HRCT characteristics of severe emphysema patients: Interobserver variability among expert readers and comparison with quantitative software

Jorine E Hartman,Gerard J Criner,William H Moore,Eva M Van Rikxoort,Frank C Sciurba,Pallav L Shah,Rozemarijn Vliegenthart,Jorrit B.A Welling,Dirk-Jan Slebos

doi:10.1016/j.ejrad.2021.109561

Abstract

PurposeFor a successful bronchoscopic lung volume reduction coil treatment it is important to place the coils in the most emphysematous lobes. Therefore assessment of the lobe with greatest destruction is essential. Our aims were to investigate the level of agreement among expert reviewers of HRCT-scans in emphysema patients and the comparison with QCT (quantitative computed tomography) software. MethodFive experienced CT-assessors, conducted a visual assessment of the baseline HRCT-scans of emphysema patients who participated in the RENEW bronchoscopic lung volume reduction coil study. On the same HRCT-scans, a QCT analysis was performed. ResultsIn total 134 HRCT-scans were rated by all 5 experts. All 5 CT-assessors agreed on which was the most destructed lobe in 61 % of the left lungs (ƙ:0.459) and 60 % of the right lungs (ƙ:0.370). The consensus of the 5 assessors matched the QCT in the left lung for 77 % of the patients (ƙ:0.425) and in the right lung for 82 % (ƙ:0.524). ConclusionsOur results show that the interobserver agreement between five expert CT-assessors was only fair to moderate when evaluating the most destructed lobe. CT-assessor consensus improved matching with QCT determination of lobar destruction compared to individual assessor determinations. Because some CT-features are associated with treatment outcomes and important for optimal patient selection of bronchoscopic lung volume reduction treatment, we recommend including more than one CT-reviewer and supported by QCT measurements.

Highlights

Computed tomography of the chest (CT scans) are important in pa tient selection for bronchoscopic lung volume reduction treatments, like the endobronchial valve or lung volume reduction coil treatment in Chronic Obstructive Pulmonary Disease (COPD) patients with emphy sema [1,2]
For bronchoscopic lung volume reduction with endobronchial valves, Quantitative assessment of CT-scans (QCT) is already incorporated in patient selection as it has proven additional value for the evaluation of fissure completeness [3,4]
The RENEW-study, a large multicenter randomized controlled trial investi gating the coil treatment, relied on a visual CT-analysis by the pulmo nologist without support of QCT to select the most destructed lobes for treatment [6,7] A recent post-hoc analysis of the RENEW-study showed that 38 % of patients received one or both coil treatments in the ipsi lateral lobe of lesser emphysematous destruction according to the QCT-analysis [7]

Summary

Introduction

Computed tomography of the chest (CT scans) are important in pa tient selection for bronchoscopic lung volume reduction treatments, like the endobronchial valve or lung volume reduction coil treatment in Chronic Obstructive Pulmonary Disease (COPD) patients with emphy sema [1,2]. The RENEW-study, a large multicenter randomized controlled trial investi gating the coil treatment, relied on a visual CT-analysis by the pulmo nologist without support of QCT to select the most destructed lobes for treatment [6,7] A recent post-hoc analysis of the RENEW-study showed that 38 % of patients received one or both coil treatments in the ipsi lateral lobe of lesser emphysematous destruction according to the QCT-analysis [7]. These patients had significantly inferior clinical out comes one year after treatment compared to the patients who were treated in the most destructed lobes according to the QCT-analysis [7]

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Methods

Results