Halligan Steve, Altman Douglas G, Mallett Susan, Taylor Stuart A, Burling David, Roddie Mary, Honeyfield Lesley, McQuillan Justine, Amin Hamdan, Dehmeshki Jamshid
Department of Specialist Radiology, University College Hospital, London, England.
Gastroenterology. 2006 Dec;131(6):1690-9. doi: 10.1053/j.gastro.2006.09.051. Epub 2006 Oct 1.
BACKGROUND & AIMS: In isolation, computer-aided detection (CAD) for computed tomographic (CT) colonography is as effective as optical colonoscopy for detection of significant adenomas. However, the unavoidable interaction between CAD and the reader has not been addressed.
Ten readers trained in CT but without special expertise in colonography interpreted CT colonography images of 107 patients (60 with 142 polyps), first without CAD and then with CAD after temporal separation of 2 months. Per-patient and per-polyp detection were determined by comparing responses with known patient status.
With CAD, 41 (68%; 95% confidence interval [CI], 55%-80%) of the 60 patients with polyps were identified more frequently by readers. Per-patient sensitivity increased significantly in 70% of readers, while specificity dropped significantly in only one. Polyp detection increased significantly with CAD; on average, 12 more polyps were detected by each reader (9.1%, 95% CI, 5.2%-12.8%). Small- (< or =5 mm) and medium-sized (6-9 mm) polyps were significantly more likely to be detected when prompted correctly by CAD. However, overall performance was relatively poor; even with CAD, on average readers detected only 10 polyps (51.0%) > or =10 mm and 24 (38.2%) > or =6 mm. Interpretation time was shortened significantly with CAD: by 1.9 minutes (95% CI, 1.4-2.4 minutes) for patients with polyps and by 2.9 minutes (95% CI, 2.5-3.3 minutes) for patients without. Overall, 9 readers (90%) benefited significantly from CAD, either by increased sensitivity and/or by reduced interpretation time.
CAD for CT colonography significantly increases per-patient and per-polyp detection and significantly reduces interpretation times but cannot substitute for adequate training.
单独而言，计算机断层扫描（CT）结肠成像的计算机辅助检测（CAD）在检测显著腺瘤方面与光学结肠镜检查效果相当。然而，CAD与阅片者之间不可避免的相互作用尚未得到研究。
10名接受过CT培训但在结肠成像方面无专业特长的阅片者对107例患者（60例有142个息肉）的CT结肠成像图像进行解读，先在无CAD的情况下进行，然后在间隔2个月后在有CAD的情况下进行。通过将反应与已知患者状况进行比较来确定每位患者和每个息肉的检测情况。
在有CAD的情况下，60例有息肉的患者中，41例（68%；95%置信区间[CI]，55% - 80%）被阅片者更频繁地识别出来。70%的阅片者每位患者的敏感性显著增加，而只有1位阅片者的特异性显著下降。有CAD时息肉检测显著增加；平均而言，每位阅片者多检测出12个息肉（9.1%，95%CI，5.2% - 12.8%）。当CAD正确提示时，小（≤5mm）和中等大小（6 - 9mm）的息肉被检测到的可能性显著更高。然而，总体表现相对较差；即使有CAD，阅片者平均仅检测到10个（51.0%）≥10mm的息肉和24个（38.2%）≥6mm的息肉。有CAD时解读时间显著缩短：有息肉的患者缩短1.9分钟（95%CI，1.4 - 2.4分钟），无息肉的患者缩短2.9分钟（95%CI，2.5 - 3.3分钟）。总体而言，9名阅片者（90%）从CAD中显著受益，要么通过提高敏感性和/或通过缩短解读时间。
CT结肠成像的CAD显著增加每位患者和每个息肉的检测，并显著缩短解读时间，但不能替代充分的培训。
