title: Back to the future: sagittal CT in the evaluation of COPD.
abstract: OBJECTIVE
  To identify features of obstructive airway disease on sagittal reconstruction, compare the accuracy of findings to traditional imaging characteristics of COPD, and determine the fraction of additional cases identified using new characteristics.
  
  
  METHODS
  The study was approved by the centre's Institutional Review Board and is HIPAA compliant. Two hundred sixteen patients with HRCT and spirometry within a 3-month window were included. Four radiologists evaluated each HRCT for traditional characteristics of COPD and new quantitative and qualitative features of obstruction on axial and sagittal reconstructions. Imaging characteristics were assessed for correlation with the spirometric diagnosis of obstructive airway disease.
  
  
  RESULTS
  Quantitative and qualitative findings on sagittal reconstruction are highly specific for COPD (specificity >90 %). Features of hyperinflation on sagittal reconstruction are more accurate predictors of obstruction than traditional axial measures, with greater interobserver reliability (hyperinflation left hemidiaphragm: accuracy: 70.08 % ± 2.49 %; kappa: 0.511 versus traditional measures: accuracy: 62.00 % ± 5.38 %; kappa: 0.407). Sagittal reconstruction identified 27-70 % more patients with COPD than traditional axial findings (p < 0.05).
  
  
  CONCLUSIONS
  Analysis of sagittal reconstruction enables greater accuracy and specificity in the diagnosis of obstructive airway disease compared to traditional measures on axial imaging. Use of sagittal reconstructions can help identify up to 70 % more patients with COPD than traditional imaging findings alone.
  
  
  CONCLUSIONS
  • HRCT sagittal reconstruction is useful in the evaluation of obstructive lung disease. • Findings on sagittal reconstructions allow physicians to more accurately diagnose COPD. • Routine use of sagittal reconstructions increases the sensitivity for diagnosing COPD.
authors.affiliation: Perelman School of Medicine, The University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Hightower
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA, 19104, USA.
authors.forename: Chiemezie
authors.initials: C
authors.lastname: Amadi
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA, 19104, USA.
authors.forename: Elana
authors.initials: E
authors.lastname: Den
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA, 19104, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Schmitt
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA, 19104, USA.
authors.forename: Rosita M
authors.initials: RM
authors.lastname: Shah
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA, 19104, USA. millerw@uphs.upenn.edu.
authors.forename: Wallace T
authors.initials: WT
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D015203:Reproducibility of Results; D013147:Spirometry; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords: COPD; Diagnostic accuracy; HRCT; Obstruction; Sagittal reconstruction