What is the value of the chest radiograph as a simple method of diagnosing emphysema and assessing its severity?

The objectives of our study were to reappraise chest radiography in the diagnosis of emphysema using computed tomography (CT) as the reference standard, and to establish whether chest radiography is useful in phenotyping chronic obstructive pulmonary disease (COPD). We studied 154 patients who had postero-anterior and lateral chest radiographs and CT for diagnostic purposes. CT were scored for emphysema using the picture-grading method. Chest radiographs were examined independently by five raters using four criteria for emphysema validated against lung pathology. Next, we applied these criteria to assess the prevalence of emphysema in 458 COPD patients. Patients with and without evidence of emphysema were compared as regards age, gender, pack-years of smoking, BMI, FEV1, DLCO, and health status. Chest radiography yielded 90% sensitivity and 98% specificity for emphysema. Of 458 COPD patients, 245 had radiologic evidence of emphysema. Emphysemic patients had significantly lower BMI, FEV1, and DLCO, greater restriction of physical activity, and worse quality of life than non emphysemic ones. There was no difference across the two groups as to age, gender, or pack-years of smoking. Chest radiography is a simple means for diagnosing moderate to severe emphysema. It is useful in phenotyping COPD, and may aid physicians in their choice of treatment.

Reproduced with permission from European Respiratory Society Journals Ltd.