Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine.
Department of Radiology, Stanford University School of Medicine.
J Thorac Imaging. 2022 Mar 1;37(2):109-116. doi: 10.1097/RTI.0000000000000595.
Computed tomography (CT) findings of bronchiolitis obliterans syndrome (BOS) can be nonspecific and variable. This study aims to measure the incremental value of automated quantitative lung CT analysis to clinical CT interpretation. A head-to-head comparison of quantitative CT lung density analysis by parametric response mapping (PRM) with qualitative radiologist performance in BOS diagnosis was performed.
Inspiratory and end-expiratory CTs of 65 patients referred to a post-bone marrow transplant lung graft-versus-host-disease clinic were reviewed by 3 thoracic radiologists for the presence of mosaic attenuation, centrilobular opacities, airways dilation, and bronchial wall thickening. Radiologists' majority consensus diagnosis of BOS was compared with automated PRM air trapping quantification and to the gold-standard diagnosis of BOS as per National Institutes of Health (NIH) consensus criteria.
Using a previously established threshold of 28% air trapping on PRM, the diagnostic performance for BOS was as follows: sensitivity 56% and specificity 94% (area under the receiver operator curve [AUC]=0.75). Radiologist review of inspiratory CT images alone resulted in a sensitivity of 80% and a specificity of 69% (AUC=0.74). When radiologists assessed both inspiratory and end-expiratory CT images in combination, the sensitivity was 92% and the specificity was 59% (AUC=0.75). The highest performance was observed when the quantitative PRM report was reviewed alongside inspiratory and end-expiratory CT images, with a sensitivity of 92% and a specificity of 73% (AUC=0.83).
In the CT diagnosis of BOS, qualitative expert radiologist interpretation was noninferior to quantitative PRM. The highest level of diagnostic performance was achieved by the combination of quantitative PRM measurements with qualitative image feature assessments.
细支气管炎闭塞性综合征（BOS）的计算机断层扫描（CT）表现可能是非特异性和多变的。本研究旨在测量自动化定量肺部 CT 分析对临床 CT 解读的增量价值。通过参数响应映射（PRM）对定量 CT 肺密度分析与定性放射科医师在 BOS 诊断中的表现进行了直接比较。
对 65 例因骨髓移植后肺移植物抗宿主病而转诊至肺移植后诊所的患者进行吸气和呼气相 CT 检查，3 名胸部放射科医师评估马赛克衰减、小叶中心性混浊、气道扩张和支气管壁增厚的存在情况。放射科医师对 BOS 的多数共识诊断与自动 PRM 空气滞留定量进行了比较，并与 NIH 共识标准对 BOS 的金标准诊断进行了比较。
使用先前建立的 PRM 上 28%空气滞留的阈值，BOS 的诊断性能如下：敏感性为 56%，特异性为 94%（接受者操作特征曲线下面积[AUC]=0.75）。单独使用吸气 CT 图像评估放射科医师的结果导致敏感性为 80%，特异性为 69%（AUC=0.74）。当放射科医师联合评估吸气和呼气相 CT 图像时，敏感性为 92%，特异性为 59%（AUC=0.75）。当定量 PRM 报告与吸气和呼气相 CT 图像一起评估时，观察到最高的性能，敏感性为 92%，特异性为 73%（AUC=0.83）。
在 BOS 的 CT 诊断中，定性专家放射科医师的解释并不逊于定量 PRM。定量 PRM 测量与定性图像特征评估的结合实现了最高的诊断性能水平。
