The National Emphysema Treatment Trial (NETT) found patients with upper lobe-predominant emphysema have a better survival rate and often show improvements in symptoms and exercise tolerance after lung volume reduction surgery (LVRS). High-resolution CT scanning of the chest typically determines whether this procedure is appropriate for a patient.
Craig P. Hersh, MD, MPH, and Edwin K. Silverman, MD, PhD, both from the Channing Laboratory, and colleagues evaluated the agreement between radiologist and pulmonary physicians in terms of determining whether a patient has upper lobe-predominant emphysema, which may determine if they are eligible for LVRS. These 
findings appear in the February 2007 issue of Chest.
The researchers found poor agreement between multiple readers, including radiologists and pulmonary physicians, in the determination of upper lobe-predominant disease for the group of 30 patients with varying emphysema severity; however, agreement between clinicians tended to be better in cases with clear upper lobe-predominance, as determined by computer software. In Figure 1, two of five clinicians interpreted this HRCT scan as showing upper lobe-predominant emphysema.
The National Institutes of Health funded this research.
