• European radiology · Nov 2014

    Randomized Controlled Trial

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

    • Mathilde Marie Winkler Wille, Laura H Thomsen, Asger Dirksen, Jens Petersen, Jesper Holst Pedersen, and Saher B Shaker.
    • Department of Respiratory Medicine, Gentofte Hospital, Niels Andersensvej 65, opg. 30A, st.th., 2900, Hellerup, Denmark, mathilde.winkler@gmail.com.
    • Eur Radiol. 2014 Nov 1;24(11):2692-9.

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