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

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Abstract

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.

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Abbreviations

LAA−950 :

Low-attenuation area with attenuation values of −950 HU or lower

GEE:

Generalised estimating equations

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Acknowledgments

The authors acknowledge the valuable assistance of Yoshitami Murayama, Hideki Yamaguchi and Kouhei Satoh in image collection and of Akira Kasai and Shingo Baba for their important suggestions.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Yoshitake Yamada, Masahiro Jinzaki, Masahiro Hashimoto, Eisuke Shiomi & Sachio Kuribayashi

  2. Department of Radiology, Nippon Koukan Hospital, 1-2-1, Kokandori, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-0852, Japan

    Yoshitake Yamada & Kenji Ogawa

  3. Center for Clinical Research, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Takayuki Abe

Authors
  1. Yoshitake Yamada
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  2. Masahiro Jinzaki
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  3. Masahiro Hashimoto
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  4. Eisuke Shiomi
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Correspondence to Yoshitake Yamada.

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Yamada, Y., Jinzaki, M., Hashimoto, M. et al. Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference. Eur Radiol 23, 2118–2126 (2013). https://doi.org/10.1007/s00330-013-2814-1

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  • DOI: https://doi.org/10.1007/s00330-013-2814-1

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