Interobserver variability in high-resolution CT of the lungs

PURPOSE: To quantify the interobserver variability among the most frequently encountered parenchymal patterns in High Resolution CT (HRCT) and to compare the interobserver variability in the application of the 2011 and 2018 usual interstitial pneumonia (UIP) criteria according to the joint guidelines from international thoracic and respiratory societies. MATERIAL AND METHODS: Two observers independently evaluated 126 HRCT, with examples of most common parenchymal patterns, and noted the presence of each pattern. The readers also noted whether the findings met the 2011 criteria for UIP. In a second reading, the same readers noted whether the HRCT met the UIP criteria according to the 2018 UIP update. RESULTS: The kappa values for interobserver variability for the different patterns ranged from 0.28 (intralobular lines) to 0.85 (tree-in-bud nodules). The kappa value for UIP pattern was similar for 2011 and 2018 criteria, 0.58 and 0.69, respectively. Compared to the 2011 UIP criteria, there was no statistically significant difference in the number of HRCT classified as UIP using the 2018 criteria. CONCLUSIONS: There is a substantial variation in interobserver agreement between the different parenchymal patterns, which suggests that some patterns a more easily identified than others. There is also a considerable reader variation in the assessment of UIP applying the 2011 UIP criteria as well as applying the 2018 UIP update.