Division of Radiology, National Jewish Health, Denver, CO 80206, USA.
COPD. 2012 Apr;9(2):151-9. doi: 10.3109/15412555.2012.654923. Epub 2012 Mar 19.
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.
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.
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.
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.
本研究旨在描述正常不吸烟者和 COPD 吸烟者的胸部 CT 表现，比较 CT 异常与 COPD 严重程度的相关性，并评估 CT 目测评分与定量分析的一致性。
在多读者研讨会上，对 294 例患者（包括正常不吸烟者、无 COPD 的吸烟者和 GOLD Ⅰ-IV 期 COPD 吸烟者）的吸气和呼气容积 CT 扫描进行了评分，使用标准化工作表进行评分。共有 58 名观察者（33 名肺病专家，25 名放射科医生），每个扫描由 9-11 名观察者评分。采用κ统计量计算观察者间的一致性。比较目测评分中位数与 QCT 测量值。
观察者间对肺气肿的有无、全小叶肺气肿的有无、中央型肺气肿、间隔旁型肺气肿和大疱型肺气肿的存在与否的判断具有中等一致性，对支气管壁增厚、气腔实变、中央型结节和支气管扩张的判断具有较差一致性。放射科医生和肺病专家的判断结果相似。大多数异常（如肺气肿、支气管壁增厚、马赛克衰减、呼气性气体陷闭）在 CT 读片上的发生率随 COPD 严重程度的增加而显著增加，而中央型结节的发生率则降低。肺气肿、气腔实变和气道壁增厚的目测评分与定量评分之间的一致性分别为 75%、87%和 65%。
尽管存在较大的观察者间差异，但对吸烟人群的胸部 CT 扫描进行目测评估可提供有关肺部疾病严重程度的信息；目测评分可能与定量评估互补。
