Thin-section CT in obstructive pulmonary disease: discriminatory value.

PURPOSE To use thin-section computed tomography (CT) to distinguish between causes of obstructive pulmonary disease, to determine which distinctions give rise to diagnostic imprecision, and to identify the most useful CT features. MATERIALS AND METHODS Thin-section CT scans of 105 patients with obstructive pulmonary disease (asthma, n = 35; centrilobular emphysema, n = 30; panlobular emphysema, n = 21; and obliterative bronchiolitis, n = 19) and 33 healthy subjects were assessed independently by two observers. The most likely diagnosis and a confidence rating were assigned. Individual thin-section CT features were recorded. Accuracy, sensitivity, specificity, negative predictive value, and positive predictive value for first-choice diagnoses were calculated. The prevalence of CT features between pairs of conditions was compared with the chi(2) or Fisher exact test as appropriate. RESULTS A correct first-choice diagnosis was made in 199 of 276 (72%) observations. A correct first-choice diagnosis was made in 35 of 38 (92%) observations in patients with obliterative bronchiolitis, in 53 of 60 (88%) observations in patients with centrilobular emphysema, in 53 of 66 (80%) observations in healthy subjects, in 37 of 70 (53%) observations in patients with asthma, and in 20 of 42 (48%) observations in patients with panlobular emphysema. The major sources of diagnostic inaccuracy were differentiation between panlobular and centrilobular emphysema, asthma and normality, and asthma and obliterative bronchiolitis. There were significant increases in prevalence of (a) bronchial wall thickening and vascular attenuation in patients with asthma when compared with healthy subjects and (b) vascular attenuation and decreased attenuation in patients with obliterative bronchiolitis when compared with patients with asthma (P <.001). CONCLUSION CT helps to distinguish diseases that cause airflow obstruction. Thin-section CT is particularly accurate in the identification of obliterative bronchiolitis.

[1]  G Gamsu,et al.  High-resolution CT diagnosis of emphysema in symptomatic patients with normal chest radiographs and isolated low diffusing capacity. , 1992, Radiology.

[2]  S. C. Yang.  Lung volume reduction surgery: let the trials begin. , 1997, Radiology.

[3]  T Takishima,et al.  Site of airway obstruction in pulmonary disease: direct measurement of intrabronchial pressure. , 1992, Journal of applied physiology.

[4]  P. Grenier,et al.  Chronic diffuse interstitial lung disease: diagnostic value of chest radiography and high-resolution CT. , 1991, Radiology.

[5]  N L Müller,et al.  Airway obstruction in asthmatic and healthy individuals: inspiratory and expiratory thin-section CT findings. , 1997, Radiology.

[6]  N. Müller,et al.  Panacinar Emphysema: CT and Pathologic Findings , 1993, Journal of computer assisted tomography.

[7]  P. Paré,et al.  A model of airway narrowing in asthma and in chronic obstructive pulmonary disease. , 1992, The American review of respiratory disease.

[8]  J. Hogg,et al.  Inflammation of small airways in asthma. , 1997, The Journal of allergy and clinical immunology.

[9]  D. Hansell,et al.  Comparative accuracy of high resolution computed tomography and chest radiography in the diagnosis of chronic diffuse infiltrative lung disease. , 1991, Clinical radiology.

[10]  E. Ingenito,et al.  Preoperative screening for lung volume reduction surgery: usefulness of combining thin-section CT with physiologic assessment. , 1998, AJR. American journal of roentgenology.

[11]  J D Newell,et al.  Uncomplicated asthma in adults: comparison of CT appearance of the lungs in asthmatic and healthy subjects. , 1993, Radiology.

[12]  N L Müller,et al.  Bronchiolitis obliterans after lung transplantation: high-resolution CT findings in 15 patients. , 1997, AJR. American journal of roentgenology.

[13]  N L Müller,et al.  Chronic diffuse infiltrative lung disease: comparison of diagnostic accuracy of CT and chest radiography. , 1989, Radiology.

[14]  M. Cosio,et al.  Extent of centrilobular and panacinar emphysema in smokers' lungs: pathological and mechanical implications. , 1994, The European respiratory journal.

[15]  D. Hansell,et al.  Airflow obstruction in bronchiectasis: correlation between computed tomography features and pulmonary function tests , 2000, Thorax.

[16]  D. Hansell,et al.  High resolution computed tomography (HRCT) in emphysema associated with alpha-1-antitrypsin deficiency. , 1992, Clinical radiology.

[17]  A. Millar,et al.  Computed tomography in adult obliterative bronchiolitis. , 1990, Clinical radiology.

[18]  P. Paré,et al.  The diagnosis of emphysema. A computed tomographic-pathologic correlation. , 1986, The American review of respiratory disease.

[19]  P. Diaz,et al.  Alpha 1-antitrypsin deficiency: evaluation of bronchiectasis with CT. , 1996, Radiology.

[20]  M. Cosio,et al.  Centrilobular and panlobular emphysema in smokers. Two distinct morphologic and functional entities. , 1991, The American review of respiratory disease.

[21]  G. Berry,et al.  Bronchiolitis obliterans after lung transplantation: detection using expiratory HRCT. , 1998, Chest.

[22]  R. Stockley,et al.  Physiological and radiological characterisation of patients diagnosed with chronic obstructive pulmonary disease in primary care , 2000, Thorax.

[23]  D. Hansell,et al.  Obliterative bronchiolitis: individual CT signs of small airways disease and functional correlation. , 1997, Radiology.

[24]  B. Mazoyer,et al.  Abnormalities of the airways and lung parenchyma in asthmatics: CT observations in 50 patients and inter- and intraobserver variability , 2004, European Radiology.

[25]  A. Silman,et al.  Statistical methods for assessing observer variability in clinical measures. , 1992, BMJ.

[26]  M. Green,et al.  Cryptogenic obliterative bronchiolitis in adults. , 1981, Thorax.

[27]  H Itoh,et al.  Airway wall thickness in asthma assessed by computed tomography. Relation to clinical indices. , 2000, American journal of respiratory and critical care medicine.

[28]  V. Kinnula,et al.  Value of high-resolution computed tomography in routine evaluation of lung transplantation recipients during development of bronchiolitis obliterans syndrome. , 1996, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[29]  G. Laszlo,et al.  Computed tomography in pulmonary emphysema. , 1982, Clinical radiology.