학술논문
Dark-Field Chest Radiography Outperforms Conventional Chest Radiography for the Diagnosis and Staging of Pulmonary Emphysema.
Document Type
Academic Journal
Author
Urban T; From the Department of Physics, School of Natural Sciences (T.U., M.F., K.W., W.N., H.B., R.S., J.H., F.P.), Munich Institute of Biomedical Engineering (T.U., M.F., K.W., W.N., H.B., R.S., J.H., B.G., F.P.), and Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, Garching (T.U., A.P.S., M.F., K.W., H.B., R.S., F.T.G., J.H.B., A.A.F., B.R., M.R.M., F.P., D.P.); Philips GmbH Innovative Technologies, Philips Research, Hamburg (T.K.); and Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.).; Sauter AP; Frank M; Willer K; Noichl W; Bast H; Schick R; Herzen J; Koehler T; Gassert FT; Bodden JH; Fingerle AA; Gleich B; Renger B; Makowski MR; Pfeiffer F; Pfeiffer D
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0045377 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1536-0210 (Electronic) Linking ISSN: 00209996 NLM ISO Abbreviation: Invest Radiol Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: Dark-field chest radiography (dfCXR) has recently reached clinical trials. Here we compare dfCXR to conventional radiography for the detection and staging of pulmonary emphysema.
Materials and Methods: Subjects were included after a medically indicated computed tomography (CT) scan, showing either no lung impairments or different stages of emphysema. To establish a ground truth, all CT scans were assessed by 3 radiologists assigning emphysema severity scores based on the Fleischner Society classification scheme.Participants were imaged at a commercial chest radiography device and at a prototype for dfCXR, yielding both attenuation-based and dark-field images. Three radiologists blinded to CT score independently assessed images from both devices for presence and severity of emphysema (no, mild, moderate, severe).Statistical analysis included evaluation of receiver operating characteristic curves and pairwise comparison of adjacent Fleischner groups using an area under the curve (AUC)-based z test with a significance level of 0.05.
Results: A total of 88 participants (54 men) with a mean age of 64 ± 12 years were included. Compared with conventional images (AUC = 0.73), readers were better able to identify emphysema with images from the dark-field prototype (AUC = 0.85, P = 0.005). Although ratings of adjacent emphysema severity groups with conventional radiographs differed only for trace and mild emphysema, ratings based on images from the dark-field prototype were different for trace and mild, mild and moderate, and moderate and confluent emphysema.
Conclusions: Dark-field chest radiography is superior to conventional chest radiography for emphysema diagnosis and staging, indicating the technique's potential as a low-dose diagnostic tool for emphysema assessment.
Competing Interests: Conflicts of interest and sources of funding: This study was supported by the European Research Council (AdG 695045); the Federal Ministry of Education and Research; the Free State of Bavaria under the Excellence Strategy of the Federal Government and the Länder; the German Research Foundation (GRK2274); Philips Medical Systems DMC; the Institute for Advanced Study, Technische Universität München; and the Karlsruhe Nano Micro Facility, a Helmholtz Research Infrastructure at Karlsruhe Institute of Technology.
(Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
Materials and Methods: Subjects were included after a medically indicated computed tomography (CT) scan, showing either no lung impairments or different stages of emphysema. To establish a ground truth, all CT scans were assessed by 3 radiologists assigning emphysema severity scores based on the Fleischner Society classification scheme.Participants were imaged at a commercial chest radiography device and at a prototype for dfCXR, yielding both attenuation-based and dark-field images. Three radiologists blinded to CT score independently assessed images from both devices for presence and severity of emphysema (no, mild, moderate, severe).Statistical analysis included evaluation of receiver operating characteristic curves and pairwise comparison of adjacent Fleischner groups using an area under the curve (AUC)-based z test with a significance level of 0.05.
Results: A total of 88 participants (54 men) with a mean age of 64 ± 12 years were included. Compared with conventional images (AUC = 0.73), readers were better able to identify emphysema with images from the dark-field prototype (AUC = 0.85, P = 0.005). Although ratings of adjacent emphysema severity groups with conventional radiographs differed only for trace and mild emphysema, ratings based on images from the dark-field prototype were different for trace and mild, mild and moderate, and moderate and confluent emphysema.
Conclusions: Dark-field chest radiography is superior to conventional chest radiography for emphysema diagnosis and staging, indicating the technique's potential as a low-dose diagnostic tool for emphysema assessment.
Competing Interests: Conflicts of interest and sources of funding: This study was supported by the European Research Council (AdG 695045); the Federal Ministry of Education and Research; the Free State of Bavaria under the Excellence Strategy of the Federal Government and the Länder; the German Research Foundation (GRK2274); Philips Medical Systems DMC; the Institute for Advanced Study, Technische Universität München; and the Karlsruhe Nano Micro Facility, a Helmholtz Research Infrastructure at Karlsruhe Institute of Technology.
(Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)