Effect of contrast enhancement on diagnosis of interstitial lung abnormality in automatic quantitative CT measurement

Abstract

Objective: To investigate the effect of contrast enhancement on the diagnosis of interstitial lung abnormalities (ILA) in automatic quantitative CT measurement in patients with paired pre- and post-contrast scans.

Materials and methods: Patients who underwent chest CT for thoracic surgery between April 2017 and December 2020 were retrospectively analyzed. ILA quantification was performed using deep learning-based automated software. Cases were categorized as ILA or non-ILA according to the Fleischner Society's definition, based on the quantification results or radiologist assessment (reference standard). Measurement variability, agreement, and diagnostic performance between the pre- and post-contrast scans were evaluated.

Results: In 1134 included patients, post-contrast scans quantified a slightly larger volume of nonfibrotic ILA (mean difference: -0.2%), due to increased ground-glass opacity and reticulation volumes (-0.2% and -0.1%), whereas the fibrotic ILA volume remained unchanged (0.0%). ILA was diagnosed in 15 (1.3%), 22 (1.9%), and 40 (3.5%) patients by pre- and post-contrast scans and radiologists, respectively. The agreement between the pre- and post-contrast scans was substantial (κ = 0.75), but both pre-contrast (κ = 0.46) and post-contrast (κ = 0.54) scans demonstrated moderate agreement with the radiologist. The sensitivity for ILA (32.5% vs. 42.5%, p = 0.221) and specificity for non-ILA (99.8% vs. 99.5%, p = 0.248) were comparable between pre- and post-contrast scans. Radiologist's reclassification for equivocal ILA due to unilateral abnormalities increased the sensitivity for ILA (67.5% and 75.0%, respectively) in both pre- and post-contrast scans.

Conclusion: Applying automated quantification on post-contrast scans appears to be acceptable in terms of agreement and diagnostic performance; however, radiologists may need to improve sensitivity reclassifying equivocal ILA.

Key points: Question The effect of contrast enhancement on the automated quantification of interstitial lung abnormality (ILA) remains unknown. Findings Automated quantification measured slightly larger ground-glass opacity and reticulation volumes on post-contrast scans than on pre-contrast scans; however, contrast enhancement did not affect the sensitivity for interstitial lung abnormality. Clinical relevance Applying automated quantification on post-contrast scans appears to be acceptable in terms of agreement and diagnostic performance.

Keywords: Agreement; Contrast media; Interstitial lung abnormality; Quantification; Tomography (X-ray computed).