Petrick Nicholas, Haider Maruf, Summers Ronald M, Yeshwant Srinath C, Brown Linda, Iuliano Edward M, Louie Adeline, Choi J Richard, Pickhardt Perry J
National Institute of Biomedical Imaging and Bioengineering/Center for Devices and Radiological Health Joint Laboratory for the Assessment of Medical Imaging Systems, U.S. Food and Drug Administration, Rockville, MD, USA.
Radiology. 2008 Jan;246(1):148-56. doi: 10.1148/radiol.2453062161.
To evaluate the effect of computer-aided detection (CAD) as second reader on radiologists' diagnostic performance in interpreting computed tomographic (CT) colonographic examinations by using a primary two-dimensional (2D) approach, with segmental, unblinded optical colonoscopy as the reference standard.
This HIPAA-compliant study was IRB-approved with written informed consent. Four board-certified radiologists analyzed 60 CT examinations with a commercially available review system. Two-dimensional transverse views were used for initial polyp detection, while three-dimensional (3D) endoluminal and 2D multiplanar views were available for problem solving. After initial review without CAD, the reader was shown CAD-identified polyp candidates. The readers were then allowed to add to or modify their original diagnoses. Polyp location, CT Colonography Reporting and Data System categorization, and reader confidence as to the likelihood of a candidate being a polyp were recorded before and after CAD reading. The area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, and specificity were estimated for CT examinations with and without CAD readings by using multireader multicase analysis.
Use of CAD led to nonsignificant average reader AUC increases of 0.03, 0.03, and 0.04 for patients with adenomatous polyps 6 mm or larger, 6-9 mm, and 10 mm or larger, respectively (P > or = .25); likewise, CAD increased average reader sensitivity by 0.15, 0.16, and 0.14 for those respective groups, with a corresponding decrease in specificity of 0.14. These changes achieved significance for the 6 mm or larger group (P < .01), 6-9 mm group (P < .02), and for specificity (P < .01), but not for the 10 mm or larger group (P > .16). The average reading time was 5.1 minutes +/- 3.4 (standard deviation) without CAD. CAD added an average of 3.1 minutes +/- 4.3 (62%) to each reading (supine and prone positions combined); average total reading time, 8.2 minutes +/- 5.8.
Use of CAD led to a significant increase in sensitivity for detecting polyps in the 6 mm or larger and 6-9 mm groups at the expense of a similar significant reduction in specificity.
以分段、非盲法光学结肠镜检查作为参考标准，评估计算机辅助检测（CAD）作为第二阅片者对放射科医生解读计算机断层扫描（CT）结肠成像检查的诊断性能的影响，采用主要的二维（2D）方法。
本符合健康保险流通与责任法案（HIPAA）的研究经机构审查委员会（IRB）批准并获得书面知情同意。四位获得委员会认证的放射科医生使用商用审查系统分析了60例CT检查。二维横断面视图用于初始息肉检测，而三维（3D）腔内视图和二维多平面视图用于解决问题。在无CAD的初始审查后，向阅片者展示CAD识别出的息肉候选者。然后允许阅片者补充或修改其原始诊断。记录CAD阅片前后息肉位置、CT结肠成像报告和数据系统分类以及阅片者对候选者为息肉可能性的信心。使用多阅片者多病例分析估计有无CAD阅片的CT检查的受试者工作特征（ROC）曲线下面积（AUC）、敏感性和特异性。
对于直径6mm及以上、6 - 9mm和10mm及以上的腺瘤性息肉患者，使用CAD导致阅片者的平均AUC分别非显著增加0.03、0.03和0.04（P≥0.25）；同样，对于这些相应组，CAD使阅片者的平均敏感性分别增加0.15、0.16和0.14，特异性相应降低0.14。这些变化在直径6mm及以上组（P < 0.01）、6 - 9mm组（P < 0.02）以及特异性方面（P < 0.01）达到显著水平，但在直径10mm及以上组未达到显著水平（P > 0.16）。无CAD时平均阅读时间为5.1分钟±3.4（标准差）。CAD使每次阅读（仰卧位和俯卧位合并）平均增加3.1分钟±4.3（62%）；平均总阅读时间为8.2分钟±5.8。
使用CAD导致直径6mm及以上和6 - 9mm组检测息肉的敏感性显著增加，但特异性也有类似的显著降低。
