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Pulmonary emphysema: subjective visual grading versus objective quantification with macroscopic morphometry and

A A Bankier1, V De Maertelaer, C Keyzer

  • 1Department of Radiology, University of Vienna, Austria.

Radiology
|June 3, 1999
PubMed
Summary
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Subjective visual grading of emphysema is less accurate than computed tomographic (CT) densitometry, showing systematic overestimation and moderate agreement. Objective CT methods are recommended for precise emphysema quantification.

Area of Science:

  • Pulmonary Medicine
  • Radiology
  • Quantitative Imaging

Background:

  • Pulmonary emphysema assessment often relies on subjective visual grading.
  • Objective quantification methods like macroscopic morphometry and CT densitometry offer potential improvements.

Purpose of the Study:

  • To compare the accuracy of subjective visual emphysema grading with objective macroscopic morphometry and CT densitometry.
  • To evaluate interobserver and intraobserver agreement for subjective emphysema assessment.

Main Methods:

  • Sixty-two patients underwent thin-section CT scans prior to lung resection.
  • Emphysema was quantified using computer-assisted macroscopic morphometry and CT densitometry.
  • Three readers performed subjective visual grading of emphysema, with data analyzed for correlations and agreement.

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Main Results:

  • Subjective grading showed weaker correlation with the macroscopic reference standard (r=0.439-0.505) than CT densitometry (r=0.555-0.623).
  • Readers systematically overestimated emphysema, with moderate interobserver agreement (kappa=0.431-0.589) and good to excellent intraobserver agreement (kappa=0.738-0.936).
  • Reader expertise did not significantly impact the results.

Conclusions:

  • Subjective visual grading of emphysema is prone to systematic overestimation and moderate interobserver variability.
  • Objective methods, particularly CT densitometry, provide more precise and reader-independent quantification of emphysema.
  • Supplementing subjective grading with objective techniques is recommended for accurate emphysema assessment.