Mascalchi Mario, Diciotti Stefano, Sverzellati Nicola, Camiciottoli Gianna, Ciccotosto Cesareo, Falaschi Fabio, Zompatori Maurizio
Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Italy.
Acta Radiol. 2012 Feb 1;53(1):53-60. doi: 10.1258/ar.2011.110419. Epub 2011 Nov 23.
Multidetector spiral computed tomography (CT) has opened the possibility of quantitative evaluation of emphysema extent in the whole lung. Visual assessment can be used for such a purpose, but its reproducibility has not been established.
To assess agreement of detailed assessment of pulmonary emphysema on whole-lung CT using a visual scale.
Thirty patients with chronic obstructive pulmonary disease underwent whole-lung inspiratory CT. Four chest radiologists rated the same 22 ± 2 thin sections using a visual scale which defines a range of emphysema extent between 0 and 100. Two of them repeated the rating two months later. Inter- and intra-operator agreement was evaluated with the Bland and Altman method. In addition, the percentage of emphysema at -950 Hounsfield units in the whole lung was determined using fully automated commercially available software for 3D densitometry.
In three of six operator pairs and in one of two intra-operator pairs the Kendall τ test showed a significant correlation between the difference and the average magnitude of visual scores. Among different operators the half-width of 95% limits of agreement (95% LoA) was wide ranging between a score of 14.2-27.7 for an average visual score of 20 and between 18.5-36.8 for an average visual score of 80. Within the same operator the half-width of 95% LoA ranged between a score of 10.9-21.0 for an average visual score of 20 and between 25.1-30.1 for an average visual score of 80. The visual scores of the four radiologists were correlated with the results of densitometry (P < 0.001; r = 0.65-0.81).
The inter- and intra-operator agreement of detailed assessment of emphysema in the whole lung using a visual scale is low and decreases with increasing emphysema extent.
多排螺旋计算机断层扫描（CT）开启了对全肺肺气肿范围进行定量评估的可能性。视觉评估可用于此目的，但其可重复性尚未得到证实。
使用视觉量表评估全肺CT上肺气肿详细评估的一致性。
30例慢性阻塞性肺疾病患者进行全肺吸气CT扫描。四位胸部放射科医生使用视觉量表对相同的22±2层薄层图像进行评分，该量表将肺气肿范围定义为0至100。其中两位医生在两个月后重复评分。采用Bland和Altman方法评估不同医生之间以及同一医生内部的一致性。此外，使用全自动商用三维密度测定软件确定全肺-950亨氏单位处的肺气肿百分比。
在六组不同医生的配对中，有三组以及同一医生内部的两组配对中的一组，Kendall τ检验显示差异与视觉评分的平均幅度之间存在显著相关性。在不同医生之间，一致性界限（95% LoA）的半宽范围较宽，平均视觉评分为20分时，半宽在14.2 - 27.7分之间；平均视觉评分为80分时，半宽在18.5 - 36.8分之间。在同一医生内部，平均视觉评分为20分时，95% LoA的半宽在10.9 - 21.0分之间；平均视觉评分为80分时，半宽在25.1 - 30.1分之间。四位放射科医生的视觉评分与密度测定结果相关（P < 0.001；r = 0.65 - 0.81）。
使用视觉量表对全肺肺气肿进行详细评估时，不同医生之间以及同一医生内部的一致性较低，且随着肺气肿程度的增加而降低。
