Accuracy of multidetector computed tomography with maximum intensity projection technique in the assessment of fissure integrity.

Autor:	Soder SA; Health Sciences Postgraduation Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.; Division of Thoracic Surgery, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil., Perin FA; Division of Thoracic Surgery, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil., Felicetti JC; Division of Thoracic Surgery, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil., Camargo JJP; Division of Thoracic Surgery, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil., Camargo SM; Division of Thoracic Surgery, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil., Hochhegger B; Department of Radiology, University of Florida, Gainesville, FL, USA., Teixeira PJZ; Division of Pneumology, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2022 Jan; Vol. 14 (1), pp. 54-63.
DOI:	10.21037/jtd-21-1359
Abstrakt:	Background: Bronchoscopic lung volume reduction (BLVR) is a potential treatment for patients with severe emphysema, performed through the placement of unidirectional endobronchial valves (EBVs). Their benefits are only achieved in patients that significantly reduce lobar volume, and it is mandatory that the fissures are complete. Fissure evaluation is preferably done by computed tomography, but little is known if its evaluation corresponds to the anatomical findings. The aim of this study is to evaluate the accuracy of thoracic radiologists in the identification of complete fissures by multidetector computed tomography (MDCT) using maximum intensity projection (MIP) technique, compared with direct anatomical evaluation. Methods: Prospective study, conducted in a single institution. Patients submitted to thoracic surgery had their fissures classified as complete or incomplete by thoracic surgeons and their preoperative chest scans evaluated by three radiologists, blinded for surgical evaluation. With the intraoperative categorization as a reference, the accuracy and concordance of the three thoracic radiologists' evaluation were calculated. The most experienced radiologist evaluated the fissures at two different moments to estimate the intra-observer agreement. Results: There were included 67 patients, being 37 (55%) males, with a mean age of 64 years. The accuracy of radiological identification of complete fissures ranged from 76.8% for left posterior oblique fissure to 85.1% for left anterior oblique fissure, with the best performance achieved by the most experienced radiologist. The concordance of the radiological evaluation for fissure integrity compared to the surgical assessment (k) was 0.53-0.68. Intra-observer agreement ranged from 0.74 to 0.87. Conclusions: The evaluation of the fissure integrity by MDCT analysis using MIP technique by thoracic radiologists had high accuracy among the thoracic radiologists. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-21-1359/coif). The authors have no conflicts of interest to declare. (2022 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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