to Tobacco Smoke

Methods to diagnose COPD

• Patient shortness of breath× not sensitive

• Pulmonary function test× not sensitive

• CT× radiation exposure

• Helium MRI (New Technique) √ none radiation exposure

Hyperpolarized Helium MRI

Conventional MRI Helium MRI

Helium Diffusion MRI

• Measures apparent diffusion coefficient (ADC)• ADC reflects the alveolar size

Emphysema

Normal alveoliNormal ADC

Healthy

Enlarged alveoliElevated ADC

COPD

ADC maps

Healthy55 yrs

COPD (Gold stage 0)70 yrs

0.06

0.04

0.02

0

Normal ADCNormal alveoli

Elevated ADCEnlarged Alveoli

•Red - > small ADC values -> good•Yellow -> large ADC values -> bad

0.06

0

Purpose

Determine whether Helium diffusion MRI detects the effects of secondhand smoke in the lungs

Subjects

60 total subjects

• 23 low exposure to secondhand smoke Negative control group 10 M, 13 F; age: 46 - 71 yrs

• 22 high exposure to secondhand smoke 3 M, 19 F; age: 41 - 79 yrs

• 15 past or active smokers Positive control group 4 M, 11 F; age: 45 - 73 yrs

Results: ADC

67%

33%73%

27%

96%

4%

P=0.047

P<0.001

(n=23) (n=22) (n=15)

Elevated

Normal

Results: ADC

Normal ADCNormal alveoli

Highly elevated ADCEnlarged Alveoli

Elevated ADCEnlarged Alveoli??

Early emphysema??

cm2/s

0.06

0.00

•Red - > small ADC values -> good•Yellow -> large ADC values -> bad

Summary

• An increased ADC has been found in: 67% of the smokers 27% of the subjects with high exposure 4% of subjects with low exposure

• This finding may reflect a response to smoking

Conclusions

• Helium diffusion MRI detects elevated ADC in subjects with high exposure to secondhand smoke

• Elevated ADC may reflect lung structural damage or subclinical emphysema

• Helium diffusion MRI may be more sensitive than other methods to detect mild emphysematous changes

Acknowledgments

CHOP Talissa A Altes, MD

Kai Ruppert, PhD

Yulin Chang, PhD

UVA• John P Mugler, III, PhD • Eduard E de Lange, MD• James R Brookeman, PhD• G Wilson Miller, PhD• Jaime Mata, PhD• Gordon D Cates, Jr, PhD

Mike Salerno, MD, PhDJing Cai, PhD

• John M Christopher, RT• Doris A Harding, RN• Joanne Gersbach, RN

Funding NHLBI: RO1- HL079077

Flight Attendant Medical Research Institute

Commonwealth of Virginia Technology Research Fund

Siemens Medical Solutions

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