Eur Radiol (2012) 22:302–309 DOI 10.1007/s00330-011-2278-0 CHEST A method for the automatic quantification of the completeness of pulmonary fissures: evaluation in a database of subjects with severe emphysema Eva M. van Rikxoort & Jonathan G. Goldin & Maya Galperin-Aizenberg & Fereidoun Abtin & Hyun J. Kim & Peiyun Lu & Bram van Ginneken & Greg Shaw & Matthew S. Brown Received: 23 April 2011 / Revised: 12 July 2011 / Accepted: 8 August 2011 / Published online: 8 October 2011 # The Author(s) 2011. This article is published with open access at Springerlink.com Abstract Objectives To propose and evaluate a technique for automatic quantification of fissural completeness from chest computed tomography (CT) in a database of subjects with severe emphysema. Methods Ninety-six CT studies of patients with severe emphysema were included. The lungs, fissures and lobes were automatically segmented. The completeness of the fissures was calculated as the percentage of the lobar border defined by a fissure. The completeness score of the automatic method was compared with a visual consensus read by three radiologists using boxplots, rank sum tests and ROC analysis. Results The consensus read found 49% (47/96), 15% (14/ 96) and 67% (64/96) of the right major, right minor and left E. M. van Rikxoort (*) : J. G. Goldin : M. Galperin-Aizenberg : F. Abtin : H. J. Kim : P. Lu : G. Shaw : M. S. Brown Center for Computer Vision and Imaging Biomarkers and Thoracic Imaging Research Group, Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, 924 Westwood Blvd, suite 650, Los Angeles, CA 90024, USA e-mail: e.vanrikxoort@rad.umcn.nl B. van Ginneken Diagnostic Image Analysis Group, Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands B. van Ginneken Image Sciences Institute, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands major fissures to be complete. For all fissures visually assessed as being complete the automatic method resulted in significantly higher completeness scores (mean 92.78%) than for those assessed as being partial or absent (mean 77.16%; all p values <0.001). The areas under the curves for the automatic fissural completeness were 0.88, 0.91 and 0.83 for the right major, right minor and left major fissures respectively. Conclusions An automatic method is able to quantify fissural completeness in a cohort of subjects with severe emphysema consistent with a visual consensus read of three radiologists. Key Points Lobar fissures are important for assessing the extent and distribution of lung disease Modern CT allows automatic lobar segmentation and assessment of the fissures This segmentation can also assess the completeness of the fissures. Such assessment is important for decisions about novel therapies (eg for emphysema). Keywords Lung/radiography . X-ray computed tomography . Computer-assisted radiographic image interpretation . Automation . Chronic obstructive pulmonary disease Introduction Lobar fissures consist of a double layer of visceral pleura that separates the anatomical lung lobes [1]. As such they serve as important anatomical landmarks in recognising