A new imaging method has revealed early signs of emphysema in smokers with no external symptoms of the disease, according to a study published in the June issue of Radiology. The study, supported by the National Institutes of Health, details a new magnetic resonance imaging (MRI) technique that appears to be much more sensitive to lung changes than even the current modality of choice, computed tomography (CT).

The researchers had 19 volunteers inhale a special kind of “hyperpolarized” helium before they performed two MRI tests of the lungs. Eleven of the volunteers were smokers with no symptoms of emphysema, and the remaining eight were nonsmokers. The first image the researchers acquired showed obstructed areas of the lungs, where the air was unable to pass. The second image they obtained is called an apparent diffusion coefficient (ADC) map, which shows the size of the airspaces in the lungs. Because emphysema increases airspace size, the ADC map shows the location and severity of the disease.

With increasing smoking history, the ADC maps showed progressive breakdown of the lung structure in all regions of the lungs. All smokers with a history greater than 18 pack-years (equivalent to one pack of cigarettes per day for 18 years) showed significant abnormalities compared to nonsmokers.

CT was performed after MRI, to allow comparison between the two modalities. Even though CT is the more established modality in the investigation of lung disease, it failed to show the same defects detected with MRI. Moreover, with the combination of MRI and hyperpolarized helium, the researchers were able to measure lung structures with 2 1/2 times more precision than with CT, and 10 times more precision than with conventional MRI methods.

Age is a significant factor in the development of emphysema-like changes. The researchers found that, in general, the airspaces in the lungs enlarge with age. However, smoking compounds the problem.