The purposes of this study were: to describe chest CT findings in normal non-smoking controls and cigarette smokers with and without COPD; to compare the prevalence of CT abnormalities with severity of COPD; and to evaluate concordance between visual and quantitative chest CT (QCT) scoring Methods Volumetric inspiratory and expiratory CT scans of 294 subjects, including normal non-smokers, smokers without COPD, and smokers with GOLD Stage I-IV COPD, were scored at a multi-reader workshop using a standardized worksheet. There were fifty-eight observers (33 pulmonologists, 25 radiologists); each scan was scored by 9–11 observers. Interobserver agreement was calculated using kappa statistic. Median score of visual observations was compared with QCT measurements. Results Interobserver agreement was moderate for the presence or absence of emphysema and for the presence of panlobular emphysema; fair for the presence of centrilobular, paraseptal, and bullous emphysema subtypes and for the presence of bronchial wall thickening; and poor for gas trapping, centrilobular nodularity, mosaic attenuation, and bronchial dilation. Agreement was similar for radiologists and pulmonologists. The prevalence on CT readings of most abnormalities (e.g. emphysema, bronchial wall thickening, mosaic attenuation, expiratory gas trapping) increased significantly with greater COPD severity, while the prevalence of centrilobular nodularity decreased. Concordances between visual scoring and quantitative scoring of emphysema, gas trapping and airway wall thickening were 75%, 87% and 65%, respectively. Conclusions Despite substantial inter-observer variation, visual assessment of chest CT scans in cigarette smokers provides information regarding lung disease severity; visual scoring may be complementary to quantitative evaluation.

P ulmonary MRI has had limited clinical use for patients with lung disease, especially when compared with radiography, CT, and PET/CT. However, MRI has become practical in many countries due to advances in MRI pulse sequences, multicoil parallel imaging, and acceleration methods, along with the increased (but not universal) availability of postprocessing software. Recently, ultrashort echo time (UTE) and zero echo time proton MRI have extended the use of conventional or anatomic proton MRI for clinical examinations, and inhaled-gas methods have opened up avenues for functional lung imaging. The transition to MRI from radiography-based methods has been driven by the fact that MRI does not impart ionizing radiation, which is particularly important in younger patients with chronic illness (eg, cystic fibrosis [CF]), for young and pregnant women, or for those patients requiring extensive longitudinal follow-up (eg, severe asthma).The purpose of this Fleischner Society position paper is to familiarize our community with recent advances in pulmonary MRI and to provide a consensus expert opinion regarding appropriate clinical indications for this modality. These opinions were initially endorsed in consensus among the writing committee members, following which the manuscript was endorsed by the Society members at large and was approved by the Fleischner Society Publication Development and Oversight Committee and the Fleischner Executive Committee before submission to Radiology.Common clinical indications for pulmonary MRI were reviewed by members of the writing committee and have been divided into three groups: (a) group 1 indications are suggested for current clinical use of pulmonary MRI (four or more publications from multiple institutions with clinical studies of more than 100 patients); (b) group 2 indications are promising but require further validation or regulatory approval (two to three publications with fewer than 100 patients, those that use methods requiring further confirmation or regulatory approval, such as hyperpolarized gases); and (c) group 3 indications are appropriate for research investigations (clinical studies not meeting the above criteria or limited to preclinical research) (Table 1).

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Laparoscopic surgery has already begun to influence the management of diverticular disease, but the randomized controlled trials needed to support therapy decisions are largely missing.

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