Daniel Alamidi1, Simon Kindvall2, Penny Hubbard Cristinacce3, Deirdre McGrath3, Simon Young4, Josephine Naish3, John Waterton3, Per Wollmer5, Sandra Diaz5, Marita Olsson6, Paul Hockings7,8, Kerstin Lagerstrand1, Geoffrey Parker3,9, and Lars E Olsson2
1Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 2Department of Medical Physics, Lund University, Translational Sciences, Malmö, Sweden, 3Centre for Imaging Sciences and Biomedical Imaging Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom, 4AstraZeneca R&D, Alderley Park, United Kingdom, 5Department of Translational Medicine, Lund University, Malmö, Sweden, 6AstraZeneca R&D, Mölndal, Sweden, 7Medtech West, Chalmers University of Technology, Gothenburg, Sweden, 8Antaros Medical, BioVenture Hub, Mölndal, Sweden, 9Bioxydyn Ltd, Manchester, United Kingdom
Synopsis
Tobacco smoking is the primary
cause of COPD. MRI may improve the characterization of COPD where T1 of the lungs
is a potential biomarker. We investigated whether smoking affects lung T1 in individuals
with no known lung disease. Lung T1 measurements were performed in asymptomatic
current and never smokers. T1 was shortened with age and an indication of shortened T1 in smokers
was observed that most likely reflects early signs of smoking-induced lung
pathology. Our results may be of utility to power future prospective studies
with larger cohorts and improved regional analysis. Purpose
Lung T1 is a potential MRI
biomarker of chronic obstructive pulmonary disease (COPD)
1,2 which
is commonly caused by tobacco smoking. Smoking might affect the evaluation of
lung T1 due to the
presence of paramagnetic substances trapped in the lung tissue
3 or
the subsequent lung damage. The aim for this study was to examine whether
tobacco smoking, pack years (PY), influenced T1 of the lung parenchyma in individuals with no known
lung disease, to separate the smoking effect from disease related factors.
Methods
Informed
consent was taken from 35
asymptomatic volunteers, 23 never smokers and 12 current smokers that underwent
MRI scanning and spirometry and reported physiological data. A snapshot FLASH
acquisition
4 was carried out on a 1.5 T Philips Achieva system (Philips
Medical Systems, Best, NL) during free breathing (TR=2.2 ms, TE=1.0 ms, FA=5°, FOV=445
2
mm
2, slice thickness=15 mm, matrix=64x256 (zero filled to 256x256), NA=10) and on a 1.5 T-Siemens Magnetom Avanto Fit
(Siemens Healthcare, Erlangen, Germany) during a light inspiration breath hold
over 3 seconds (TR=3 ms, TE=0.7 ms, FA=7°, FOV=450
2 mm
2, slice
thickness=15 mm, matrix=128x64 (zero filled to 256x256)). No significant
difference on T1 was found the between the systems
among the never smokers (p=0.35). Median lung T1 values were calculated by fitting the Look-Locker
equation
5 pixel-by-pixel and large pulmonary vessels were excluded in the
quantification. A backward linear model approach was used with FEV1, FVC,
weight, height, age and PY as covariates to
investigate the most important variables in determining the value of a
response on T1.
Results
The final backward regression model included age and
PY with negative slopes of -3.1 ms/year (95%CI [-5.5, -0.6], p=0.02) and -2.3
ms/PY (95%CI [-4.9, 0.3], p=0.08), respectively. The negative slope was -4.0
ms/year (95%CI [-6.3, -1.7], p=0.001) when only age was included in the model
with r=-0.52, indicating that lung T1
shortens with ageing (Fig 1). Among the never smokers, the slope of T1 as a function of age was
found to be -3.7 ms/year (95%CI [-6.0, -1.3], p=0.003).
Discussion
Lung T1 shortens with ageing and smoking did not reach significant correlation
to T1 (p=0.08).
Age is a significant confounding factor when T1 is used as a biomarker in lung MRI studies that must
be taken into account to detect underlying patterns of disease. The observed
indication with shortened T1
in the smokers (p=0.08) most likely reflects early signs of smoking-induced
lung pathology, that is not picked up by the spirometric measurements, rather
than paramagnetic substances. Structural lung changes has been found in
asymptomatic smokers with He-3 imaging
6 that correlated ADC values
and PY in asymptomatic subjects with similar smoking histories as in the
present study. Lung T1 as a biomarker needs to be validated in larger cohorts
with improved regional analysis that would increase the possibility to find a T1 relationship to PY. Our
results may be of utility to power future prospective studies and increase the
knowledge of the lung T1 relationship to tobacco smoking.
Acknowledgements
This work was
supported by AstraZeneca and Allmänna Sjukhusets i
Malmö stiftelse för bekämpande av Cancer.References
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al. JMRI 2001;14:795-799.
[5] Deichmann R and Haase A. JMRI 1992;96:608-612.
[6] Fain et al. Radiology 2006:239:875-883.