Background: This study was designed to measure inter-observer variation between thoracic radiologists in the diagnosis of diffuse parenchymal lung disease (DPLD) using high resolution computed tomography (HRCT) and to identify areas of difficulty where expertise, in the form of national panels, would be of particular value. Methods: HRCT images of 131 patients with DPLD (from a tertiary referral hospital (n = 66) and regional teaching centres (n = 65)) were reviewed by 11 thoracic radiologists. Inter-observer variation for the first choice diagnosis was quantified using the unadjusted kappa coefficient of agreement. Observers stated differential diagnoses and assigned a percentage likelihood to each. A weighted kappa was calculated for the likelihood of each of the six most frequently diagnosed disease entities. Results: Observer agreement on the first choice diagnosis was moderate for the entire cohort (k = 0.48) and was higher for cases from regional centres (k = 0.60) than for cases from the tertiary referral centre (k = 0.34). 62% of cases from regional teaching centres were diagnosed with high confidence and good observer agreement (k = 0.77). Non-specific interstitial pneumonia (NSIP) was in the differential diagnosis in most disagreements (55%). Weighted kappa values quantifying the likelihood of specific diseases were moderate to good (mean 0.57, range 0.49-0.70). Conclusion: There is good agreement between thoracic radiologists for the HRCT diagnosis of DPLD encountered in regional teaching centres. However, cases diagnosed with low confidence, particularly where NSIP is considered as a differential diagnosis, may benefit from the expertise of a reference panel.
A number of mediastinal reflections are visible at conventional radiography that represent points of contact between the mediastinum and adjacent lung. The presence or distortion of these reflections is the key to the detection and interpretation of mediastinal abnormalities. Anterior mediastinal masses can be identified when the hilum overlay sign is present and the posterior mediastinal lines are preserved. Widening of the right paratracheal stripe and convexity relative to the aortopulmonary window reflection indicate a middle mediastinal abnormality. Disruption of the azygoesophageal recess can result from disease in either the middle or posterior mediastinum. Paravertebral masses disrupt the paraspinal lines, and the location of masses above the level of the clavicles can be inferred by their lateral margins, which are sharp in posterior masses but not in anterior masses. The divisions of the mediastinum are not absolute; however, referring to the local anatomy of the mediastinal reflections in an attempt to more accurately localize an abnormality may help narrow the differential diagnosis. Identification of the involved mediastinal compartment helps determine which imaging modality might be appropriate for further study.
Microbiological cure of tuberculosis does not restore PM within 6 mo, despite a strong anabolic response. Change in the p-ratio is a suitable parameter for use in studying the effect of disease on body composition because it allows transformation of such effects into a normal distribution across a wide range of baseline proportion between fat and protein mass.
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