Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference

• Published in: European radiology Vol. 23; no. 8; pp. 2118 - 2126
• Main Authors: Yamada, Yoshitake, Jinzaki, Masahiro, Hashimoto, Masahiro, Shiomi, Eisuke, Abe, Takayuki, Kuribayashi, Sachio, Ogawa, Kenji
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2013; Springer Nature B.V
• Subjects: Aged; Chest; Chronic obstructive pulmonary disease; Diagnostic Radiology; Drug dosages; Emphysema; Female; Humans; Imaging; Inflammation; Internal Medicine; Interventional Radiology; Lung diseases; Male; Medicine; Medicine & Public Health; Middle Aged; Multidetector Computed Tomography - methods; Neuroradiology; Nuclear accidents & safety; Patients; Predictive Value of Tests; Pulmonary Emphysema - diagnostic imaging; Radiation; Radiographic Image Enhancement - methods; Radiographic Image Interpretation, Computer-Assisted - methods; Radiography; Radiography, Thoracic - methods; Radiology; Radiology - methods; Reproducibility of Results; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Tomography; Tomography, X-Ray Computed - methods; Ultrasound; Japan; Radiography; Thorax; Pulmonary emphysema; Tomosynthesis; Multidetector computed tomography
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-013-2814-1

Objectives To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Methods Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of −950 HU or lower (LAA −950 ) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. Results ROC analysis revealed significantly better performance ( P < 0.0001) of tomosynthesis than radiography for the detection of pulmonary emphysema. The average sensitivity, specificity, positive predictive value and negative predictive value of tomosynthesis were 0.875, 0.968, 0.955 and 0.910, respectively, whereas the values for radiography were 0.479, 0.913, 0.815 and 0.697, respectively. For both tomosynthesis and radiography, the sensitivity increased with increasing LAA −950 . Conclusions The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA −950 . Key Points • Tomosynthesis showed significantly better diagnostic performance for pulmonary emphysema than radiography. • Interobserver agreement for tomosynthesis was significantly higher than that for radiography. • Sensitivity increased with increasing LAA − 950 in both tomosynthesis and radiography. • Tomosynthesis imparts a similar radiation dose to two projection chest radiography. • Radiation dose and cost of tomosynthesis are lower than those of MDCT.