Takeyuki Watadani MD, Presenter: Nothing to Disclose

Fumikazu Sakai MD, PhD, Abstract Co-Author: Research Consultant, Bayer AG Research Consultant, Chugai Pharmaceutical Co, Ltd Research Consultant, Wythe

Takeshi Johkoh MD, PhD, Abstract Co-Author: Research Consultant, Bayer AG Research Consultant, Chugai Pharmaceutical Co, Ltd Research Consultant, Wythe

Satoshi Noma MD, PhD, Abstract Co-Author: Nothing to Disclose

Masanori Akira, Abstract Co-Author: Nothing to Disclose

Kiminori Fujimoto MD, PhD, Abstract Co-Author: Advisory Board, Bayer AG

Honeycomb lung (Hc) is one of the most important findings in the evaluation of interstitial pneumonia (IP). Purposes of the study are to investigate interobserver difference of Hc diagnosis and investigate the causes of the discordance.

Eighty HRCT images (single image per one patient) of Hc and mimickers (without pathological confirmation) were collected from 30 chest radiologists and chest physicians. Hc and UIP diagnosis was determined by the consensus of 5 experienced chest radiologists. Forty-two observers (18 domestic and overseas expert chest radiologists in IP, 10 board-certified chest radiologists, 5 non-chest board-certified radiologists and 9 chest physicians majoring in IP) scored five points scale (5 = definite, 4 = probable, 3 = possible 2 = probably not, 1 = definite not ) to evaluate the probability of Hc and usual interstitial pneumonia (UIP) pattern. Concordance of Hc diagnosis among observers and groups, concordance of Hc and UIP diagnosis were investigated.

In general, concordance of Hc diagnosis is not so good (k values range from 0.47 to 0.56) among expert radiologists, board-certified chest radiologists and chest physicians, while, concordance in non-chest radiologists is relatively low (k= 0.4). Worldwide interregional concordance of expert radiologists were approximately same (k ranges 0.52 to 0. 56), except relatively low concordance rate of North America (k=0.47), however: not statistically significant. Wide range of concordance rate was observed within each observer group and between observers in same regions. The cases showing discordant Hc diagnosis included IP with emphysema, cluster of very large cyst, cluster of traction bronchiectasis, single layered alignment of cysts, small areas of multilayer constellation of cysts. Kappa value of Hc and UIP score in each observer varies widely (0.2 to 0.9).

Concordance rate of atypical Hc is not so high even among experienced chest radiologists. The different score of Hc is seen in cases with small extent of multicystic shadow, single layered alignment of cyst, and prominent destructive change with cluster of large cysts or severe emphysema.

It should be remained that relatively wide variation in Hc diagnosis. Attention must be paid to use the term of “honeycomb lung”.

Watadani, T, Sakai, F, Johkoh, T, Noma, S, Akira, M, Fujimoto, K, Diagnosis of Honeycomb Lung Is Sometimes Discordant even among Experienced Radiologists.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9010697.html