Matthew P Moy1, Jeffrey M Levsky2, Netanel S Berko1, Alla Godelman1, Vineet R Jain1, Linda B Haramati3. 1. Department of Radiology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY. 2. Department of Radiology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY. Electronic address: jlevsky@montefiore.org. 3. Department of Radiology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY; Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY.
Abstract
BACKGROUND: There is no standardized system to grade pleural effusion size on CT scans. A validated, systematic grading system would improve communication of findings and may help determine the need for imaging guidance for thoracentesis. METHODS: CT scans of 34 patients demonstrating a wide range of pleural effusion sizes were measured with a volume segmentation tool and reviewed for qualitative and simple quantitative features related to size. A classification rule was developed using the features that best predicted size and distinguished among small, moderate, and large effusions. Inter-reader agreement for effusion size was assessed on the CT scans for three groups of physicians (radiology residents, pulmonologists, and cardiothoracic radiologists) before and after implementation of the classification rule. RESULTS: The CT imaging features found to best classify effusions as small, moderate, or large were anteroposterior (AP) quartile and maximum AP depth measured at the midclavicular line. According to the decision rule, first AP-quartile effusions are small, second AP-quartile effusions are moderate, and third or fourth AP-quartile effusions are large. In borderline cases, AP depth is measured with 3-cm and 10-cm thresholds for the upper limit of small and moderate, respectively. Use of the rule improved interobserver agreement from κ = 0.56 to 0.79 for all physicians, 0.59 to 0.73 for radiology residents, 0.54 to 0.76 for pulmonologists, and 0.74 to 0.85 for cardiothoracic radiologists. CONCLUSIONS: A simple, two-step decision rule for sizing pleural effusions on CT scans improves interobserver agreement from moderate to substantial levels.
BACKGROUND: There is no standardized system to grade pleural effusion size on CT scans. A validated, systematic grading system would improve communication of findings and may help determine the need for imaging guidance for thoracentesis. METHODS: CT scans of 34 patients demonstrating a wide range of pleural effusion sizes were measured with a volume segmentation tool and reviewed for qualitative and simple quantitative features related to size. A classification rule was developed using the features that best predicted size and distinguished among small, moderate, and large effusions. Inter-reader agreement for effusion size was assessed on the CT scans for three groups of physicians (radiology residents, pulmonologists, and cardiothoracic radiologists) before and after implementation of the classification rule. RESULTS: The CT imaging features found to best classify effusions as small, moderate, or large were anteroposterior (AP) quartile and maximum AP depth measured at the midclavicular line. According to the decision rule, first AP-quartile effusions are small, second AP-quartile effusions are moderate, and third or fourth AP-quartile effusions are large. In borderline cases, AP depth is measured with 3-cm and 10-cm thresholds for the upper limit of small and moderate, respectively. Use of the rule improved interobserver agreement from κ = 0.56 to 0.79 for all physicians, 0.59 to 0.73 for radiology residents, 0.54 to 0.76 for pulmonologists, and 0.74 to 0.85 for cardiothoracic radiologists. CONCLUSIONS: A simple, two-step decision rule for sizing pleural effusions on CT scans improves interobserver agreement from moderate to substantial levels.
Authors: David Jiménez; Gema Díaz; Daniel Gil; Ana Cicero; Esteban Pérez-Rodríguez; Antonio Sueiro; Richard W Light Journal: Respir Med Date: 2005-04-07 Impact factor: 3.415
Authors: Yu Jin Kim; Woo Sun Kim; Young Hun Choi; Jung-Eun Cheon; Jung Yoon Choi; Hyoung Jin Kang; Ji-Eun Park; Young Jin Ryu; In-One Kim Journal: Pediatr Radiol Date: 2018-08-18
Authors: Roberto Lo Gullo; Shelly Mishra; Diego A Lira; Atul Padole; Alexi Otrakji; Ranish Deedar Ali Khawaja; Sarvenaz Pourjabbar; Sarabjeet Singh; Jo-Anne O Shepard; Subba R Digumarthy; Mannudeep K Kalra; James R Stone Journal: Forensic Sci Med Pathol Date: 2015-11-05 Impact factor: 2.007