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CT-Based Visual Grading System Predicts Deaths from Emphysema

Routine use of classification system could identify high-risk individuals for preventive interventions.

Janelle Weaver, Contributor
Tuesday, June 5, 2018


Emphysema is a smoking-related lung disease that causes progressive damage of the air sacs, frequently resulting in shortness of breath and chronic cough. Computed tomography (CT) has been extensively validated as a tool for assessing the presence, pattern and severity of emphysema. In 2015, a visual classification system for grading the severity of emphysema based on CT images was proposed by the Fleischner Society -- an international, multidisciplinary medical society for thoracic radiology, dedicated to the diagnosis and treatment of diseases of the chest.

In a study published May 15 in the journal Radiology, researchers set out to determine whether the Fleischner Society classification system might provide a simple way to assess mortality risk among cigarette smokers. In the study, trained research analysts used the visual classification system to evaluate chest CT scans from 3,171 current and former cigarette smokers. Five hundred nineteen of the study participants died over an average follow-up period of more than seven years. Compared with subjects who did not have visible signs of emphysema, mortality was greater in those with any grade of emphysema beyond trace.

According to the authors, this is the first analysis of the relationship between visually assessed emphysema patterns and mortality. In the future, applying the Fleischner Society classification system to routine clinical radiology readings could identify individuals at higher risk of death, potentially leading to preventive interventions, including smoking cessation and other risk-factor modifications.