TY - JOUR
T1 - CT-based emphysema characterization per lobe
T2 - A proof of concept
AU - Wisselink, Hendrik Joost
AU - Yang, Xiaofei
AU - Rook, Mieneke
AU - Heuvelmans, Marjolein A.
AU - Jiang, Wenzhen
AU - Zhang, Jianing
AU - du, Yihui
AU - Vonder, Marleen
AU - Dorrius, Monique D.
AU - Ye, Zhaoxiang
AU - de Bock, Geertruida H.
AU - Vliegenthart, Rozemarijn
N1 - Publisher Copyright: © 2023 The Author(s)
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Purpose: The Fleischner society criteria are global criteria to visually evaluate and classify pulmonary emphysema on CT. It may group heterogeneous disease severity within the same category, potentially obscuring clinically relevant differences in emphysema severity. This proof-of-concept study proposes to split emphysema into more categories and to assess each lobe separately, and applies this to two general population-based cohort samples to assess what information such an extension adds. Method: From a consecutive sample in two general population-based cohorts with low-dose chest CT, 117 participants with more than a trace of emphysema were included. Two independent readers performed an extended per-lobe classification and assessed overall severity semi-quantitatively. An emphysema sum score was determined by adding the severity score of all lobes. Inter-reader agreement was quantified with Krippendorff Alpha. Results: Based on Fleischner society criteria, 69 cases had mild to severe centrilobular emphysema, and 90 cases had mild or moderate paraseptal emphysema (42 had both types of emphysema). The emphysema sum score was significantly different between mild (10.7 ± 4.3, range 2–22), moderate (20.1 ± 3.1, range: 15–24), and severe emphysema (23.6 ± 3.4, range: 17–28, p < 0.001), but ranges showed significant overlap. Inter-reader agreement for the extended classification and sum score was substantial (alpha 0.79 and 0.85, respectively). Distribution was homogenous across lobes in never-smokers, yet heterogenous in current smokers, with upper-lobe predominance. Conclusions: The proposed emphysema evaluation method adds information to the original Fleischner society classification. Individuals in the same Fleischner category have diverse emphysema sum scores, and lobar emphysema distribution differs between smoking groups.
AB - Purpose: The Fleischner society criteria are global criteria to visually evaluate and classify pulmonary emphysema on CT. It may group heterogeneous disease severity within the same category, potentially obscuring clinically relevant differences in emphysema severity. This proof-of-concept study proposes to split emphysema into more categories and to assess each lobe separately, and applies this to two general population-based cohort samples to assess what information such an extension adds. Method: From a consecutive sample in two general population-based cohorts with low-dose chest CT, 117 participants with more than a trace of emphysema were included. Two independent readers performed an extended per-lobe classification and assessed overall severity semi-quantitatively. An emphysema sum score was determined by adding the severity score of all lobes. Inter-reader agreement was quantified with Krippendorff Alpha. Results: Based on Fleischner society criteria, 69 cases had mild to severe centrilobular emphysema, and 90 cases had mild or moderate paraseptal emphysema (42 had both types of emphysema). The emphysema sum score was significantly different between mild (10.7 ± 4.3, range 2–22), moderate (20.1 ± 3.1, range: 15–24), and severe emphysema (23.6 ± 3.4, range: 17–28, p < 0.001), but ranges showed significant overlap. Inter-reader agreement for the extended classification and sum score was substantial (alpha 0.79 and 0.85, respectively). Distribution was homogenous across lobes in never-smokers, yet heterogenous in current smokers, with upper-lobe predominance. Conclusions: The proposed emphysema evaluation method adds information to the original Fleischner society classification. Individuals in the same Fleischner category have diverse emphysema sum scores, and lobar emphysema distribution differs between smoking groups.
KW - CT
KW - Emphysema
KW - Per-lobe assessment
KW - Proof of concept
KW - Visual assessment
UR - http://www.scopus.com/inward/record.url?scp=85147285906&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejrad.2023.110709
DO - https://doi.org/10.1016/j.ejrad.2023.110709
M3 - Article
C2 - 36731401
SN - 0720-048X
VL - 160
JO - European Journal of Radiology
JF - European Journal of Radiology
M1 - 110709
ER -