Taylor Stuart A, Charman Susan C, Lefere Philippe, McFarland Elizabeth G, Paulson Erik K, Yee Judy, Aslam Rizwan, Barlow John M, Gupta Arun, Kim David H, Miller Chad M, Halligan Steve
Department of Specialist X-Ray, University College Hospital, 235 Euston Rd, 2F Podium, London NW1 2BU, England.
Radiology. 2008 Feb;246(2):463-71. doi: 10.1148/radiol.2461070190. Epub 2007 Dec 19.
To prospectively compare the diagnostic performance and time efficiency of both second and concurrent computer-aided detection (CAD) reading paradigms for retrospectively obtained computed tomographic (CT) colonography data sets by using consensus reading (three radiologists) of colonoscopic findings as a reference standard.
Ethical permission, HIPAA compliance (for U.S. institutions), and patient consent were obtained from all institutions for use of CT colonography data sets in this study. Ten radiologists each read 25 CT colonography data sets (12 men, 13 women; mean age, 61 years) containing 69 polyps (28 were 1-5 mm, 41 were >or=6 mm) by using workstations integrated with CAD software. Reading was randomized to either "second read" CAD (applied only after initial unassisted assessment) or "concurrent read" CAD (applied at the start of assessment). Data sets were reread 6 weeks later by using the opposing paradigm. Polyp sensitivity and reading times were compared by using multilevel logistic and linear regression, respectively. Receiver operating characteristic (ROC) curves were generated.
Compared with the unassisted read, odds of improved polyp (>or=6 mm) detection were 1.5 (95% confidence interval [CI]: 1.0, 2.2) and 1.3 (95% CI: 0.9, 1.9) by using CAD as second and concurrent reader, respectively. Detection odds by using CAD concurrently were 0.87 (95% CI: 0.59, 1.3) and 0.76 (95% CI: 0.57, 1.01) those of second read CAD, excluding and including polyps 1-5 mm, respectively. The concurrent read took 2.9 minutes (95% CI: -3.8, -1.9) less than did second read. The mean areas under the ROC curve (95% CI) for the unassisted read, second read CAD, and concurrent read CAD were 0.83 (95% CI: 0.78, 0.87), 0.86 (95% CI: 0.82, 0.90), and 0.88 (95% CI: 0.83, 0.92), respectively.
CAD is more time efficient when used concurrently than when used as a second reader, with similar sensitivity for polyps 6 mm or larger. However, use of second read CAD maximizes sensitivity, particularly for smaller lesions.
通过使用结肠镜检查结果的一致性阅读（三位放射科医生）作为参考标准，前瞻性地比较第二代和同步计算机辅助检测（CAD）阅读模式对回顾性获得的计算机断层扫描（CT）结肠造影数据集的诊断性能和时间效率。
本研究已获得所有机构的伦理许可、符合健康保险流通与责任法案（HIPAA，适用于美国机构）要求，并取得了患者的同意，以使用CT结肠造影数据集。十位放射科医生分别阅读25个CT结肠造影数据集（12名男性，13名女性；平均年龄61岁），这些数据集中包含69个息肉（28个息肉大小为1 - 5毫米，41个息肉大小大于或等于6毫米），阅读时使用集成了CAD软件的工作站。阅读方式随机分为“二次阅读”CAD（仅在初始无辅助评估后应用）或“同步阅读”CAD（在评估开始时应用）。六周后使用相反的模式对数据集进行再次阅读。分别使用多级逻辑回归和线性回归比较息肉敏感性和阅读时间。生成了受试者操作特征（ROC）曲线。
与无辅助阅读相比，使用CAD作为二次阅读和同步阅读时，检测出更大息肉（大于或等于6毫米）的几率分别为1.5（95%置信区间[CI]：1.0，2.2）和1.3（95%CI：0.9，1.9）。同步使用CAD时的检测几率分别是二次阅读CAD的0.87（95%CI：0.59，1.3）和0.76（95%CI：0.57，1.01），分别不包括和包括1 - 5毫米的息肉。同步阅读比二次阅读少用2.9分钟（95%CI：-3.8，-1.9）。无辅助阅读、二次阅读CAD和同步阅读CAD的ROC曲线下平均面积（95%CI）分别为0.83（95%CI：0.78，0.87）、0.86（95%CI：0.82，0.90）和0.88（95%CI：0.83，0.92）。
与作为二次阅读使用时相比，同步使用CAD更节省时间，对6毫米或更大的息肉具有相似的敏感性。然而，使用二次阅读CAD可使敏感性最大化，特别是对于较小的病变。
