A combined pulmonary-radiology workshop for visual evaluation of COPD: study design, chest CT findings and concordance with quantitative evaluation.
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COPDGene CT Workshop Group, Barr R Graham, Berkowitz Eugene A, Bigazzi Francesca, Bode Frederick, Bon Jessica, Bowler Russell P, Chiles Caroline, Crapo James D, Criner Gerard J, Curtis Jeffrey L, Dass Chandra, Dirksen Asger, Dransfield Mark T, Edula Goutham, Erikkson Leif, Friedlander Adam, Galperin-Aizenberg Maya, Gefter Warren B, Gierada David S, Grenier Philippe A, Goldin Jonathan, Han MeiLan K, Hanania Nicola A, Hansel Nadia N, Jacobson Francine L, Kauczor Hans-Ulrich, Kinnula Vuokko L, Lipson David A, Lynch David A, MacNee William, Make Barry J, Mamary A James, Mann Howard, Marchetti Nathaniel, Mascalchi Mario, McLennan Geoffrey, Murphy James R, Naidich David, Nath Hrudaya, Newell John D, Pistolesi Massimo, Regan Elizabeth A, Reilly John J, Sandhaus Robert, Schroeder Joyce D, Sciurba Frank, Shaker Saher, Sharafkhaneh Amir, Silverman Edwin K, Steiner Robert M, Strange Charlton, Sverzellati Nicola, Tashjian Joseph H, van Beek Edwin J R, Washington Lacey, Washko George R, Westney Gloria, Wood Susan A, Woodruff Prescott G
Аннотация
METHODS: Volumetric inspiratory and expiratory CT scans of 294 subjects, including normal non-smokers, smokers without COPD, and smokers with GOLD Stage I-IV COPD, were scored at a multi-reader workshop using a standardized worksheet. There were 58 observers (33 pulmonologists, 25 radiologists); each scan was scored by 9-11 observers. Interobserver agreement was calculated using kappa statistic. Median score of visual observations was compared with QCT measurements.
RESULTS: Interobserver agreement was moderate for the presence or absence of emphysema and for the presence of panlobular emphysema; fair for the presence of centrilobular, paraseptal, and bullous emphysema subtypes and for the presence of bronchial wall thickening; and poor for gas trapping, centrilobular nodularity, mosaic attenuation, and bronchial dilation. Agreement was similar for radiologists and pulmonologists. The prevalence on CT readings of most abnormalities (e.g. emphysema, bronchial wall thickening, mosaic attenuation, expiratory gas trapping) increased significantly with greater COPD severity, while the prevalence of centrilobular nodularity decreased. Concordances between visual scoring and quantitative scoring of emphysema, gas trapping and airway wall thickening were 75%, 87% and 65%, respectively.
CONCLUSIONS: Despite substantial inter-observer variation, visual assessment of chest CT scans in cigarette smokers provides information regarding lung disease severity; visual scoring may be complementary to quantitative evaluation.