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Visual vs Automated Assessment of EmphysemaVisual vs Automated Assessment of Emphysema FREE TO VIEW

Bruno Hochhegger, MD, PhD; Edson Marchiori, MD, PhD; Klaus Irion, MD, PhD; Arthur Souza, Jr., MD, PhD; Gláucia Zanetti, MD, PhD
Author and Funding Information

From the Radiology Department (Drs Hochhegger, Marchiori, and Zanetti), Federal University of Rio de Janeiro; Radiology Department (Dr Irion), Liverpool Heart and Chest Hospital NHS Trust, Royal Liverpool and Broadgreen University NHS; Radiology Department, Medical School (Dr Souza Jr), São José do Rio Preto.

Correspondence to: Bruno Hochhegger, MD, PhD, Rua 24 de outubro 925/903, Porto Alegre, Brazil; e-mail: brunohochhegger@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Irion has published articles and presented lectures related to the topic in different countries, and his travel expenses were supported by the organizing institution of such meetings. Drs Hochhegger, Marchiori, Souza Jr, and Zanetti have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1384. doi:10.1378/chest.11-1310
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To the Editor:

We congratulate Bafadhel and her team1 for their important article recently published in CHEST (September 2011) that discussed the assessment of COPD. The authors suggested that CT scanning could provide additional data for the evaluation of clinical and physiologic parameters in the multidimensional phenotyping of COPD. However, we would like to point out some technical aspects of this technique. The authors used high-resolution CT scanning and visual assessment to evaluate the CT scan findings of COPD. Previous studies have compared the visual and densitometric assessment of pulmonary emphysema with CT scanning2,3; however, because emphysema is defined histopathologically, only a single publication has correlated CT scan findings with the characteristics of anatomic specimens.3

Bankier et al3 used a nonspiral CT scanning system to obtain thin-section images at full inspiration of 62 thoracic surgery candidates with lung cancer or emphysema. Three operators with varying degrees of expertise (one thoracic radiologist with a special interest in emphysema, one thoracic radiologist, and one medical student) visually evaluated the extent of pulmonary emphysema in one of every 10 thin-section slices from the apex to the base of the lungs. Emphysema volumes also were computed automatically for the same images. The results of the densitometric and visual evaluations were compared with those of the morphometric evaluation of emphysema in the excised specimens. The measurement of visual score reproducibility using weighted κ statistics yielded an interoperator agreement ranging from 0.43 to 0.58 and intraoperator agreement between 0.73 and 0.96. The anatomic extent of emphysema was correlated more closely with RA950 than with visual scores. Cavigli et al4 also demonstrated that densitometry was preferable to visual assessment because it enabled a more reproducible evaluation of the extent of pulmonary emphysema through volumetric acquisition in the entire lung. Several free software programs for the measurement of emphysema have been developed on the basis of these findings and are currently available. Moreover, automated assessment allows the evaluation of lung volumes and investigation of their influence on emphysema indices in follow-up studies. Several recent articles have demonstrated good correlations between visual and automatic assessment.5

Thus, we believe that the evaluation of pulmonary emphysema should use automated assessment because of its superior correlation with histopathologic assessments, superior reproducibility, and the ability to evaluate lung volumes and their influence on emphysema indices. This is particularly true during the early establishment of criteria for multidimensional COPD phenotyping.

Bafadhel M, Umar I, Gupta S, et al. The role of CT scanning in multidimensional phenotyping of COPD. Chest. 2011;1403:634-642 [CrossRef] [PubMed]
 
Desai SR, Hansell DM, Walker A, MacDonald SL, Chabat F, Wells AU. Quantification of emphysema: a composite physiologic index derived from CT estimation of disease extent. Eur Radiol. 2007;174:911-918 [CrossRef] [PubMed]
 
Bankier AA, De Maertelaer V, Keyzer C, Gevenois PA. Pulmonary emphysema: subjective visual grading versus objective quantification with macroscopic morphometry and thin-section CT densitometry. Radiology. 1999;2113:851-858 [PubMed]
 
Cavigli E, Camiciottoli G, Diciotti S, et al. Whole-lung densitometry versus visual assessment of emphysema. Eur Radiol. 2009;197:1686-1692 [CrossRef] [PubMed]
 
Gietema HA, Müller NL, Fauerbach PV, et al; Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators Quantifying the extent of emphysema: factors associated with radiologists’ estimations and quantitative indices of emphysema severity using the ECLIPSE cohort. Acad Radiol. 2011;186:661-671 [CrossRef] [PubMed]
 

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References

Bafadhel M, Umar I, Gupta S, et al. The role of CT scanning in multidimensional phenotyping of COPD. Chest. 2011;1403:634-642 [CrossRef] [PubMed]
 
Desai SR, Hansell DM, Walker A, MacDonald SL, Chabat F, Wells AU. Quantification of emphysema: a composite physiologic index derived from CT estimation of disease extent. Eur Radiol. 2007;174:911-918 [CrossRef] [PubMed]
 
Bankier AA, De Maertelaer V, Keyzer C, Gevenois PA. Pulmonary emphysema: subjective visual grading versus objective quantification with macroscopic morphometry and thin-section CT densitometry. Radiology. 1999;2113:851-858 [PubMed]
 
Cavigli E, Camiciottoli G, Diciotti S, et al. Whole-lung densitometry versus visual assessment of emphysema. Eur Radiol. 2009;197:1686-1692 [CrossRef] [PubMed]
 
Gietema HA, Müller NL, Fauerbach PV, et al; Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators Quantifying the extent of emphysema: factors associated with radiologists’ estimations and quantitative indices of emphysema severity using the ECLIPSE cohort. Acad Radiol. 2011;186:661-671 [CrossRef] [PubMed]
 
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