Skip to main content
SpringerLink
Log in

Chest Computed Tomography-Based Scoring of Thoracic Sarcoidosis: Inter-rater Reliability of CT Abnormalities

  • Chest
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine inter-rater reliability of sarcoidosis-related computed tomography (CT) findings that can be used for scoring of thoracic sarcoidosis.

Materials and methods

CT images of 51 patients with sarcoidosis were scored by five chest radiologists for various abnormal CT findings (22 in total) encountered in thoracic sarcoidosis. Using intra-class correlation coefficient (ICC) analysis, inter-rater reliability was analysed and reported according to the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) criteria. A pre-specified sub-analysis was performed to investigate the effect of training. Scoring was trained in a distinct set of 15 scans in which all abnormal CT findings were represented.

Results

Median age of the 51 patients (36 men, 70 %) was 43 years (range 26 – 64 years). All radiographic stages were present in this group. ICC ranged from 0.91 for honeycombing to 0.11 for nodular margin (sharp versus ill-defined). The ICC was above 0.60 in 13 of the 22 abnormal findings. Sub-analysis for the best-trained observers demonstrated an ICC improvement for all abnormal findings and values above 0.60 for 16 of the 22 abnormalities.

Conclusions

In our cohort, reliability between raters was acceptable for 16 thoracic sarcoidosis-related abnormal CT findings.

Key Points

• Thoracic sarcoidosis is common; knowledge on reliability of CT scoring is limited.

• Scoring CT abnormalities in pulmonary sarcoidosis can achieve good inter-rater agreement.

• CT scoring validation in thoracic sarcoidosis is important for diagnostic and prognostic studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

CT:

Computed tomography

ICC:

Intra-class correlation coefficient

GRRAS:

Guidelines for Reporting reliability and Agreement Studies

PACS:

Picture Archiving and Communication System

WASOG:

World Association of Sarcoidosis and Other Granulomatous disorders

ANOVA:

Analysis of variance

References

  1. Chiles C (2002) Imaging features of thoracic sarcoidosis. Semin Roentgenol 37:82–93

    Article  PubMed  Google Scholar 

  2. Hennebicque AS, Nunes H, Brillet PY, Moulahi H, Valeyre D, Brauner MW (2005) CT findings in severe thoracic sarcoidosis. Eur Radiol 15(1):23–30

    Article  PubMed  Google Scholar 

  3. Criado E, Sanchez M, Ramirez J et al (2010) Pulmonary sarcoidosis: Typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics 30:1567–1586

    Article  PubMed  Google Scholar 

  4. Spagnolo P, Sverzellati N, Wells AU, Hansell D (2014) Imaging aspects of the diagnosis of sarcoidosis. Eur Radiol 24(4):807–816

    Article  PubMed  Google Scholar 

  5. Naccache JM, Lavole A, Nunes H et al (2008) High-resolution computed tomographic imaging of airways in sarcoidosis patients with airflow obstruction. J Comput Assist Tomogr 32:905–912

    Article  PubMed  Google Scholar 

  6. Drent M, De Vries J, Lenters M et al (2003) Sarcoidosis: Assessment of disease severity using HRCT. Eur Radiol 13:2462–2471

    Article  PubMed  Google Scholar 

  7. Abehsera M, Valeyre D, Grenier P, Jaillet H, Battesti JP, Brauner MW (2000) Sarcoidosis with pulmonary fibrosis: CT patterns and correlation with pulmonary function. AJR Am J Roentgenol 174:1751–1757

    Article  CAS  PubMed  Google Scholar 

  8. Bergin CJ, Bell DY, Coblentz CL et al (1989) Sarcoidosis: Correlation of pulmonary parenchymal pattern at CT with results of pulmonary function tests. Radiology 171:619–624

    Article  CAS  PubMed  Google Scholar 

  9. Hansell DM, Milne DG, Wilsher ML, Wells AU (1998) Pulmonary sarcoidosis: Morphologic associations of airflow obstruction at thin-section CT. Radiology 209:697–704

    Article  CAS  PubMed  Google Scholar 

  10. Murdoch J, Muller NL (1992) Pulmonary sarcoidosis: Changes on follow-up CT examination. AJR Am J Roentgenol 159:473–477

    Article  CAS  PubMed  Google Scholar 

  11. Brauner MW, Lenoir S, Grenier P, Cluzel P, Battesti JP, Valeyre D (1992) Pulmonary sarcoidosis: CT assessment of lesion reversibility. Radiology 182:349–354

    Article  CAS  PubMed  Google Scholar 

  12. Fazzi P, Sbragia P, Solfanelli S, Troilo S, Giuntini C (2001) Functional significance of the decreased attenuation sign on expiratory CT in pulmonary sarcoidosis. Chest 119:1270–1274

    Article  CAS  PubMed  Google Scholar 

  13. Akira M, Kozuka T, Inoue Y, Sakatani M (2005) Long-term follow-up CT scan evaluation in patients with pulmonary sarcoidosis. Chest 127:185–191

    Article  PubMed  Google Scholar 

  14. Zappala CJ, Desai SR, Copley SJ et al (2014) Accuracy of individual variables in the monitoring of long-term change in pulmonary sarcoidosis as judged by serial high- resolution CT scan data. Chest 145:101–107

    Article  PubMed  Google Scholar 

  15. Scadding JG (1961) Prognosis of intrathoracic sarcoidosis in england. A review of 136 cases after five years' observation. Br Med J 2:1165–1172

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Costabel U, Hunninghake GW (1999) ATS/ERS/WASOG statement on sarcoidosis. sarcoidosis statement committee. american thoracic society. european respiratory society. world association for sarcoidosis and other granulomatous disorders. Eur Respir J 14:735–737

    Article  CAS  PubMed  Google Scholar 

  17. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J (2008) Fleischner society: Glossary of terms for thoracic imaging. Radiology 246:697–722

    Article  PubMed  Google Scholar 

  18. Sverzellati N, Devaraj A, Desai SR, Quigley M, Wells AU, Hansell DM (2011) Method for minimizing observer variation for the quantitation of high-resolution computed tomographic signs of lung disease. J Comput Assist Tomogr 35:596–601

    Article  PubMed  Google Scholar 

  19. Kottner J, Audige L, Brorson S et al (2011) Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. J Clin Epidemiol 64:96–106

    Article  PubMed  Google Scholar 

  20. Rosner B (2010) Fundamentals in biostatisctics 7th, edn. Brooks/Cole, Pacific Grove California United States

    Google Scholar 

  21. Rankin G, Stokes M (1998) Reliability of assessment tools in rehabilitation: An illustration of appropriate statistical analyses. Clin Rehabil 12:187–199

    Article  CAS  PubMed  Google Scholar 

  22. Mostard RL, Verschakelen JA, van Kroonenburgh MJ (2013) Severity of pulmonary involvement and (18)F-FDG PET activity in sarcoidosis. Respir Med 107(3):439–447

    Article  PubMed  Google Scholar 

  23. Marchiori E, Zanetti G, Barreto MM, de Andrade FT, Rodrigues RS (2011) Atypical distribution of small nodules on high resolution CT studies: patterns and differentials. Respir Med 105(9):1263–1267

    Article  PubMed  Google Scholar 

  24. Walsh SL, Wells AU, Sverzellati N et al (2014) An integrated clinicoradiological staging system for pulmonary sarcoidosis: a case-cohort study. Lancet Respir Med 2(2):123–130

    Article  PubMed  Google Scholar 

  25. Oberstein A, von Zitzewitz H, Schweden F, Muller-Quernheim J (1997) Non invasive evaluation of the inflammatory activity in sarcoidosis with high-resolution computed tomography. Sarcoidosis Vasc Diffuse Lung Dis 14:65–72

    CAS  PubMed  Google Scholar 

  26. Baughman RP, Shipley R, Desai S et al (2009) Changes in chest roentgenogram of sarcoidosis patients during a clinical trial of infliximab therapy: comparison of different methods of evaluation. Chest 136(2):526–535

    CAS  PubMed  Google Scholar 

  27. Zappala CJ, Desai SR, Copley SJ et al (2011) Optimal scoring of serial change on chest radiography in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 28(2):130–138

    CAS  PubMed  Google Scholar 

  28. Muers MF, Middleton WG, Gibson GJ et al (1997) A simple radiographic scoring method for monitoring pulmonary sarcoidosis: relations between radiographic scores, dyspnoea grade and respiratory function in the British Thoracic Society Study of Long-Term Corticosteroid Treatment. Sarcoidosis Vasc Diffuse Lung Dis 14(1):46–56

    CAS  PubMed  Google Scholar 

  29. Johkoh T, Sakai F, Noma S et al (2014) Honeycombing on CT; its definition, pathologic correlation, and future direction of its diagnosis. Eur J Radiol 83:27–31

    Article  PubMed  Google Scholar 

  30. Ng CS, Desai SR, Rubens MB, Padley SP, Wells AU, Hansell DM (1999) Visual quantitation and observer variation of signs of small airways disease at inspiratory and expiratory CT. J Thorac Imaging 14:279–285

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The scientific guarantor of this publication is prof. J.C. Grutters. 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. The authors state that this work has not received any funding. 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. None of the study subjects or cohorts have been previously reported. Methodology: retrospective, cross sectional study, multicenter study.

Author information

Authors and Affiliations

  1. Department of Radiology, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands

    D. A. Van den Heuvel, H. W. van Es, J. P. van Heesewijk & M. Spee

  2. Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    P. A. de Jong

  3. Division Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    P. Zanen & J. C. Grutters

  4. Center of Interstitial Lung Diseases, Department of Pulmonology, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands

    P. Zanen & J. C. Grutters

Authors
  1. D. A. Van den Heuvel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. A. de Jong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Zanen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. W. van Es
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. P. van Heesewijk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Spee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. C. Grutters
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. A. Van den Heuvel.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Van den Heuvel, D.A., de Jong, P.A., Zanen, P. et al. Chest Computed Tomography-Based Scoring of Thoracic Sarcoidosis: Inter-rater Reliability of CT Abnormalities. Eur Radiol 25, 2558–2566 (2015). https://doi.org/10.1007/s00330-015-3685-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-015-3685-4

Keywords

Search

Navigation