title: Alterations of regional alveolar oxygen tension in asymptomatic current smokers: assessment with hyperpolarized (3)He MR imaging.
abstract: OBJECTIVE
  To assess the ability of helium 3 ((3)He) magnetic resonance (MR) imaging of regional alveolar partial pressure of oxygen (Pao2) to depict smoking-induced functional alterations and to compare its efficacy to that of current diagnostic techniques.
  
  
  METHODS
  This study was approved by the local institutional review board and was compliant with HIPAA. All subjects provided informed consent. A total of 43 subjects were separated into three groups: nonsmokers, asymptomatic smokers, and symptomatic smokers. All subjects underwent a Pao2 imaging session followed by clinically standard pulmonary function tests (PFTs), the 6-minute walk test, and St George Respiratory Questionnaire (SGRQ). The whole-lung mean and standard deviation of Pao2 were compared with metrics derived from PFTs, the 6-minute walk test, and the SGRQ. A logistic regression model was developed to identify the predictors of alterations to the lungs of asymptomatic smokers.
  
  
  RESULTS
  The whole-lung standard deviation of Pao2 correlated with PFT metrics (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC], Pearson r = -0.69, P < .001; percentage predicted FEV1, Pearson r = -0.67, P < .001; diffusing capacity of lung for carbon monoxide [Dlco], Pearson r = -0.45, P = .003), SGRQ score (Pearson r = 0.67, P < .001), and distance walked in 6 minutes (Pearson r = -0.47, P = .002). The standard deviation of Pao2 was significantly higher in asymptomatic smokers than in nonsmokers (change in the standard deviation of Pao2 = 7.59 mm Hg, P = .041) and lower when compared with symptomatic smokers (change in the standard deviation of Pao2 = 10.72 mm Hg, P = .001). A multivariate prediction model containing FEV1/FVC and the standard deviation of Pao2 (as significant predictors of subclinical changes in smokers) and Dlco (as a confounding variable) was formulated. This model resulted in an area under the receiver operating characteristic curve with a significant increase of 29.2% when compared with a prediction model based solely on nonimaging clinical tests.
  
  
  CONCLUSIONS
  The (3)He MR imaging heterogeneity metric (standard deviation of Pao2) enabled the differentiation of all three study cohorts, which indicates that it can depict smoking-related functional alterations in asymptomatic current smokers.
authors.affiliation: From the Department of Radiology (H.H., S.J.K., M.I., Y.X., K.E., B.H., H.S., D.G., W.G., R.R.R.), Department of Anesthesiology and Critical Care (M.C.), and Pulmonary, Allergy and Critical Care Division (M.D.R.), University of Pennsylvania, 308 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104.
authors.forename: Hooman
authors.initials: H
authors.lastname: Hamedani
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kadlecek
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishii
authors.forename: Yi
authors.initials: Y
authors.lastname: Xin
authors.forename: Kiarash
authors.initials: K
authors.lastname: Emami
authors.forename: Biao
authors.initials: B
authors.lastname: Han
authors.forename: Hoora
authors.initials: H
authors.lastname: Shaghaghi
authors.forename: Diana
authors.initials: D
authors.lastname: Gopstein
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cereda
authors.forename: Warren B
authors.initials: WB
authors.lastname: Gefter
authors.forename: Milton D
authors.initials: MD
authors.lastname: Rossman
authors.forename: Rahim R
authors.initials: RR
authors.lastname: Rizi
mesh_terms: D005260:Female; D006371:Helium; D006801:Humans; D007554:Isotopes; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000502:physiology*; D010313:Partial Pressure; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D012129:Respiratory Function Tests; D012907:Smoking / Q000503:physiopathology*
chemical_list: D007554:Isotopes; D006371:Helium; D010100:Oxygen