Quantitative Dual-Energy Computed Tomography Supports a Vascular Etiology of Smoking-induced Inflammatory Lung Disease

Krishna S Iyer; John D Jr Newell; Dakai Jin; Matthew K Fuld; Punam K Saha; Sif Hansdottir; Eric A Hoffman

doi:10.1164/rccm.201506-1196OC

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Quantitative Dual-Energy Computed Tomography Supports a Vascular Etiology of Smoking-induced Inflammatory Lung Disease

Journal article

Open access

Peer reviewed

Quantitative Dual-Energy Computed Tomography Supports a Vascular Etiology of Smoking-induced Inflammatory Lung Disease

Krishna S Iyer, John D Jr Newell, Dakai Jin, Matthew K Fuld, Punam K Saha, Sif Hansdottir and Eric A Hoffman

American journal of respiratory and critical care medicine, Vol.193(6), pp.652-661

03/15/2016

DOI: 10.1164/rccm.201506-1196OC

PMCID: PMC4824939

PMID: 26569033

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Abstract

Endothelial dysfunction is of interest in relation to smoking-associated emphysema, a component of chronic obstructive pulmonary disease (COPD). We previously demonstrated that computed tomography (CT)-derived pulmonary blood flow (PBF) heterogeneity is greater in smokers with normal pulmonary function tests (PFTs) but who have visual evidence of centriacinar emphysema (CAE) on CT. We introduced dual-energy CT (DECT) perfused blood volume (PBV) as a PBF surrogate to evaluate whether the CAE-associated increased PBF heterogeneity is reversible with sildenafil. Seventeen PFT-normal current smokers were divided into CAE-susceptible (SS; n = 10) and nonsusceptible (NS; n = 7) smokers, based on the presence or absence of CT-detected CAE. DECT-PBV images were acquired before and 1 hour after administration of 20 mg oral sildenafil. Regional PBV and PBV coefficients of variation (CV), a measure of spatial blood flow heterogeneity, were determined, followed by quantitative assessment of the central arterial tree. After sildenafil administration, regional PBV-CV decreased in SS subjects but did not decrease in NS subjects (P < 0.05), after adjusting for age and pack-years. Quantitative evaluation of the central pulmonary arteries revealed higher arterial volume and greater cross-sectional area (CSA) in the lower lobes of SS smokers, which suggested arterial enlargement in response to increased peripheral resistance. After sildenafil, arterial CSA decreased in SS smokers but did not decrease in NS smokers (P < 0.01). These results demonstrate that sildenafil restores peripheral perfusion and reduces central arterial enlargement in normal SS subjects with little effect in NS subjects, highlighting DECT-PBV as a biomarker of reversible endothelial dysfunction in smokers with CAE.

Radiography, Dual-Energy Scanned Projection

Smoking - adverse effects

Pulmonary Emphysema - physiopathology

Humans

Middle Aged

Endothelium, Vascular - physiopathology

Male

Tomography, X-Ray Computed

Lung - diagnostic imaging

Lung - physiopathology

Pulmonary Emphysema - diagnostic imaging

Endothelium, Vascular - diagnostic imaging

Adult

Female

Details

Title: Subtitle: Quantitative Dual-Energy Computed Tomography Supports a Vascular Etiology of Smoking-induced Inflammatory Lung Disease
Creators: Krishna S Iyer - 1 Department of Biomedical Engineering
John D Jr Newell - 2 Department of Radiology
Dakai Jin - 3 Department of Electrical Engineering, and
Matthew K Fuld - 4 Siemens Medical Solutions Inc., Malvern, Pennsylvania
Punam K Saha - 3 Department of Electrical Engineering, and
Sif Hansdottir - 5 Division of Pulmonary Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa; and
Eric A Hoffman - 5 Division of Pulmonary Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa; and
Resource Type: Journal article
Publication Details: American journal of respiratory and critical care medicine, Vol.193(6), pp.652-661
DOI: 10.1164/rccm.201506-1196OC
PMID: 26569033
PMCID: PMC4824939
NLM abbreviation: Am J Respir Crit Care Med
ISSN: 1073-449X
eISSN: 1535-4970
Publisher: United States
Grant note: P30 ES005605 / NIEHS NIH HHS S10 OD018526 / NIH HHS T32 GM007337 / NIGMS NIH HHS R01 HL130883 / NHLBI NIH HHS R01 HL112986 / NHLBI NIH HHS R01HL-112986 / NHLBI NIH HHS P30 DK054759 / NIDDK NIH HHS P30 CA086862 / NCI NIH HHS 5T32-GM007337 / NIGMS NIH HHS
Language: English
Date published: 03/15/2016
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Electrical and Computer Engineering; Internal Medicine
Record Identifier: 9984051890702771

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