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Objective: To evaluate whether a simple semi-quantitative method aided by software enhanced visualization can be reliable enough for the quantification of emphysema during the daily workload.Patients and methods: Thirty patients with COPD were included. Patients had a standard non enhanced MDCT study of the chest using a 16 slice machine. The images were evaluated visually and scored. This scoring was repeated after applying a density mask. Three radiologists evaluated the images on separate occasions. Repeatability was also tested. The CT emphysema index and the mean lung attenuation were calculated. The extent of airway disease was not assessed.Results: Kappa test between the 3 readers revealed slight agreement (k = 0.122, p = 0.001) before the density mask and substantial agreement (k = 0.75, p < 0.0005) after its application. A high degree of repeatability was found. The median visual score after density mask application, showed a stronger correlation to the emphysema index (r = 0.81, p < 0.0005) than before.Conclusion: We present a simple visual score for quantitation of emphysema, that when combined with a simple density mask, the inter-rater agreement and repeatability of scoring are markedly improved. This method appears to be fast and easy to perform

CT quantification of emphysema: Is semi-quantitative scoring a reliable enough method?