Maria Carmela Andrisani1, Valentina Vespro1, Stefano Fusco2, Alessandro Palleschi3,4, Valeria Musso3,4, Andrea Esposito5, Alessandra Coppola6, Pierino Spadafora7, Francesco Damarco4, Vittorio Scaravilli8,9, Laura Cortesi10, Luigia Scudeller11, Anna Rita Larici12,13, Gianpaolo Carrafiello1,14. 1. Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. 2. Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Milan, Italy. stefano.fusco@unimi.it. 3. University of Milan, Milan, Italy. 4. Thoracic Surgery and Lung Transplantation Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. 5. Deparment of Radiology, ASST Bergamo Ovest, Ospedale Treviglio-Caravaggio, Treviglio, BG, Italy. 6. Department of Radiology, ASST Santi Paolo e Carlo, Presidio San Paolo, Milan, Italy. 7. Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Milan, Italy. 8. Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. 9. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. 10. Department of Clinical Epidemiology and Biostatistics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 11. Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy. 12. Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy. 13. Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy. 14. Department of Health Science, University of Milan, Milan, Italy.
Abstract
PURPOSE: Radiologic criteria for the diagnosis of primary graft dysfunction (PGD) after lung transplantation are nonspecific and can lead to misinterpretation. The primary aim of our study was to assess the interobserver agreement in the evaluation of chest X-rays (CXRs) for PGD diagnosis and to establish whether a specific training could have an impact on concordance rates. Secondary aim was to analyze causes of interobserver discordances. MATERIAL AND METHODS: We retrospectively enrolled 164 patients who received bilateral lung transplantation at our institution, between February 2013 and December 2019. Three radiologists independently reviewed postoperative CXRs and classified them as suggestive or not for PGD. Two of the Raters performed a specific training before the beginning of the study. A senior thoracic radiologist subsequently analyzed all discordant cases among the Raters with the best agreement. Statistical analysis to calculate interobserver variability was percent agreement, Cohen's kappa and intraclass correlation coefficient. RESULTS: A total of 473 CXRs were evaluated. A very high concordance among the two trained Raters, 1 and 2, was found (K = 0.90, ICC = 0.90), while a poorer agreement was found in the other two pairings (Raters 1 and 3: K = 0.34, ICC = 0.40; Raters 2 and 3: K = 0.35, ICC = 0.40). The main cause of disagreement (52.4% of discordant cases) between Raters 1 and 2 was the overestimation of peribronchial thickening in the absence of unequivocal bilateral lung opacities or the incorrect assessment of unilateral alterations. CONCLUSION: To properly identify PGD, it is recommended for radiologists to receive an adequate specific training.
PURPOSE: Radiologic criteria for the diagnosis of primary graft dysfunction (PGD) after lung transplantation are nonspecific and can lead to misinterpretation. The primary aim of our study was to assess the interobserver agreement in the evaluation of chest X-rays (CXRs) for PGD diagnosis and to establish whether a specific training could have an impact on concordance rates. Secondary aim was to analyze causes of interobserver discordances. MATERIAL AND METHODS: We retrospectively enrolled 164 patients who received bilateral lung transplantation at our institution, between February 2013 and December 2019. Three radiologists independently reviewed postoperative CXRs and classified them as suggestive or not for PGD. Two of the Raters performed a specific training before the beginning of the study. A senior thoracic radiologist subsequently analyzed all discordant cases among the Raters with the best agreement. Statistical analysis to calculate interobserver variability was percent agreement, Cohen's kappa and intraclass correlation coefficient. RESULTS: A total of 473 CXRs were evaluated. A very high concordance among the two trained Raters, 1 and 2, was found (K = 0.90, ICC = 0.90), while a poorer agreement was found in the other two pairings (Raters 1 and 3: K = 0.34, ICC = 0.40; Raters 2 and 3: K = 0.35, ICC = 0.40). The main cause of disagreement (52.4% of discordant cases) between Raters 1 and 2 was the overestimation of peribronchial thickening in the absence of unequivocal bilateral lung opacities or the incorrect assessment of unilateral alterations. CONCLUSION: To properly identify PGD, it is recommended for radiologists to receive an adequate specific training.
Authors: Mayil S Krishnam; Robert D Suh; Anderanik Tomasian; Jonathan G Goldin; Chi Lai; Kathleen Brown; Poonam Batra; Denise R Aberle Journal: Radiographics Date: 2007 Jul-Aug Impact factor: 5.333
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Authors: M O Meade; R J Cook; G H Guyatt; R Groll; J R Kachura; M Bedard; D J Cook; A S Slutsky; T E Stewart Journal: Am J Respir Crit Care Med Date: 2000-01 Impact factor: 21.405
Authors: Rupal J Shah; Joshua M Diamond; Edward Cantu; James C Lee; David J Lederer; Vibha N Lama; Jonathan Orens; Ann Weinacker; David S Wilkes; Sangeeta Bhorade; Keith M Wille; Lorraine B Ware; Scott M Palmer; Maria Crespo; A Russell Localio; Ejigayehu Demissie; Steven M Kawut; Scarlett L Bellamy; Jason D Christie Journal: Chest Date: 2013-08 Impact factor: 9.410