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Original Research |

A New, Simple Method for Estimating Pleural Effusion Size on CT ScansQuantification of Pleural Effusions on CT Scans

Matthew P. Moy, MD; Jeffrey M. Levsky, MD, PhD; Netanel S. Berko, MD; Alla Godelman, MD; Vineet R. Jain, MD; Linda B. Haramati, MD, FCCP
Author and Funding Information

From the Departments of Radiology (Drs Moy, Levsky, Berko, Godelman, Jain, and Haramati) and Medicine (Dr Haramati), Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY.

Correspondence to: Jeffrey M. Levsky, MD, PhD, Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Gold Zone, Ground Floor, 111 E 210th St, Bronx, NY 10467-2490; jlevsky@montefiore.org


Dr Moy is currently at the Department of Radiology, Massachusetts General Hospital (Boston, MA).

Funding/Support: This work was supported in part by the Clinical and Translational Science Awards Consortium [Grants UL1RR025750, KL2RR025749 and TL1RR025748] from the National Center for Advancing Translational Sciences, a component of the US National Institutes of Health (NIH), and the NIH Roadmap for Medical Research.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(4):1054-1059. doi:10.1378/chest.12-1292
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Background:  There is no standardized system to grade pleural effusion size on CT scans. A validated, systematic grading system would improve communication of findings and may help determine the need for imaging guidance for thoracentesis.

Methods:  CT scans of 34 patients demonstrating a wide range of pleural effusion sizes were measured with a volume segmentation tool and reviewed for qualitative and simple quantitative features related to size. A classification rule was developed using the features that best predicted size and distinguished among small, moderate, and large effusions. Inter-reader agreement for effusion size was assessed on the CT scans for three groups of physicians (radiology residents, pulmonologists, and cardiothoracic radiologists) before and after implementation of the classification rule.

Results:  The CT imaging features found to best classify effusions as small, moderate, or large were anteroposterior (AP) quartile and maximum AP depth measured at the midclavicular line. According to the decision rule, first AP-quartile effusions are small, second AP-quartile effusions are moderate, and third or fourth AP-quartile effusions are large. In borderline cases, AP depth is measured with 3-cm and 10-cm thresholds for the upper limit of small and moderate, respectively. Use of the rule improved interobserver agreement from κ = 0.56 to 0.79 for all physicians, 0.59 to 0.73 for radiology residents, 0.54 to 0.76 for pulmonologists, and 0.74 to 0.85 for cardiothoracic radiologists.

Conclusions:  A simple, two-step decision rule for sizing pleural effusions on CT scans improves interobserver agreement from moderate to substantial levels.

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