title: Robust, standardized quantification of pulmonary emphysema in low dose CT exams.
abstract: OBJECTIVE
  The aim of this study was to present and evaluate a fully automated system for emphysema quantification on low-dose computed tomographic images. The platform standardizes emphysema measurements against changes in the reconstruction algorithm and slice thickness.
  
  
  METHODS
  Emphysema was quantified in 149 patients using a fully automatic, in-house developed software (the Robust Automatic On-Line Pulmonary Helper). The accuracy of the system was evaluated against commercial software, and its reproducibility was assessed using pairs of volume-corrected images taken 1 year apart. Furthermore, to standardize quantifications, the effect of changing the reconstruction parameters was modeled using a nonlinear fit, and the inverse of the model function was then applied to the data. The association between quantifications and pulmonary function testing was also evaluated. The accuracy of the in-house software compared to that of commercial software was measured using Spearman's rank correlation coefficient, the mean difference, and the intrasubject variability. Agreement between the methods was studied using Bland-Altman plots. To assess the reproducibility of the method, intraclass correlation coefficients and Bland-Altman plots were used. The statistical significance of the differences between the standardized data and the reference data (soft-tissue reconstruction algorithm B40f; slice thickness, 1 mm) was assessed using a paired two-sample t test.
  
  
  RESULTS
  The accuracy of the method, measured as intrasubject variability, was 3.86 mL for pulmonary volume, 0.01% for emphysema index, and 0.39 Hounsfield units for mean lung density. Reproducibility, assessed using the intraclass correlation coefficient, was >0.95 for all measurements. The standardization method applied to compensate for variations in the reconstruction algorithm and slice thickness increased the intraclass correlation coefficients from 0.87 to 0.97 and from 0.99 to 1.00, respectively. The correlation of the standardized measurements with pulmonary function testing parameters was similar to that of the reference (for the emphysema index and the obstructive subgroup: forced expiratory volume in 1 second, -0.647% vs -0.615%; forced expiratory volume in 1 second/forced vital capacity, -0.672% vs -0.654%; and diffusing capacity for carbon monoxide adjusted for hemoglobin concentration, -0.438% vs -0.523%).
  
  
  CONCLUSIONS
  The new emphysema quantification method presented in this report is accurate and reproducible and, thanks to its standardization method, robust to changes in the reconstruction parameters.
authors.affiliation: Cancer Imaging Laboratory, Oncology Division, Center for Applied Medical Research, University of Navarra, 55 Pio XII, 31008 Pamplona, Spain. mceresa@unav.es
authors.forename: Mario
authors.initials: M
authors.lastname: Ceresa
authors.forename: Gorka
authors.initials: G
authors.lastname: Bastarrika
authors.forename: Juan P
authors.initials: JP
authors.lastname: de Torres
authors.forename: Luis M
authors.initials: LM
authors.lastname: Montuenga
authors.forename: Javier J
authors.initials: JJ
authors.lastname: Zulueta
authors.forename: Carlos
authors.initials: C
authors.lastname: Ortiz-de-Solorzano
authors.forename: Arrate
authors.initials: A
authors.lastname: Muñoz-Barrutia
mesh_terms: D000328:Adult; D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging*; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D012984:Software; D014057:Tomography, X-Ray Computed / Q000379:methods*