The Objective Identification and Quantification of Interstitial Lung Abnormalities in Smokers

Samuel Y. Ash, Rola Harmouche, James C. Ross, Alejandro A. Diaz, Gary M. Hunninghake, Rachel K. Putman, Jorge Onieva, Fernando J. Martinez, Augustine M. Choi, David A. Lynch, Hiroto Hatabu, Ivan O. Rosas, Raul San Jose Estepar, George R. Washko

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Rationale and Objectives Previous investigation suggests that visually detected interstitial changes in the lung parenchyma of smokers are highly clinically relevant and predict outcomes, including death. Visual subjective analysis to detect these changes is time-consuming, insensitive to subtle changes, and requires training to enhance reproducibility. Objective detection of such changes could provide a method of disease identification without these limitations. The goal of this study was to develop and test a fully automated image processing tool to objectively identify radiographic features associated with interstitial abnormalities in the computed tomography scans of a large cohort of smokers. Materials and Methods An automated tool that uses local histogram analysis combined with distance from the pleural surface was used to detect radiographic features consistent with interstitial lung abnormalities in computed tomography scans from 2257 individuals from the Genetic Epidemiology of COPD study, a longitudinal observational study of smokers. The sensitivity and specificity of this tool was determined based on its ability to detect the visually identified presence of these abnormalities. Results The tool had a sensitivity of 87.8% and a specificity of 57.5% for the detection of interstitial lung abnormalities, with a c-statistic of 0.82, and was 100% sensitive and 56.7% specific for the detection of the visual subtype of interstitial abnormalities called fibrotic parenchymal abnormalities, with a c-statistic of 0.89. Conclusions In smokers, a fully automated image processing tool is able to identify those individuals who have interstitial lung abnormalities with moderate sensitivity and specificity.

Original languageEnglish (US)
Pages (from-to)941-946
Number of pages6
JournalAcademic Radiology
Issue number8
StatePublished - Aug 2017


  • CT scanner
  • Pulmonary fibrosis
  • cigarettes
  • diffuse parenchymal lung diseases
  • idiopathic
  • interstitial
  • pneumonia
  • x-ray

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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