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Emphysema progression is visually detectable in low-dose CT in continuous but not in former smokers

  • Chest
  • Published:
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Abstract

Objectives

To evaluate interobserver agreement and time-trend in chest CT assessment of emphysema, airways, and interstitial abnormalities in a lung cancer screening cohort.

Methods

Visual assessment of baseline and fifth-year examination of 1990 participants was performed independently by two observers. Results were standardised by means of an electronic score sheet; kappa and time-trend analyses were performed.

Results

Interobserver agreement was substantial in early emphysema diagnosis; highly significant (p < 0.001) time-trends in both emphysema presence and grading were found (higher prevalence and grade of emphysema in late CT examinations). Significant progression in emphysema was seen in continuous smokers, but not in former smokers. Agreement on centrilobular emphysema subtype was substantial; agreement on paraseptal subtype, moderate. Agreement on panlobular and mixed subtypes was only fair. Agreement was fair regarding airway analysis. Interstitial abnormalities were infrequent in the cohort, and agreement on these was fair to moderate. A highly significant time-trend was found regarding interstitial abnormalities, which were more frequent in late examinations.

Conclusions

Visual scoring of chest CT is able to characterise the presence, pattern, and progression of early emphysema. Continuous smokers progress; former smokers do not.

Key Points

• Substantial interobserver consistency in determining early-stage emphysema in low-dose CT.

• Longitudinal analyses show clear time-trends for emphysema presence and grading.

• For continuous smokers, progression of emphysema was seen in all lung zones.

• For former smokers, progression of emphysema was undetectable by visual assessment.

• Onset and progression of interstitial abnormalities are visually detectable.

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Abbreviations

CT:

Computed tomography

COPD:

Chronic obstructive pulmonary disease

HU:

Hounsfield units

ILD:

Interstitial lung disease

UIP:

Usual interstitial pneumonia

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Acknowledgments

The scientific guarantor of this publication is Professor Asger Dirksen, MD, DMSc. The authors of this manuscript declare no relationship with any companies whose products or services may be related to the subject matter of the article. This study has received funding from the Danish Ministry of Interior and Health. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in studies regarding lung cancer screening, nodule characteristics, lung function, and lung density in the Danish Lung Cancer Screening Trial. However, visual assessment of emphysema, airway abnormalities, and interstitial abnormalities was not previously performed, and thus the data of this study are new and have not yet been published. All relevant references are disclosed. Methodology: prospective randomised intervention trial, performed at one institution.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Gentofte Hospital, Niels Andersensvej 65, opg. 30A, st.th., 2900, Hellerup, Denmark

    Mathilde Marie Winkler Wille, Laura H. Thomsen, Asger Dirksen & Saher B. Shaker

  2. Department of Computer Science, Copenhagen University, Copenhagen, Denmark

    Jens Petersen

  3. Department of Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Jesper Holst Pedersen

Authors
  1. Mathilde Marie Winkler Wille
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  2. Laura H. Thomsen
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  3. Asger Dirksen
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  4. Jens Petersen
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  5. Jesper Holst Pedersen
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  6. Saher B. Shaker
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Corresponding author

Correspondence to Mathilde Marie Winkler Wille.

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Wille, M.M.W., Thomsen, L.H., Dirksen, A. et al. Emphysema progression is visually detectable in low-dose CT in continuous but not in former smokers. Eur Radiol 24, 2692–2699 (2014). https://doi.org/10.1007/s00330-014-3294-7

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  • DOI: https://doi.org/10.1007/s00330-014-3294-7

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