The diagnostic value of grey-scale inversion technique in chest radiography

Roberta Eufrasia Ledda; Mario Silva; Nicole McMichael; Carlotta Sartorio; Cristina Branchi; Gianluca Milanese; Sundeep M Nayak; Nicola Sverzellati

doi:10.1007/s11547-022-01453-0

The diagnostic value of grey-scale inversion technique in chest radiography

Radiol Med. 2022 Mar;127(3):294-304. doi: 10.1007/s11547-022-01453-0. Epub 2022 Jan 18.

Authors

Roberta Eufrasia Ledda^#¹, Mario Silva^#¹, Nicole McMichael², Carlotta Sartorio¹, Cristina Branchi¹, Gianluca Milanese³, Sundeep M Nayak⁴, Nicola Sverzellati¹

Affiliations

¹ Department of Medicine and Surgery, University of Parma, Scienze Radiologiche, University Hospital of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy.
² Department of Radiology Diagnostics, Skåne University Hospital of Malmö, Malmö, Sweden.
³ Department of Medicine and Surgery, University of Parma, Scienze Radiologiche, University Hospital of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy. gianluca.milanese@unipr.it.
⁴ Department of Radiology, Kaiser Permanente Northern California, San Leandro, CA, USA.

^# Contributed equally.

Abstract

Purpose: We investigated whether the additional use of grey-scale inversion technique improves the interpretation of eight chest abnormalities, in terms of diagnostic performance and interobserver variability.

Material and methods: A total of 507 patients who underwent a chest computed tomography (CT) examination and a chest radiography (CXR) within 24 h were enrolled. CT was the standard of reference. Images were retrospectively reviewed for the presence of atelectasis, consolidation, interstitial abnormality, nodule, mass, pleural effusion, pneumothorax and rib fractures. Four CXR reading settings, involving 3 readers were organized: only standard; only inverted; standard followed by inverted; and inverted followed by standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy, assessed with the area under the curve (AUC), and their 95% confidence interval were calculated for each reader and setting. Interobserver agreement was tested by Cohen's K test with quadratic weights (K_w) and its 95%CI.

Results: CXR sensitivity % for any finding was 35.1 (95% CI: 33 to 37) for setting 1, 35.9 (95% CI: 33 to 37), for setting 2, 32.59 (95% CI: 30 to 34) for setting 3, and 35.56 (95% CI: 33 to 37) for setting 4; specificity % 93.78 (95% CI: 91 to 95), 93.92 (95% CI: 91 to 95), 94.43 (95% CI: 92 to 96), 93.86 (95% CI: 91 to 95); PPV % 56.22 (95% CI: 54.2 to 58.2), 56.49 (95% CI: 54.5 to 58.5), 57.15 (95% CI: 55 to 59), 56.75 (95% CI: 54 to 58); NPV % 85.66 (95% CI: 83 to 87), 85.74 (95% CI: 83 to 87), 85.29 (95% CI: 83 to 87), 85.73 (95% CI: 83 to 87); AUC values 0.64 (95% CI: 0.62 to 0.66), 0.65 (95% CI: 0.63 to 0.67), 0.64 (95% CI: 0.62 to 0.66), 0.65 (95% CI: 0.63 to 0.67); K_w values 0.42 (95% CI: 0.4 to 0.44), 0.40 (95% CI: 0.38 to 0.42), 0.42 (95% CI: 0.4 to 0.44), 0.41 (95% CI: 0.39 to 0.43) for settings 1, 2, 3 and 4, respectively.

Conclusions: No significant advantages were observed in the use of grey-scale inversion technique neither over standard display mode nor in combination at the detection of eight chest abnormalities.

Keywords: Chest radiography; Diagnostic performance of chest radiography; Grey-scale inversion; Interobserver agreement.

MeSH terms

Humans
Lung Diseases* / diagnostic imaging
Radiography
Radiography, Thoracic* / methods
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed