Muehlematter Urs J, Caviezel Claudio, Martini Katharina, Messerli Michael, Vokinger Kerstin N, Wetzler Iris R, Tutic-Horn Michaela, Weder Walter, Frauenfelder Thomas
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
J Thorac Dis. 2019 Mar;11(3):766-776. doi: 10.21037/jtd.2019.02.36.
Adequate patient selection is the key to successful lung volume reduction in patients with pulmonary emphysema. Computed tomography (CT) enables a reliable detection of pulmonary emphysema and allows an accurate quantification of the severity. Our goal was to investigate the usefulness and reliability of color-coded (CC) CT images in classification of emphysema and preoperative lung volume reduction planning.
Fifty patients undergoing lung volume reduction surgery at our institution between September 2015 and February 2016 were retrospectively investigated. Three readers visually assessed the amount and distribution patterns of pulmonary emphysema on axial, multi-planar and CC CT images using the Goddard scoring system and a surgically oriented grading system (bilateral markedly heterogenous, bilateral intermediately heterogenous, bilateral homogenous and unilateral heterogenous emphysema). Observer dependency was investigated by using Fleiss' kappa (κ) and the intraclass correlation coefficient (ICC). Results were compared to quantitative results from densitometry measurements and lung perfusion scintigraphy by using Spearman correlation. Recommendations for lung volume reduction sites based on emphysema amount and distribution of all readers were compared to removal sites from the surgical reports.
Inter-rater agreement for emphysema distribution rating was substantial for CC images (κ=0.70; 95% CI, 0.64-0.80) and significantly better compared to axial and multiplanar images (P≤0.001). The inter-rater agreement for recommended segment removal was moderate for CC images (κ=0.56; 95% CI, 0.49-0.63) and significantly better compared to axial and multiplanar images (P<0.001). Visual emphysema rating correlated significantly with measurements from densitometry and perfusion scintigraphy in the upper and lower lung zones in all image types.
CC CT images allow a precise, less observer-dependent evaluation of distribution of pulmonary emphysema and resection recommendation compared to axial and multiplanar CT images and might therefore be useful in lung volume resection surgery planning.
合适的患者选择是肺气肿患者肺减容手术成功的关键。计算机断层扫描（CT）能够可靠地检测肺气肿，并能准确量化其严重程度。我们的目标是研究彩色编码（CC）CT图像在肺气肿分类和术前肺减容规划中的实用性和可靠性。
回顾性研究了2015年9月至2016年2月在我院接受肺减容手术的50例患者。三名阅片者使用戈达德评分系统和一个以手术为导向的分级系统（双侧明显不均一、双侧中度不均一、双侧均一和单侧不均一肺气肿），在轴向、多平面和CC CT图像上直观评估肺气肿的数量和分布模式。通过使用Fleiss' kappa（κ）和组内相关系数（ICC）来研究观察者依赖性。将结果与密度测量和肺灌注闪烁扫描的定量结果进行Spearman相关性比较。将基于所有阅片者的肺气肿数量和分布的肺减容部位建议与手术报告中的切除部位进行比较。
CC图像在肺气肿分布评级方面的阅片者间一致性较高（κ=0.70；95%CI，0.64-0.80），与轴向和多平面图像相比显著更好（P≤0.001）。CC图像在推荐节段切除方面的阅片者间一致性为中等（κ=0.56；95%CI，0.49-0.63），与轴向和多平面图像相比显著更好（P<0.001）。在所有图像类型中，上、下肺区的视觉肺气肿评级与密度测量和灌注闪烁扫描的测量结果显著相关。
与轴向和多平面CT图像相比，CC CT图像能够对肺气肿分布进行精确、较少依赖观察者的评估，并给出切除建议，因此可能有助于肺减容手术规划。
