Can hyperpolarized xenon-129 MRI change lung disease care for smokers?

Using hyperpolarized xenon-129 (HXe) MR imaging, clinicians can better detect early lung disease in smokers before it progresses to chronic obstructive pulmonary disease (COPD), according to a Dec. 3 study published in Academic Radiology.

In the study, researchers used hyperpolarized xenon-129 MR spectroscopy to evaluate functional alveolar wall thickness in healthy smokers, hypothesizing the thickness would be elevated in the healthy cohort before xenon MR diffusion revealed emphysema-destroyed tissue.

“Smoking is a factor crucial to the development of pulmonary emphysema; however, there are no current prognostic tools to determine which smokers will develop emphysema or have progression,” wrote first author Kai Ruppert of the department of radiology at the University of Pennsylvania in Philadelphia, and colleagues.

Using the prognostic tool HXe MR, Ruppert et al. measured functional septal wall thickness and apparent diffusion coefficient of the gas phase in 16 patients with smoking-related COPD, nine healthy current or former smokers and 10 participants who had never smoked. Eleven datasets from young healthy smokers was added to generate the age dependence of the septal wall thickness measurements.

They found septal wall thickness increased by 0.04 micrometers (μm) per year of age in those who had never smoked. Never smokers also showed normal pulmonary function measures similar to the healthy smokers group. Additionally, age-corrected septal wall thickness corresponded well with diffusion capacity for carbon monoxide, while also showing “significant” differences between healthy patients and those with COPD.

“In conclusion, our cross-sectional study suggests great potential of functional septal wall thickness measurements for detecting early stages of lung disease but future studies will have to show whether this technique can be used to more sensitively classify the risk for developing emphysematous lung tissue destruction,” the authors concluded. “It might be of particular interest to perform longitudinal studies to investigate if healthy smokers with thicker septal walls are more likely to develop emphysema in the future.”