A combined pulmonary-radiology workshop for visual evaluation of COPD: Study design, chest CT findings and concordance with quantitative evaluation

R. Graham Barr, Eugene A. Berkowitz, Francesca Bigazzi, Frederick Bode, Jessica Bon, Russell P. Bowler, Caroline Chiles, James D. Crapo, Gerard J. Criner, Jeffrey L. Curtis, Chandra Dass, Asger Dirksen, Mark T. Dransfield, Goutham Edula, Leif Erikkson, Adam Friedlander, Maya Galperin-Aizenberg, Warren B. Gefter, David S. Gierada, Philippe A. GrenierJonathan Goldin, Mei Lan K. Han, Nicola A. Hanania, Nadia N. Hansel, Francine L. Jacobson, Hans Ulrich Kauczor, Vuokko L. Kinnula, David A. Lipson, David A. Lynch, William MacNee, Barry J. Make, A. James Mamary, Howard Mann, Nathaniel Marchetti, Mario Mascalchi, Geoffrey McLennan, James R. Murphy, David Naidich, Hrudaya Nath, John D. Newell, Massimo Pistolesi, Elizabeth A. Regan, John J. Reilly, Robert Sandhaus, Joyce D. Schroeder, Frank Sciurba, Saher Shaker, Amir Sharafkhaneh, Edwin K. Silverman, Robert M. Steiner, Charlton Strange, Nicola Sverzellati, Joseph H. Tashjian, Edwin J.R. Van Beek, Lacey Washington, George R. Washko, Gloria Westney, Susan A. Wood, Prescott G. Woodruff

Research output: Contribution to journalArticlepeer-review

135 Scopus citations


The purposes of this study were: to describe chest CT findings in normal non-smoking controls and cigarette smokers with and without COPD; to compare the prevalence of CT abnormalities with severity of COPD; and to evaluate concordance between visual and quantitative chest CT (QCT) scoring. Methods: Volumetric inspiratory and expiratory CT scans of 294 subjects, including normal non-smokers, smokers without COPD, and smokers with GOLD Stage I-IV COPD, were scored at a multi-reader workshop using a standardized worksheet. There were 58 observers (33 pulmonologists, 25 radiologists); each scan was scored by 9-11 observers. Interobserver agreement was calculated using kappa statistic. Median score of visual observations was compared with QCT measurements. Results: Interobserver agreement was moderate for the presence or absence of emphysema and for the presence of panlobular emphysema; fair for the presence of centrilobular, paraseptal, and bullous emphysema subtypes and for the presence of bronchial wall thickening; and poor for gas trapping, centrilobular nodularity, mosaic attenuation, and bronchial dilation. Agreement was similar for radiologists and pulmonologists. The prevalence on CT readings of most abnormalities (e.g. emphysema, bronchial wall thickening, mosaic attenuation, expiratory gas trapping) increased significantly with greater COPD severity, while the prevalence of centrilobular nodularity decreased. Concordances between visual scoring and quantitative scoring of emphysema, gas trapping and airway wall thickening were 75%, 87% and 65%, respectively. Conclusions: Despite substantial inter-observer variation, visual assessment of chest CT scans in cigarette smokers provides information regarding lung disease severity; visual scoring may be complementary to quantitative evaluation.

Original languageEnglish
Pages (from-to)151-159
Number of pages9
JournalCOPD: Journal of Chronic Obstructive Pulmonary Disease
Issue number2
StatePublished - Apr 2012


  • Airways
  • CT
  • Emphysema
  • Visual evaluation


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