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Interobserver variability in the evaluation of primary graft dysfunction after lung transplantation: impact of radiological training and analysis of discordant cases

  • Chest Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

Radiologic criteria for the diagnosis of primary graft dysfunction (PGD) after lung transplantation are nonspecific and can lead to misinterpretation. The primary aim of our study was to assess the interobserver agreement in the evaluation of chest X-rays (CXRs) for PGD diagnosis and to establish whether a specific training could have an impact on concordance rates. Secondary aim was to analyze causes of interobserver discordances.

Material and methods

We retrospectively enrolled 164 patients who received bilateral lung transplantation at our institution, between February 2013 and December 2019. Three radiologists independently reviewed postoperative CXRs and classified them as suggestive or not for PGD. Two of the Raters performed a specific training before the beginning of the study. A senior thoracic radiologist subsequently analyzed all discordant cases among the Raters with the best agreement. Statistical analysis to calculate interobserver variability was percent agreement, Cohen’s kappa and intraclass correlation coefficient.

Results

A total of 473 CXRs were evaluated. A very high concordance among the two trained Raters, 1 and 2, was found (K = 0.90, ICC = 0.90), while a poorer agreement was found in the other two pairings (Raters 1 and 3: K = 0.34, ICC = 0.40; Raters 2 and 3: K = 0.35, ICC = 0.40). The main cause of disagreement (52.4% of discordant cases) between Raters 1 and 2 was the overestimation of peribronchial thickening in the absence of unequivocal bilateral lung opacities or the incorrect assessment of unilateral alterations.

Conclusion

To properly identify PGD, it is recommended for radiologists to receive an adequate specific training.

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Availability of data and material

The data that support the findings of this study are available from the authors, upon reasonable request.

Code availability

N/A.

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Maria Carmela Andrisani, Valentina Vespro & Gianpaolo Carrafiello

  2. Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Milan, Italy

    Stefano Fusco & Pierino Spadafora

  3. University of Milan, Milan, Italy

    Alessandro Palleschi & Valeria Musso

  4. Thoracic Surgery and Lung Transplantation Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Alessandro Palleschi, Valeria Musso & Francesco Damarco

  5. Deparment of Radiology, ASST Bergamo Ovest, Ospedale Treviglio-Caravaggio, Treviglio, BG, Italy

    Andrea Esposito

  6. Department of Radiology, ASST Santi Paolo e Carlo, Presidio San Paolo, Milan, Italy

    Alessandra Coppola

  7. Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Vittorio Scaravilli

  8. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

    Vittorio Scaravilli

  9. Department of Clinical Epidemiology and Biostatistics, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Laura Cortesi

  10. Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy

    Luigia Scudeller

  11. Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy

    Anna Rita Larici

  12. Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

    Anna Rita Larici

  13. Department of Health Science, University of Milan, Milan, Italy

    Gianpaolo Carrafiello

Authors
  1. Maria Carmela Andrisani
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  2. Valentina Vespro
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Correspondence to Stefano Fusco.

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Andrisani, M.C., Vespro, V., Fusco, S. et al. Interobserver variability in the evaluation of primary graft dysfunction after lung transplantation: impact of radiological training and analysis of discordant cases. Radiol med 127, 145–153 (2022). https://doi.org/10.1007/s11547-021-01438-5

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  • DOI: https://doi.org/10.1007/s11547-021-01438-5

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