Visual and Quantitative Evaluation of Emphysema: A Case-Control Study of 1111 Participants in the Pilot Swedish CArdioPulmonary BioImage Study (SCAPIS)

Research output: Contribution to journalArticle


Rationale and Objectives: Emphysema is a hallmark of chronic obstructive pulmonary disease. The primary aim of this study was to investigate inter- and intraobserver agreement of visual assessment of mild emphysema in low-dose multidetector computed tomography of subjects in the pilot SCAPIS in order to certify consistent detection of mild emphysema. The secondary aim was to investigate the performance of quantitative densitometric measurements in the cohort. Materials and Methods: Participants with emphysema (n = 100, 56 males and 44 females) reported in the electronic case report form of pilot SCAPIS and 100 matched controls (gender, age, height, and weight) without emphysema were included. To assess interobserver variability the randomized examinations were evaluated by two thoracic radiologists. For intraobserver variability three radiologists re-evaluated randomized examinations which they originally evaluated. The results were evaluated statistically by Krippendorff's α. The dataset was also assessed quantitively for % lung attenuation value −950 HU (LAV950), mean lung density and total lung volume by commercially available software. Results: Emphysema was visually scored as mild and Krippendorff's α was ≥0.8 for both the inter- and intraobserver agreement regarding presence of emphysema and approaching 0.8 regarding presence and extent of emphysema by location in the upper lobes. Mean LAV950 was not different between the emphysematous and the nonemphysematous participants; 8.3% and 8.4%, respectively. Conclusion: The inter- and intraobserver agreement for visual detection of mild emphysema in low-dose multidetector computed tomography was good. Surprisingly, quantitative analysis could not reliably identify participants with mild emphysema, which hampers the use of automatic evaluation.


  • J. Vikgren
  • Mohammad Khalil
  • Kerstin Cederlund
  • K. Sörensen
  • Marianne Boijsen
  • John Brandberg
  • Erik Lampa
  • Magnus C. Sköld
  • Per Wollmer
  • Eva Lindberg
  • J. E. Engvall
  • Göran Bergström
  • K. Torén
  • Åse A. Johnsson
External organisations
  • Sahlgrenska University Hospital
  • Karolinska Institutet
  • Norrland University Hospital
  • Karolinska University Hospital
  • Uppsala University
  • Linköping University
  • Sahlgrenska Academy
  • Södertälje Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Radiology, Nuclear Medicine and Medical Imaging


  • chronic obstructive, Multidetector computed tomography, observational study, pulmonary disease, pulmonary emphysema
Original languageEnglish
JournalAcademic Radiology
Publication statusE-pub ahead of print - 2019 Jul 18
Publication categoryResearch