Hersh Craig P, Washko George R, Jacobson Francine L, Gill Ritu, Estepar Raul San Jose, Reilly John J, Silverman Edwin K
Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115, USA.
Chest. 2007 Feb;131(2):424-31. doi: 10.1378/chest.06-1040.
Appropriateness for lung volume reduction surgery is often determined based on the results of high-resolution CT (HRCT) scanning of the chest. At many centers, radiologists and pulmonary physicians both review the images, but the agreement between readers from these specialties is not known.
Two thoracic radiologists and three pulmonologists retrospectively reviewed the HRCT scans of 30 patients with emphysema involved in two clinical studies at our institution. Each reader assigned an emphysema severity score and assessed upper lobe predominance, using a methodology similar to that of the National Emphysema Treatment Trial. In addition, the percentage of emphysema at -910 Hounsfield units was objectively determined by density mask analysis.
For the emphysema severity scores, (Spearman) correlation between readers ranged from 0.59 (p = 0.0005) to 0.87 (p < 0.0001), with generally stronger correlations among readers from the same medical specialty. Emphysema severity scores were significantly correlated with prebronchodilator and postbronchodilator spirometry findings, as well as with density mask analysis. In the assessment of upper lobe predominance, kappa statistics for agreement ranged from 0.20 (p = 0.4) to 0.60 (p = 0.0008). Examining all possible radiologist-pulmonologist pairs, the two readers agreed in their assessments of emphysema distribution in 75% of the comparisons. Readers agreed on upper lobe-predominant disease in 9 of the 10 patients in which regional density mask analysis clearly showed upper lobe predominance.
In a group of patients with varying emphysema severity, interobserver agreement in the determination of upper lobe-predominant disease was poor. Agreement between readers tended to be better in cases with clear upper lobe predominance as determined by densitometry.
肺减容手术的适宜性通常根据胸部高分辨率CT（HRCT）扫描结果来确定。在许多中心，放射科医生和肺科医生都会查看图像，但这些专业的阅片者之间的一致性尚不清楚。
两名胸放射科医生和三名肺科医生回顾性分析了参与我院两项临床研究的30例肺气肿患者的HRCT扫描结果。每位阅片者使用与国家肺气肿治疗试验类似的方法，给出肺气肿严重程度评分并评估上叶优势情况。此外，通过密度掩膜分析客观确定-910亨氏单位处的肺气肿百分比。
对于肺气肿严重程度评分，阅片者之间的（斯皮尔曼）相关性在0.59（p = 0.0005）至0.87（p < 0.0001）之间，同一医学专业的阅片者之间的相关性通常更强。肺气肿严重程度评分与支气管扩张剂使用前和使用后的肺量计测量结果以及密度掩膜分析显著相关。在评估上叶优势方面，一致性的kappa统计值在0.20（p = 0.4）至0.60（p = 0.0008）之间。检查所有可能的放射科医生 - 肺科医生组合，在75%的比较中，两位阅片者对肺气肿分布的评估一致。在区域密度掩膜分析明确显示上叶优势的10例患者中，有9例阅片者对上叶优势疾病的判断一致。
在一组肺气肿严重程度不同的患者中，观察者之间对上叶优势疾病的判定一致性较差。在通过密度测定确定上叶优势明显的病例中，阅片者之间的一致性往往更好。
