OBJECTIVES: Fissure integrity (FI) plays a key role in selecting patients for interventional emphysema therapy. We investigated its interference with automated lobar segmentation in quantitative computed tomography (CT) and emphysema distribution. METHODS: CT was available for 50 patients with chronic obstructive pulmonary disease (COPD). Lobe segmentation was performed fully automated by software and corrected manually. FI was evaluated visually using a %-scale. The influence of FI on emphysema ratio (ER=percentage of lung volume with density values<-950 HU), mean lung density (MLD), emphysema and total volume of adjacent lobes was analyzed. Lobe-based results were compared with respect to FI. RESULTS: Differences in ER in adjacent lobes for complete vs. incomplete fissures were 12.4% for the right horizontal, 0.2% and 3% for the right oblique and 4.4% for the left oblique fissure (all p>0.05). Results for emphysema comparing automated vs. manually corrected segmentation exceeded clinically acceptable values, but were not significantly affected by FI (p>0.05). The widest limits of agreement for ER and MLD were noted in the right middle lobe ([-14, 17.4%], [-22.4, 32.4 Hounsfield Units]). CONCLUSIONS: Automated lobe segmentation and emphysema distribution are not significantly affected by FI. Manual correction of automated lobar segmentation is still recommended in severe emphysema.
- Muller, J.
- Lim, H. J.
- Eichinger, M.
- Jobst, B. J.
- Eberhardt, R.
- Gompelmann, D.
- Koenigkam-Santos, M.
- Puderbach, M.
- Kauczor, H. U.
- Heussel, C. P.
- Wielputz, M. O.
Keywords
- Chronic obstructive pulmonary disease
- Collateral ventilation
- Emphysema
- Fissure integrity
- Quantitative computed tomography
