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Thoracic Imaging |
1 From the Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria (A.A.B.) and the Department of Radiology, Hôpital Erasme (C.K., P.A.G.) and the Statistical Unit, Institute for Interdisciplinary Research in Human Biology and Nuclear Medicine (V.D.M.), Université Libre de Bruxelles, Belgium. Received June 22, 1998; revision requested August 8; revision received September 14; accepted December 9. Address reprint requests to A.A.B.
PURPOSE: To compare subjective visual grading of pulmonary emphysema with macroscopic morphometry and computed tomographic (CT) densitometry.
MATERIALS AND METHODS: In 62 consecutive patients who underwent thin-section CT before surgical lung resection, emphysema was objectively quantified with computer-assisted macroscopic morphometry and CT densitometry. The percentage of lung macroscopically occupied by emphysema was compared with the percentage occupied on CT scans by pixels with attenuation values lower than a predefined threshold (CT densitometry). Three readers with varying degrees of expertise subjectively graded emphysema with visual assessment at two reading sessions. Data from objective quantification and subjective grading were analyzed with correlation coefficients, and interobserver and intraobserver agreement were calculated.
RESULTS: Subjective grading of emphysema showed less agreement with the macroscopic reference standard results (r = 0.439–0.505; P < .05) than with objective CT densitometric results (r = 0.555–0.623; P < .001). The 95% CIs for the intercepts of the linear regression lines were suggestive of systematic subjective overestimation of emphysema by all three readers. Interobserver agreement was moderate (
= 0.431–0.589). Intraobserver agreement was good to excellent ( = 0.738–0.936). The expertise of individual readers did not substantially influence results.
CONCLUSION: Systematic overestimation and moderate interobserver agreement may compromise subjective visual grading of emphysema, which suggests that subjective visual grading should be supplemented with objective methods to achieve precise, reader-independent quantification of emphysema.
Index terms: Computed tomography, quantitative, 60.12111 • Emphysema, pulmonary, 60.751 • Lung, CT, 60.12111, 60.12118 • Lung, density
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