European Radiology

, Volume 26, Issue 2, pp 487–494 | Cite as

Visual assessment of early emphysema and interstitial abnormalities on CT is useful in lung cancer risk analysis

  • Mathilde M. W. WilleEmail author
  • Laura H. Thomsen
  • Jens Petersen
  • Marleen de Bruijne
  • Asger Dirksen
  • Jesper H. Pedersen
  • Saher B. Shaker



Screening for lung cancer should be limited to a high-risk-population, and abnormalities in low-dose computed tomography (CT) screening images may be relevant for predicting the risk of lung cancer. Our aims were to compare the occurrence of visually detected emphysema and interstitial abnormalities in subjects with and without lung cancer in a screening population of smokers.


Low-dose chest CT examinations (baseline and latest possible) of 1990 participants from The Danish Lung Cancer Screening Trial were independently evaluated by two observers who scored emphysema and interstitial abnormalities. Emphysema (lung density) was also measured quantitatively.


Emphysema was seen more frequently and its extent was greater among participants with lung cancer on baseline (odds ratio (OR), 1.8, p = 0.017 and p = 0.002) and late examinations (OR 2.6, p < 0.001 and p < 0.001). No significant difference was found using quantitative measurements. Interstitial abnormalities were more common findings among participants with lung cancer (OR 5.1, p < 0.001 and OR 4.5, p < 0.001).There was no association between presence of emphysema and presence of interstitial abnormalities (OR 0.75, p = 0.499).


Even early signs of emphysema and interstitial abnormalities are associated with lung cancer. Quantitative measurements of emphysema—regardless of type—do not show the same association.

Key Points

Visually detected emphysema on CT is more frequent in individuals who develop lung cancer.

Emphysema grading is higher in those who develop lung cancer.

Interstitial abnormalities, including discrete changes, are associated with lung cancer.

Quantitative lung density measurements are not useful in lung cancer risk prediction.

Early CT signs of emphysema and interstitial abnormalities can predict future risk.


Computed tomography Lung cancer Emphysema Interstitial abnormalities Comorbidity 



Body mass index


Chronic obstructive pulmonary disease


Computed tomography


Danish Lung Cancer Screening Trial


Forced expiratory volume in one second


Hounsfield units


Interstitial lung disease


Idiopathic pulmonary fibrosis


Low attenuation area percentage under −910 HU


Low attenuation area percentage under −950 HU


15th percentile density


Predicted total lung capacity



We thank AstraZeneca, Sweden, for financial support. The scientific guarantor of this publication is Asger Dirksen. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in DLCST studies regarding nodule characteristics, lung function and lung density. Therefore an extensive overlap between study populations in these publications exists. We have previously published a study on the interobserver agreement and emphysema progression in visual assessments of DLCST scans [21]. The association of visual findings with lung cancer has, however, not previously been explored, and the data from the present study have not been published before. All relevant references are disclosed. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

Supplementary material

330_2015_3826_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 20 kb)


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Mathilde M. W. Wille
    • 1
    Email author
  • Laura H. Thomsen
    • 2
  • Jens Petersen
    • 3
  • Marleen de Bruijne
    • 3
    • 4
  • Asger Dirksen
    • 1
  • Jesper H. Pedersen
    • 5
  • Saher B. Shaker
    • 1
  1. 1.Department of Respiratory MedicineGentofte HospitalHellerupDenmark
  2. 2.Department of Respiratory MedicineHvidovre HospitalHvidovreDenmark
  3. 3.Department of Computer Science, DIKUUniversity of CopenhagenKøbenhavn ØDenmark
  4. 4.Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical InformaticsErasmus MC -University Medical Center RotterdamRotterdamThe Netherlands
  5. 5.Department of Thoracic Surgery, RigshospitaletCopenhagen University HospitalKøbenhavn ØDenmark

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