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We sought to test the hypothesis, via multidetector row CT (MDCT) perfusion imaging, that smokers showing early signs of emphysema susceptibility have a greater heterogeneity in regional perfusion parameters than emphysema-free smokers and persons who had never smoked (NS). Assuming that all smokers have a consistent inflammatory response, increased perfusion heterogeneity in emphysema-susceptible smokers would be consistent with the notion that these subjects may have the inability to block hypoxic vasoconstriction in patchy, small regions of inflammation. Dynamic ECG-gated MDCT perfusion scans with a central bolus injection of contrast were acquired in 17 NS, 12 smokers with normal CT imaging studies (SNI), and 12 smokers with subtle CT findings of centrilobular emphysema (SCE). All subjects had normal spirometry. Quantitative image analysis determined regional perfusion parameters, pulmonary blood flow (PBF), and mean transit time (MTT). Mean and coefficient of variation were calculated, and statistical differences were assessed with one-way ANOVA. MDCT-based MTT and PBF measurements demonstrate globally increased heterogeneity in SCE subjects compared with NS and SNI subjects but demonstrate similarity between NS and SNI subjects. These findings demonstrate a functional lung-imaging measure that provides a more mechanistically oriented phenotype that differentiates smokers with and without evidence of emphysema susceptibility.<\/jats:p>","DOI":"10.1073\/pnas.0913880107","type":"journal-article","created":{"date-parts":[[2010,4,5]],"date-time":"2010-04-05T20:35:31Z","timestamp":1270499731000},"page":"7485-7490","update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":99,"title":["Heterogeneity of pulmonary perfusion as a mechanistic image-based phenotype in emphysema susceptible smokers"],"prefix":"10.1073","volume":"107","author":[{"given":"Sara K.","family":"Alford","sequence":"first","affiliation":[{"name":"Departments of aRadiology,"},{"name":"Biomedical Engineering, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin J. 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