Head-to-head Comparison of Qualitative Radiologist Assessment With Automated Quantitative Computed Tomography Analysis for Bronchiolitis Obliterans Syndrome After Hematopoietic Cell Transplantation.
Head-to-head Comparison of Qualitative Radiologist Assessment With Automated Quantitative Computed Tomography Analysis for Bronchiolitis Obliterans Syndrome After Hematopoietic Cell Transplantation.
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造血细胞移植后闭塞性细支气管炎综合征的定性放射科医生评估与自动定量计算机断层扫描分析的头对头比较。
DOI：
10.1097/rti.0000000000000595
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发表时间：
2022
影响因子：
3.3
通讯作者：
Guo,HHenry
中科院分区：
文献类型：
--
作者：
Sharifi,Husham;Guenther,ZacharyD;Leung,AnnNC;Johnston,Laura;Lai,YuK;Hsu,JoeL;Guo,HHenry
目的：闭塞性毛细支气管炎综合征(BOS)的CT表现具有非特异性和可变性。本研究旨在评估肺CT自动定量分析对临床CT解释的增量价值。材料和方法：对65例骨髓移植后肺移植后肺部移植物抗宿主病门诊患者的吸气和呼气末CT表现进行检查，观察其是否存在马赛克衰减、小叶中心阴影、呼吸道扩张和支气管壁增厚。根据美国国立卫生研究院(NIH)的标准，将放射科医生对BOS的大多数共识诊断与自动PRM空气滞留定量和金标准进行比较。结果：以先前建立的PRM空气滞留28%为阈值，BOS诊断的灵敏度为56%，特异度为94%(受试者操作曲线下面积[AUC]=0.75)。放射科医师仅对吸气CT图像进行复查，其敏感性为80%，特异性为69%(AUC=0.74)。当放射科医生同时评估吸气和呼气末CT图像时，敏感性为92%，特异性为59%(AUC=0.75)。与吸气相和呼气末CT相结合，定量PRM诊断的敏感性为92%，特异性为73%(AUC=0.83)。结论：在BOS的CT诊断中，定性的专家判读不逊于定量的PRM。通过将定量PRM测量与定性图像特征评估相结合，实现了最高水平的诊断性能。
Purpose:Computed tomography (CT) findings of bronchiolitis obliterans syndrome (BOS) can be nonspecific and variable. This study aims to measure the incremental value of automated quantitative lung CT analysis to clinical CT interpretation. A head-to-head comparison of quantitative CT lung density analysis by parametric response mapping (PRM) with qualitative radiologist performance in BOS diagnosis was performed.Materials and Methods:Inspiratory and end-expiratory CTs of 65 patients referred to a post–bone marrow transplant lung graft-versus-host-disease clinic were reviewed by 3 thoracic radiologists for the presence of mosaic attenuation, centrilobular opacities, airways dilation, and bronchial wall thickening. Radiologists’ majority consensus diagnosis of BOS was compared with automated PRM air trapping quantification and to the gold-standard diagnosis of BOS as per National Institutes of Health (NIH) consensus criteria.Results:Using a previously established threshold of 28% air trapping on PRM, the diagnostic performance for BOS was as follows: sensitivity 56% and specificity 94%(area under the receiver operator curve [AUC]= 0.75). Radiologist review of inspiratory CT images alone resulted in a sensitivity of 80% and a specificity of 69%(AUC= 0.74). When radiologists assessed both inspiratory and end-expiratory CT images in combination, the sensitivity was 92% and the specificity was 59%(AUC= 0.75). The highest performance was observed when the quantitative PRM report was reviewed alongside inspiratory and end-expiratory CT images, with a sensitivity of 92% and a specificity of 73%(AUC= 0.83).Conclusions:In the CT diagnosis of BOS, qualitative expert radiologist interpretation was noninferior to quantitative PRM. The highest level of diagnostic performance was achieved by the combination of quantitative PRM measurements with qualitative image feature assessments.