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. 2012 Apr;9(2):151-9.
doi: 10.3109/15412555.2012.654923. Epub 2012 Mar 19.

A combined pulmonary-radiology workshop for visual evaluation of COPD: study design, chest CT findings and concordance with quantitative evaluation

COPDGene CT Workshop Group  1 ; R Graham Barr, Eugene A Berkowitz, Francesca Bigazzi, Frederick Bode, Jessica Bon, Russell P Bowler, Caroline Chiles, James D Crapo, Gerard J Criner, Jeffrey L Curtis, Chandra Dass, Asger Dirksen, Mark T Dransfield, Goutham Edula, Leif Erikkson, Adam Friedlander, Maya Galperin-Aizenberg, Warren B Gefter, David S Gierada, Philippe A Grenier, Jonathan Goldin, MeiLan K Han, Nicola A Hanania, Nadia N Hansel, Francine L Jacobson, Hans-Ulrich Kauczor, Vuokko L Kinnula, David A Lipson, David A Lynch, William MacNee, Barry J Make, A James Mamary, Howard Mann, Nathaniel Marchetti, Mario Mascalchi, Geoffrey McLennan, James R Murphy, David Naidich, Hrudaya Nath, John D Newell Jr, Massimo Pistolesi, Elizabeth A Regan, John J Reilly, Robert Sandhaus, Joyce D Schroeder, Frank Sciurba, Saher Shaker, Amir Sharafkhaneh, Edwin K Silverman, Robert M Steiner, Charlton Strange, Nicola Sverzellati, Joseph H Tashjian, Edwin J R van Beek, Lacey Washington, George R Washko, Gloria Westney, Susan A Wood, Prescott G Woodruff
Affiliations

A combined pulmonary-radiology workshop for visual evaluation of COPD: study design, chest CT findings and concordance with quantitative evaluation

COPDGene CT Workshop Group et al. COPD. 2012 Apr.

Abstract

The purposes of this study were: to describe chest CT findings in normal non-smoking controls and cigarette smokers with and without COPD; to compare the prevalence of CT abnormalities with severity of COPD; and to evaluate concordance between visual and quantitative chest CT (QCT) scoring.

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.

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Conflict of interest statement

Declaration of Interest

The authors report no conflict of interest relevant to this publication, with the exception of the funding support indicated on the title page.

Figures

Fig. 1
Fig. 1
(a) Axial CT image in a subject with GOLD Stage 1 COPD, where reviewers scored visual emphysema, but quantitative % of emphysema was less than 1%. CT shows mild centrilobular emphysema, which did not reach the quantitative threshold for emphysema. (b) Axial CT image in a subject with GOLD Stage 1 COPD where reviewers scored no visual emphysema, but quantitative % of emphysema was 18%. Close inspection shows multiple small foci of decreased attenuation adjacent to vessels which may either represent dilated peripheral airways or very early emphysema.
Fig. 1
Fig. 1
(a) Axial CT image in a subject with GOLD Stage 1 COPD, where reviewers scored visual emphysema, but quantitative % of emphysema was less than 1%. CT shows mild centrilobular emphysema, which did not reach the quantitative threshold for emphysema. (b) Axial CT image in a subject with GOLD Stage 1 COPD where reviewers scored no visual emphysema, but quantitative % of emphysema was 18%. Close inspection shows multiple small foci of decreased attenuation adjacent to vessels which may either represent dilated peripheral airways or very early emphysema.
Fig. 2
Fig. 2
Axial CT image in a non-smoking, physiologically normal subject, where reviewers scored visual gas trapping, but quantitative % of gas trapping was only 11%. CT shows relatively mild multilobular gas trapping, which did not reach the quantitative threshold for gas trapping.
Fig. 3
Fig. 3
(a) Axial CT image in a subject with GOLD Stage 1 COPD, where reviewers scored visual bronchial wall thickening, but wall area % of segmental bronchi was 55%. CT shows evidence of thickening of the bronchial walls, but associated moderate dilation of the bronchial lumens resulted in normalization of the wall area % value. (b) Axial CT image in a smoking control subject where reviewers scored no bronchial wall thickening, but wall area % of segmental bronchi was 63%. Although the bronchial walls appear visually normal, the bronchial lumens are relatively small, and this might have resulted in artificial elevation of the wall area % value.
Fig. 3
Fig. 3
(a) Axial CT image in a subject with GOLD Stage 1 COPD, where reviewers scored visual bronchial wall thickening, but wall area % of segmental bronchi was 55%. CT shows evidence of thickening of the bronchial walls, but associated moderate dilation of the bronchial lumens resulted in normalization of the wall area % value. (b) Axial CT image in a smoking control subject where reviewers scored no bronchial wall thickening, but wall area % of segmental bronchi was 63%. Although the bronchial walls appear visually normal, the bronchial lumens are relatively small, and this might have resulted in artificial elevation of the wall area % value.
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