Intra- and interoperator variability of lobar pulmonary volumes and emphysema scores in patients with chronic obstructive pulmonary disease and emphysema: comparison of manual and semi-automated segmentation techniques

Molinari, Francesco; Pirronti, Tommaso; Sverzellati, Nicola; Diciotti, Stefano; Amato, Michele; Paolantonio, G; Gentile, Leonarda; Parapatt, George Koshy; D’Argento, Francesco; Kuhnigk, Jan-Martin

doi:10.5152/dir.2013.047

Cited by 7 publications

(7 citation statements)

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“…As we expected, we found that right upper lobe and right middle lobe were major sources of relative variability (considering fissure) due to sharing of the other fissure (minor fissure) by visual observation, in agreement with the previous study [ 39 ]. Fissure analysis was not included as a part of algorithm in any of 4 programs that we used.…”

Section: Discussionsupporting

confidence: 93%

Fully Automated Pulmonary Lobar Segmentation: Influence of Different Prototype Software Programs onto Quantitative Evaluation of Chronic Obstructive Lung Disease

et al. 2016

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ObjectivesSurgical or bronchoscopic lung volume reduction (BLVR) techniques can be beneficial for heterogeneous emphysema. Post-processing software tools for lobar emphysema quantification are useful for patient and target lobe selection, treatment planning and post-interventional follow-up. We aimed to evaluate the inter-software variability of emphysema quantification using fully automated lobar segmentation prototypes.Material and Methods66 patients with moderate to severe COPD who underwent CT for planning of BLVR were included. Emphysema quantification was performed using 2 modified versions of in-house software (without and with prototype advanced lung vessel segmentation; programs 1 [YACTA v.2.3.0.2] and 2 [YACTA v.2.4.3.1]), as well as 1 commercial program 3 [Pulmo3D VA30A_HF2] and 1 pre-commercial prototype 4 [CT COPD ISP ver7.0]). The following parameters were computed for each segmented anatomical lung lobe and the whole lung: lobar volume (LV), mean lobar density (MLD), 15th percentile of lobar density (15th), emphysema volume (EV) and emphysema index (EI). Bland-Altman analysis (limits of agreement, LoA) and linear random effects models were used for comparison between the software.ResultsSegmentation using programs 1, 3 and 4 was unsuccessful in 1 (1%), 7 (10%) and 5 (7%) patients, respectively. Program 2 could analyze all datasets. The 53 patients with successful segmentation by all 4 programs were included for further analysis. For LV, program 1 and 4 showed the largest mean difference of 72 ml and the widest LoA of [-356, 499 ml] (p<0.05). Program 3 and 4 showed the largest mean difference of 4% and the widest LoA of [-7, 14%] for EI (p<0.001).ConclusionsOnly a single software program was able to successfully analyze all scheduled data-sets. Although mean bias of LV and EV were relatively low in lobar quantification, ranges of disagreement were substantial in both of them. For longitudinal emphysema monitoring, not only scanning protocol but also quantification software needs to be kept constant.

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Section: Discussionsupporting

confidence: 93%

Fully Automated Pulmonary Lobar Segmentation: Influence of Different Prototype Software Programs onto Quantitative Evaluation of Chronic Obstructive Lung Disease

et al. 2016

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“…This was true despite the frequent need for minor manual interventions to optimize lobe segmentation. This result is in accordance with a recent study of the interoperator agreement that used the same software (12). Conversely, this result partly contradicts another study in which the authors used a different software model that allowed only manual segmentation of the lobes, which indicates that the segmentation method used affects the reproducibility (8).…”

Section: Discussionsupporting

confidence: 88%

CT-based weight assessment of lung lobes: comparison with ex vivo measurements

Sverzellati

Kuhnigk

Furia

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to evaluate the validity of lung lobe weight assessment via computed tomography (CT) by comparing CT-derived and ex vivo measurements. MATERIALS AND METHODSUnenhanced CT scanning was performed in 30 consecutive patients before lobectomy for lung cancer. The CT images were analyzed using research software after allowing for lobar weight quantitation. The lobar weight estimated by CT was then compared with that measured after surgery using a precision scale (ex vivo measurement). Comparisons as well as assessment of intra-and interoperator variability were conducted using the Bland-Altman method and the coefficient of repeatability (CR). Correlations were examined using Pearson's correlation analysis. RESULTSComparison analyses were feasible for 28 cases. The ex vivo lobe weight was 186.2±57.3 g, whereas the weights measured by the two operators by CT were 190.0±55 and 182.4±58.2 g, respectively. As compared with ex vivo weights, the CR was 36.4 for operator 1 and 50.4 for operator 2; the mean differences were 3.8 and -3.8 for operators 1 and 2, respectively. The intraoperator and interoperator CR were 20.9 and 36.6, respectively. The mean differences for the intra-and interoperator analysis were -1.5 and -7.5, respectively. The correlation was very high between CT-based and ex vivo measurements (r=0.95 and r=0.90 for operators 1 and 2, respectively; P < 0.001). CONCLUSIONEstimation of lung lobe weight by semi-automated CT analysis is sufficiently reproducible and in agreement with ex vivo measurements. C omputed tomography (CT) is the most widely used imaging modality for the evaluation of lung disease at the lobar level. Several methods for the automatic and semi-automatic segmentation of the lung lobes have been developed (1-5).This advance in postprocessing CT technique also allows lobar assessment of several CT parameters, such as volume, mean density, and emphysema extent. Lobe-specific measurements may provide insight into both underlying disease mechanisms and the spectrum of disease phenotypes (particularly in chronic obstructive lung disease), as well as help to refine therapeutic strategies (4-6). Prior studies also evaluated the reliability of the corresponding measurements by testing the inherent interoperator variability or comparing software results with the visual score (7,8). However, the accuracies of CT-based lobe segmentation and measurements have yet to be proven in comparison with a gold standard, such as pathological measurements.The combination of lung volume and density allows the estimation of other volumetric parameters such as lung weight (9, 10). The lobe weight when assessed by automated CT analysis may be suitable for pathological correlations. Lobe weight measurement, as outlined in the present study, is based on the calculation of lobe density and volume. Lobe volume variation (e.g., due to different levels of inspiration) may be attenuated using the density of the corresponding lung. Therefore, weighing the lungs by CT may be important because suc...

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“…The relatively lower ICC for the lobar volume of the RML (ICC = 0.88) and larger confidence interval (0.84, 0.91) indicates the variance in identifying the right minor fissure. Based on the previous publication by Molinari et al [26], there is a relatively higher variability regarding the identification of the right minor fissure because it is connected with the right major fissure. A missing or indeterminate right minor fissure may cause difficulties in right lobe segmentation (Fig.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Evaluation of Lobar Pulmonary Function of Emphysema Patients with Endobronchial Coils

et al. 2019

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Background: Recent advances in bronchoscopic lung volume reduction offer new therapies for patients with emphysema and hyperinflation. Pulmonary lobe segmentation with quantification of lobar volumes and emphysema severity plays a pivotal role in treatment planning and post-interventional assessment. Computed tomography (CT)-derived lobar volumes could reflect more accurate regional changes in pulmonary function. Objectives: The aim of our study is to validate the reliability of an in-house CT Lung Segmentation software (LungSeg; the Hamlyn Centre, Imperial College London, UK) for lung lobar volume and emphysema quantification for chronic obstructive pulmonary disease (COPD) patients. Methods: A total of 108 CT scans from subjects who participated in an endobronchial coil treatment trial were included. Lobar volume and emphysema quantification were performed using the LungSeg and Syngo CT Pulmo 3D package (Siemens Healthcare GmbH, Germany). The inter-user reliability of the LungSeg program was investigated. Correlation coefficients and Bland-Altman analyses were used to quantify the inter-software variability. The agreement between CT volume analysis and plethysmography analysis was also examined. Results: The high intraclass correlation coefficients (mean ICC = 0.98) of the lobar volumes and emphysema indices measured by LungSeg suggest its excellent reproducibility. The LungSeg and Syngo program have good correlation (rho ≥0.94) and agreement for both lobar volume (median difference = 94 mL and LOA_np = 214.6 mL) and emphysema index (median difference ≤1.5% and LOA_np ≤2.03%) calculations. CT analysis provides a higher estimation of total lung capacity (TLC_CT) than body plethysmography (TLC_pleth), while there is a fair agreement on residual volume (RV_CT) by LungSeg as compared with body plethysmography (RV_pleth). Conclusions: CT-derived lobar volume and emphysema quantification using the LungSeg program is efficient and reliable in allowing lobar volume assessment. LungSeg has low inter-user variability and agrees better with plethysmography for COPD assessment in our study.

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Intra- and interoperator variability of lobar pulmonary volumes and emphysema scores in patients with chronic obstructive pulmonary disease and emphysema: comparison of manual and semi-automated segmentation techniques

Cited by 7 publications

References 30 publications

Fully Automated Pulmonary Lobar Segmentation: Influence of Different Prototype Software Programs onto Quantitative Evaluation of Chronic Obstructive Lung Disease

Fully Automated Pulmonary Lobar Segmentation: Influence of Different Prototype Software Programs onto Quantitative Evaluation of Chronic Obstructive Lung Disease

CT-based weight assessment of lung lobes: comparison with ex vivo measurements

Quantitative Evaluation of Lobar Pulmonary Function of Emphysema Patients with Endobronchial Coils

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