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Perossi J, Koenigkam-Santos M, Perossi L, dos Santos DO, Simoni LHDS, de Souza HCD, Gastaldi AC. Correlation among clinical, functional and morphological indexes of the respiratory system in non-cystic fibrosis bronchiectasis patients. PLoS One 2022; 17:e0269897. [PMID: 35793286 PMCID: PMC9258820 DOI: 10.1371/journal.pone.0269897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/29/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Non-cystic fibrosis bronchiectasis (NCFB) is a heterogeneous disease, which assessment and severity can't be defined by one particular instrument but using a multidimensional score. Thus, in additional to traditional methods, alternative tools have been developed to assist these patients' evaluation. OBJECTIVE To correlate functional and morphological indexes with severity and dyspnea in NCFB patients, focusing on the correlation between the impulse oscillometry system (IOS) and the quantitative analysis of computed tomography (CT). METHODS Clinically stable NCFB patients, between 18 and 80 years old were submitted to clinical, functional and morphological evaluations assessed by Bronchiectasis Severity Index (BSI) and Medical Research Council (MRC) scale; spirometry and IOS; and subjective and quantitative Chest CT scans analysis, respectively. RESULTS This study included 38 patients. The best correlations obtained between functional and morphological airway indexes were: resistance at 5 Hz-R5 and the normalized thickness of bronchial walls-Pi10 (r = 0.57), and the mean forced expiratory flow (FEF25-75%) and CT score (r = -0.39). BSI as well as MRC showed higher correlations with the quantitative automated analysis of CT (BSI and Pi10: r = 0.41; MRC and Pi10: r = 0.35) than with subjective CT score (BSI and CT score: r = 0.41; MRC and CT score: r = 0.15); and moderate and weak correlations were obtained on both functional airway indexes (BSI and peripheral airways resistance - R5-R20: r = 0.53; BSI and forced expiratory volume at the first second-FEV1: R = -0,64; MRC and R5-R20: r = 0.42; and MRC and VEF1: r = -0.45). CONCLUSION In NCFB patients, compartmentalized methods for assessing the respiratory system (IOS and the automated quantitative CT analysis) have a good correlation with severity and dyspnea.
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Affiliation(s)
- Jéssica Perossi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Marcel Koenigkam-Santos
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Larissa Perossi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Daniele Oliveira dos Santos
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Letícia Helena de Souza Simoni
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Hugo Celso Dutra de Souza
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Ada Clarice Gastaldi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
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Pakzad A, Jacob J. Radiology of Bronchiectasis. Clin Chest Med 2022; 43:47-60. [PMID: 35236560 DOI: 10.1016/j.ccm.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bronchiectasis is a radiological diagnosis made using computed tomographic (CT) imaging. Although visual CT assessment is necessary for the diagnosis of bronchiectasis, visual assessment of disease severity and progression is challenging. Computer tools offer the potential to improve the characterization of lung damage in patients with bronchiectasis. Newer imaging techniques such as MRI with hyperpolarized gas inhalation have the potential to identify early forms of disease and are without the constraints of requiring ionizing radiation exposure.
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Affiliation(s)
- Ashkan Pakzad
- Departments of Medical Physics and Biomedical Engineering, and Computer Science, University College London, UK; Centre for Medical Image Computing, University College London, London, UK.
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK; UCL Respiratory, University College London, London, UK
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3
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Joyce S, Carey BW, Moore N, Mullane D, Moore M, McEntee MF, Plant BJ, Maher MM, O'Connor OJ. Computed tomography in cystic fibrosis lung disease: a focus on radiation exposure. Pediatr Radiol 2021; 51:544-553. [PMID: 33743038 DOI: 10.1007/s00247-020-04706-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/03/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022]
Abstract
Thoracic computed tomography (CT) is the imaging reference method in the diagnosis, assessment and management of lung disease. In the setting of cystic fibrosis (CF), CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography, and findings correlate with clinical outcomes. Better understanding of the aetiology of CF lung disease indicates that even asymptomatic infants with CF can have irreversible pulmonary pathology. Surveillance and early diagnosis of lung disease in CF are important to preserve lung parenchyma and to optimise long-term outcomes. CF is associated with increased cumulative radiation exposure due to the requirement for repeated imaging from a young age. Radiation dose optimisation, important for the safe use of CT in children with CF, is best achieved in a team environment where paediatric radiologists work closely with paediatric respiratory physicians, physicists and radiography technicians to achieve the best patient outcomes. Despite the radiation doses incurred, CT remains a vital imaging tool in children with CF. Radiologists with special interests in CT dose optimisation and respiratory disease are key to the appropriate use of CT in paediatric imaging. Paediatric radiologists strive to minimise radiation dose to children whilst providing the best possible assessment of lung disease.
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Affiliation(s)
- Stella Joyce
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
| | - Brian W Carey
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Niamh Moore
- Department of Radiography, University College Cork, Cork, Ireland
| | - David Mullane
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Michael Moore
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Mark F McEntee
- Department of Radiography, University College Cork, Cork, Ireland
| | - Barry J Plant
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Medicine, Cork University Hospital, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland. .,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland. .,APC Microbiome Institute, University College Cork, Cork, Ireland.
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4
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Automatic Quantitative Computed Tomography Evaluation of the Lungs in Patients With Systemic Sclerosis Treated With Autologous Stem Cell Transplantation. J Clin Rheumatol 2019; 26:S158-S164. [PMID: 31868835 DOI: 10.1097/rhu.0000000000001242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVE Interstitial lung disease stands among the leading causes of death in systemic sclerosis (SSc) patients. Autologous hematopoietic stem cell transplantation (AHSCT) has been proven superior to conventional immunosuppressive therapy in severe and progressive SSc. Here, pulmonary quantitative measurements were obtained in high-resolution computed tomography (HRCT) scans of patients with SSc before and after AHSCT. METHODS The medical records of thirthy-three patients who underwent AHSCT between 2011 and 2017 were evaluated for clinical and tomographic features at baseline (pre-AHCST) and 18 months after the procedure. Quantitative analysis of HRCT images by a fully automated program calculated lung volumes, densities, attenuation percentiles, and vascular volume. Patients were divided into 2 groups, according to changes in forced vital capacity (FVC). The "best response" group included patients that had an increased FVC of 10% or greater, and the "stable response" group included those who had a decreased or an increased FVC of less than 10%. RESULTS In the best response group (15 patients), there was reduction (p < 0.05) of mean lung density and density percentile values after AHSCT. In the stable response group (18 patients), there were no significant changes in lung volumes and pulmonary densities after AHSCT. Pulmonary HRCT densities showed moderate/strong correlation with function. CONCLUSIONS Quantitative HRCT analysis identified significant reduction in pulmonary densities in patients with improved pulmonary function after AHSCT. Lung density, as evaluated by the quantitative HRCT analysis tool, has potential to become a biomarker in the evaluation of interstitial lung disease treatment in patients with SSc.
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Santos MK, Ferreira Júnior JR, Wada DT, Tenório APM, Barbosa MHN, Marques PMDA. Artificial intelligence, machine learning, computer-aided diagnosis, and radiomics: advances in imaging towards to precision medicine. Radiol Bras 2019; 52:387-396. [PMID: 32047333 PMCID: PMC7007049 DOI: 10.1590/0100-3984.2019.0049] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The discipline of radiology and diagnostic imaging has evolved greatly in recent years. We have observed an exponential increase in the number of exams performed, subspecialization of medical fields, and increases in accuracy of the various imaging methods, making it a challenge for the radiologist to "know everything about all exams and regions". In addition, imaging exams are no longer only qualitative and diagnostic, providing now quantitative information on disease severity, as well as identifying biomarkers of prognosis and treatment response. In view of this, computer-aided diagnosis systems have been developed with the objective of complementing diagnostic imaging and helping the therapeutic decision-making process. With the advent of artificial intelligence, "big data", and machine learning, we are moving toward the rapid expansion of the use of these tools in daily life of physicians, making each patient unique, as well as leading radiology toward the concept of multidisciplinary approach and precision medicine. In this article, we will present the main aspects of the computational tools currently available for analysis of images and the principles of such analysis, together with the main terms and concepts involved, as well as examining the impact that the development of artificial intelligence has had on radiology and diagnostic imaging.
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Affiliation(s)
- Marcel Koenigkam Santos
- Centro de Ciências das Imagens e Física Médica (CCIFM) da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - José Raniery Ferreira Júnior
- Escola de Engenharia de São Carlos da Universidade de São Paulo (EESC-USP), São Carlos, SP, Brazil.,Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Danilo Tadao Wada
- Centro de Ciências das Imagens e Física Médica (CCIFM) da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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6
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Oliveira DS, Araújo Filho JDA, Paiva AFL, Ikari ES, Chate RC, Nomura CH. Idiopathic interstitial pneumonias: review of the latest American Thoracic Society/European Respiratory Society classification. Radiol Bras 2018; 51:321-327. [PMID: 30369660 PMCID: PMC6198836 DOI: 10.1590/0100-3984.2016.0134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/05/2017] [Indexed: 12/17/2022] Open
Abstract
The diagnosis of idiopathic interstitial pneumonias (IIPs) involves a multidisciplinary scenario in which the radiologist assumes a key role. The latest (2013) update of the IIP classification by the American Thoracic Society/European Respiratory Society proposed some important changes to the original classification of 2002. The novelties include the addition of a new disease (idiopathic pleuroparenchymal fibroelastosis) and the subdivision of the IIPs into four main groups: chronic fibrosing IIPs (idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia); smoking-related IIPs (desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease); acute or subacute IIPs (cryptogenic organizing pneumonia and acute interstitial pneumonia); rare IIPs (lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis); and the so-called "unclassifiable" IIPs. In this study, we review the main clinical, tomographic, and pathological characteristics of each IIP.
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Affiliation(s)
- Daniel Simões Oliveira
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - José de Arimatéia Araújo Filho
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - Antonio Fernando Lins Paiva
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - Eduardo Seigo Ikari
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - Rodrigo Caruso Chate
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - César Higa Nomura
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
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7
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Congruence Between Pulmonary Function and Computed Tomography Imaging Assessment of Cystic Fibrosis Severity. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1114:67-76. [PMID: 29725972 DOI: 10.1007/5584_2018_202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In cystic fibrosis, pulmonary function tests (PFTs) and computed tomography are used to assess lung function and structure, respectively. Although both techniques of assessment are congruent there are lingering doubts about which PFTs variables show the best congruence with computed tomography scoring. In this study we addressed the issue by reinvestigating the association between PFTs variables and the score of changes seen in computed tomography scans in patients with cystic fibrosis with and without pulmonary exacerbation. This retrospective study comprised 40 patients in whom PFTs and computed tomography were performed no longer than 3 weeks apart. Images (inspiratory: 0.625 mm slice thickness, 0.625 mm interval; expiratory: 1.250 mm slice thickness, 10 mm interval) were evaluated with the Bhalla scoring system. The most frequent structural abnormality found in scans were bronchiectases and peribronchial thickening. The strongest relationship was found between the Bhalla sore and forced expiratory volume in 1 s (FEV1). The Bhalla sore also was related to forced vital capacity (FVC), FEV1/FVC ratio, residual volume (RV), and RV/total lung capacity (TLC) ratio. We conclude that lung structural data obtained from the computed tomography examination are highly congruent to lung function data. Thus, computed tomography imaging may supersede functional assessment in cases of poor compliance with spirometry procedures in the lederly or children. Computed tomography also seems more sensitive than PFTs in the assessment of cystic fibrosis progression. Moreover, in early phases of cystic fibrosis, computed tomography, due to its excellent resolution, may be irreplaceable in monitoring pulmonary damage.
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Hochhegger B, Baldisserotto M. Chest computed tomography in bronchiolitis obliterans after bone marrow transplantation. Radiol Bras 2017; 50:IX. [PMID: 28670041 PMCID: PMC5487226 DOI: 10.1590/0100-3984.2017.50.3e3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Bruno Hochhegger
- Adjunct Professor of Radiology at the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil. E-mail:
| | - Matteo Baldisserotto
- Professor in the Graduate Program of the Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil. E-mail:
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9
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Togni Filho PH, Casagrande JLM, Lederman HM. Utility of the inspiratory phase in high-resolution computed tomography evaluations of pediatric patients with bronchiolitis obliterans after allogeneic bone marrow transplant: reducing patient radiation exposure. Radiol Bras 2017; 50:90-96. [PMID: 28428651 PMCID: PMC5396998 DOI: 10.1590/0100-3984.2015.0181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/26/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the utility of the inspiratory phase in high-resolution computed tomography (HRCT) of the chest for the diagnosis of post-bone marrow transplantation bronchiolitis obliterans. MATERIALS AND METHODS This was a retrospective, observational, cross-sectional study. We selected patients of either gender who underwent bone marrow transplantation and chest HRCT between March 1, 2002 and December 12, 2014. Ages ranged from 3 months to 20.7 years. We included all examinations in which the HRCT was performed appropriately. The examinations were read by two radiologists, one with extensive experience in pediatric radiology and another in the third year of residency, who determined the presence or absence of the following imaging features: air trapping, bronchiectasis, alveolar opacities, nodules, and atelectasis. RESULTS A total of 222 examinations were evaluated (mean, 5.4 ± 4.5 examinations per patient). The expiratory phase findings were comparable to those obtained in the inspiratory phase, except in one patient, in whom a small uncharacteristic nodule was identified only in the inspiratory phase. Air trapping was identified in a larger number of scans in the expiratory phase than in the inspiratory phase, as was atelectasis, although the difference was statistically significant only for air trapping. CONCLUSION In children being evaluated for post-bone marrow transplantation bronchiolitis obliterans, the inspiratory phase can be excluded from the chest HRCT protocol, thus reducing by half the radiation exposure in this population.
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Affiliation(s)
- Paulo Henrique Togni Filho
- MD, MSc, Attending Physician, Department of Diagnostic Imaging,
Escola Paulista de Medicina da Universidade Federal de São Paulo
(EPM-Unifesp), São Paulo, SP, Brazil
| | - João Luiz Marin Casagrande
- Radiologist, Fellow in Musculoskeletal Imaging, Instituto de
Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade
de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Henrique Manoel Lederman
- Tenured Full Professor, Department of Diagnostic Imaging, Escola
Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp),
São Paulo, SP, Brazil
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de Brito MCB, Ota MK, Leitão Filho FSS, Meirelles GDSP. Radiologist agreement on the quantification of bronchiectasis by high-resolution computed tomography. Radiol Bras 2017; 50:26-31. [PMID: 28298729 PMCID: PMC5347500 DOI: 10.1590/0100-3984.2015.0146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To evaluate radiologist agreement on the quantification of bronchiectasis by
high-resolution computed tomography (HRCT). Materials and Methods The HRCT scans of 43 patients with bronchiectasis were analyzed by two
radiologists, who used a scoring system to grade the findings. Kappa
(κ) values and overall agreement were calculated. Results For the measurement and appearance of bronchiectasis, the interobserver
agreement was moderate (κ = 0.45 and κ = 0.43, respectively),
as was the intraobserver agreement (κ = 0.54 and κ = 0.47,
respectively). Agreement on the presence of mucous plugging was fair, for
central distribution (overall interobserver agreement of 68.3% and κ
= 0.39 for intraobserver agreement) and for peripheral distribution
(κ = 0.34 and κ = 0.35 for interobserver and intraobserver
agreement, respectively). The agreement was also fair for peribronchial
thickening (κ = 0.21 and κ = 0.30 for interobserver and
intraobserver agreement, respectively). There was fair interobserver and
intraobserver agreement on the detection of opacities (κ = 0.39 and
71.9%, respectively), ground-glass attenuation (64.3% and κ = 0.24,
respectively), and cysts/bullae (κ = 0.47 and κ = 0.44,
respectively). Qualitative analysis of the HRCT findings of bronchiectasis
and the resulting individual patient scores showed that there was an
excellent correlation between the observers (intraclass correlation
coefficient of 0.85 and 0.81 for interobserver and intraobserver agreement,
respectively). Conclusion In the interpretation of HRCT findings of bronchiectasis, radiologist
agreement appears to be fair. In our final analysis of the findings using
the proposed score, we observed excellent interobserver and intraobserver
agreement.
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Affiliation(s)
| | - Maurício Kenji Ota
- MD, Radiologist for the Fundação Instituto de Pesquisa e Estudos de Diagnóstico por Imagem (FIDI), São Paulo, SP, Brazil
| | | | - Gustavo de Souza Portes Meirelles
- PhD, Coordinator of the Thoracic Imaging Team of the Grupo Fleury, São Paulo, SP, Professor and Advisor for the Graduate Course in Clinical Radiology at the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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