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