Advanced Emphysema: Preoperative Chest Radiographic Findings as Predictors of Outcome Following Lung Volume Reduction Surgery1
Daniel D. Maki, MD,
Wallace T. Miller, Jr, MD,
Judith M. Aronchick, MD,
Warren B. Gefter, MD,
Wallace T. Miller, Sr, MD,
Robert M. Kotloff, MD and
Gregory Tino, MD
1 From the Departments of Radiology (D.D.M., W.T.M.Jr., J.M.A., W.B.G., W.T.M.Sr.) and Medicine, Pulmonary and Critical Care Division (R.M.K., G.T.), Hospital of the University of Pennsylvania, 1st Floor Silverstein, 3400 Spruce St, Philadelphia, PA 19104. From the 1997 RSNA scientific assembly. Received February 3, 1998; revision requested April 9; final revision received October 12; accepted December 16. Address reprint requests to W.T.M.Jr. (e-mail: miller2@rad.upenn.edu).
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Figure 1a. (a) Posteroanterior radiograph obtained in a 79-year-old man with homogeneous emphysema demonstrates very little variability in disease from one area of the lung to the next. (b) One reader's scoring of the radiograph in a, which resulted in a heterogeneity score of 0. This patient's radiograph was given a negative score for lung compression.
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Figure 1b. (a) Posteroanterior radiograph obtained in a 79-year-old man with homogeneous emphysema demonstrates very little variability in disease from one area of the lung to the next. (b) One reader's scoring of the radiograph in a, which resulted in a heterogeneity score of 0. This patient's radiograph was given a negative score for lung compression.
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Figure 2a. (a) Posteroanterior radiograph obtained in a 66-year-old man with heterogeneous emphysema demonstrates severe disease in the right upper lobe, with relatively normal lung tissue in the right base. Vascular crowding (arrow) also is evident in the lower right lung medially compared with the upper zone vasculature. (The circle is a snap on the patient's clothing.) (b) One reader's scoring of the radiograph in a, which resulted in a heterogeneity score of 3. This patient's radiograph was given a positive score for lung compression.
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Figure 2b. (a) Posteroanterior radiograph obtained in a 66-year-old man with heterogeneous emphysema demonstrates severe disease in the right upper lobe, with relatively normal lung tissue in the right base. Vascular crowding (arrow) also is evident in the lower right lung medially compared with the upper zone vasculature. (The circle is a snap on the patient's clothing.) (b) One reader's scoring of the radiograph in a, which resulted in a heterogeneity score of 3. This patient's radiograph was given a positive score for lung compression.
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Figure 3. Receiver operating characteristic analysis of disease heterogeneity scores among five independent readers. Analysis results are plotted as the heterogeneity score versus the outcome, as measured by using the FEV1. The Az values (areas under the receiver operating characteristic curves) obtained by each reader are shown on the right. The similar high Az values and highly concordant receiver operating characteristic curves indicate high performance and low interreader variability among the five readers despite their varying levels of experience.
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Copyright © 1999 by the Radiological Society of North America.
