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A novel scoring system to measure radiographic abnormalities and related spirometric values in cured pulmonary tuberculosis.

Báez-Saldaña R, López-Arteaga Y, Bizarrón-Muro A, Ferreira-Guerrero E, Ferreyra-Reyes L, Delgado-Sánchez G, Cruz-Hervert LP, Mongua-Rodríguez N, García-García L - PLoS ONE (2013)

Bottom Line: The Bland-Altman analysis of the intra-observer agreement showed a mean bias of 0.87% and -0.55% and an inter-observer agreement of -0.35% and -1.78%, indicating a minor average systematic variability.After adjustment for age, gender, height, smoking status, pack-years of smoking, and degree of dyspnea, the scoring degree of radiographic abnormalities was significantly and negatively associated with absolute and percent predicted values of FVC: -0.07 (CI:95%, -0.01 to -0.04); -2.48 (CI:95%, -3.45 to -1.50); and FEV1 -0.07 (CI:95%, -0.10 to -0.05); -2.92 (CI:95%, -3.87 to -1.97) respectively, in the patients studied.As intra-observer and inter-observer agreement of the SRA varied from good to excellent, the use of SRA in this setting appears acceptable.

View Article: PubMed Central - PubMed

Affiliation: Instituto Nacional de Enfermedades Respiratorias (INER), Mexico, D.F., Mexico ; Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico.

ABSTRACT

Background: Despite chemotherapy, patients with cured pulmonary tuberculosis may result in lung functional impairment.

Objective: To evaluate a novel scoring system based on the degree of radiographic abnormalities and related spirometric values in patients with cured pulmonary tuberculosis.

Methods: One hundred and twenty seven patients with cured pulmonary tuberculosis were prospectively enrolled in a referral hospital specializing in respiratory diseases. Spirometry was performed and the extent of radiographic abnormalities was evaluated twice by each of two readers to generate a novel quantitative score. Scoring reproducibility was analyzed by the intra-class correlation coefficient (ICC) and the Bland-Altman method. Multiple linear regression models were performed to assess the association of the extent of radiographic abnormalities with spirometric values.

Results: The intra-observer agreement for scoring of radiographic abnormalities (SRA) showed an ICC of 0.81 (CI:95%, 0.67-0.95) and 0.78 (CI:95%, 0.65-0.92), for reader 1 and 2, respectively. Inter-observer reproducibility for the first measurement was 0.83 (CI:95%, 0.71-0.95), and for the second measurement was 0.74 (CI:95%, 0.58-0.90). The Bland-Altman analysis of the intra-observer agreement showed a mean bias of 0.87% and -0.55% and an inter-observer agreement of -0.35% and -1.78%, indicating a minor average systematic variability. After adjustment for age, gender, height, smoking status, pack-years of smoking, and degree of dyspnea, the scoring degree of radiographic abnormalities was significantly and negatively associated with absolute and percent predicted values of FVC: -0.07 (CI:95%, -0.01 to -0.04); -2.48 (CI:95%, -3.45 to -1.50); and FEV1 -0.07 (CI:95%, -0.10 to -0.05); -2.92 (CI:95%, -3.87 to -1.97) respectively, in the patients studied.

Conclusion: The extent of radiographic abnormalities, as evaluated through our novel scoring system, was inversely associated with spirometric values, and exhibited good reliability and reproducibility. As intra-observer and inter-observer agreement of the SRA varied from good to excellent, the use of SRA in this setting appears acceptable.

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Related in: MedlinePlus

Representative example radiographs of quadrants for each score, according to the degree of radiographic abnormality using the same quadrant (upper left).The radiographs are from different patients from the study.
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pone-0078926-g001: Representative example radiographs of quadrants for each score, according to the degree of radiographic abnormality using the same quadrant (upper left).The radiographs are from different patients from the study.

Mentions: We used routine film posterior-anterior chest radiographs as a non-invasive technique to quantify the extent of lung remodelling in our patients. Each chest radiograph was assessed for the presence, distribution, and extent of pulmonary abnormalities, such as airspace consolidation and fibrosis, lung distortion, traction bronchiectasis, irregular interfaces, and parenchymal bands. We developed a quantitative scale to measure the degree of radiographic abnormalities. The pulmonary parenchyma was evaluated in four quadrants, with the division between the upper and lower lung in both sides being arbitrarily set at the carina section. Each quadrant was scored from 0 to 5, where 0 indicated a normal appearance, and 5 indicated severe abnormality. The score represented the percentage of lung parenchyma involvement. The maximum score for the four lung zones was 20 (Figures 1 and 2). The same image was read twice separately by two experienced observers (pulmonologist researcher RBS, reader one; and radiologist RCP, reader two) who were blinded to clinical or lung functional information. The time elapsed between the first and second measurements was two weeks.


A novel scoring system to measure radiographic abnormalities and related spirometric values in cured pulmonary tuberculosis.

Báez-Saldaña R, López-Arteaga Y, Bizarrón-Muro A, Ferreira-Guerrero E, Ferreyra-Reyes L, Delgado-Sánchez G, Cruz-Hervert LP, Mongua-Rodríguez N, García-García L - PLoS ONE (2013)

Representative example radiographs of quadrants for each score, according to the degree of radiographic abnormality using the same quadrant (upper left).The radiographs are from different patients from the study.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3815252&req=5

pone-0078926-g001: Representative example radiographs of quadrants for each score, according to the degree of radiographic abnormality using the same quadrant (upper left).The radiographs are from different patients from the study.
Mentions: We used routine film posterior-anterior chest radiographs as a non-invasive technique to quantify the extent of lung remodelling in our patients. Each chest radiograph was assessed for the presence, distribution, and extent of pulmonary abnormalities, such as airspace consolidation and fibrosis, lung distortion, traction bronchiectasis, irregular interfaces, and parenchymal bands. We developed a quantitative scale to measure the degree of radiographic abnormalities. The pulmonary parenchyma was evaluated in four quadrants, with the division between the upper and lower lung in both sides being arbitrarily set at the carina section. Each quadrant was scored from 0 to 5, where 0 indicated a normal appearance, and 5 indicated severe abnormality. The score represented the percentage of lung parenchyma involvement. The maximum score for the four lung zones was 20 (Figures 1 and 2). The same image was read twice separately by two experienced observers (pulmonologist researcher RBS, reader one; and radiologist RCP, reader two) who were blinded to clinical or lung functional information. The time elapsed between the first and second measurements was two weeks.

Bottom Line: The Bland-Altman analysis of the intra-observer agreement showed a mean bias of 0.87% and -0.55% and an inter-observer agreement of -0.35% and -1.78%, indicating a minor average systematic variability.After adjustment for age, gender, height, smoking status, pack-years of smoking, and degree of dyspnea, the scoring degree of radiographic abnormalities was significantly and negatively associated with absolute and percent predicted values of FVC: -0.07 (CI:95%, -0.01 to -0.04); -2.48 (CI:95%, -3.45 to -1.50); and FEV1 -0.07 (CI:95%, -0.10 to -0.05); -2.92 (CI:95%, -3.87 to -1.97) respectively, in the patients studied.As intra-observer and inter-observer agreement of the SRA varied from good to excellent, the use of SRA in this setting appears acceptable.

View Article: PubMed Central - PubMed

Affiliation: Instituto Nacional de Enfermedades Respiratorias (INER), Mexico, D.F., Mexico ; Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico.

ABSTRACT

Background: Despite chemotherapy, patients with cured pulmonary tuberculosis may result in lung functional impairment.

Objective: To evaluate a novel scoring system based on the degree of radiographic abnormalities and related spirometric values in patients with cured pulmonary tuberculosis.

Methods: One hundred and twenty seven patients with cured pulmonary tuberculosis were prospectively enrolled in a referral hospital specializing in respiratory diseases. Spirometry was performed and the extent of radiographic abnormalities was evaluated twice by each of two readers to generate a novel quantitative score. Scoring reproducibility was analyzed by the intra-class correlation coefficient (ICC) and the Bland-Altman method. Multiple linear regression models were performed to assess the association of the extent of radiographic abnormalities with spirometric values.

Results: The intra-observer agreement for scoring of radiographic abnormalities (SRA) showed an ICC of 0.81 (CI:95%, 0.67-0.95) and 0.78 (CI:95%, 0.65-0.92), for reader 1 and 2, respectively. Inter-observer reproducibility for the first measurement was 0.83 (CI:95%, 0.71-0.95), and for the second measurement was 0.74 (CI:95%, 0.58-0.90). The Bland-Altman analysis of the intra-observer agreement showed a mean bias of 0.87% and -0.55% and an inter-observer agreement of -0.35% and -1.78%, indicating a minor average systematic variability. After adjustment for age, gender, height, smoking status, pack-years of smoking, and degree of dyspnea, the scoring degree of radiographic abnormalities was significantly and negatively associated with absolute and percent predicted values of FVC: -0.07 (CI:95%, -0.01 to -0.04); -2.48 (CI:95%, -3.45 to -1.50); and FEV1 -0.07 (CI:95%, -0.10 to -0.05); -2.92 (CI:95%, -3.87 to -1.97) respectively, in the patients studied.

Conclusion: The extent of radiographic abnormalities, as evaluated through our novel scoring system, was inversely associated with spirometric values, and exhibited good reliability and reproducibility. As intra-observer and inter-observer agreement of the SRA varied from good to excellent, the use of SRA in this setting appears acceptable.

Show MeSH
Related in: MedlinePlus