Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Berne, Freiburgstrasse 4, Berne 3010, Switzerland.
Eur Radiol. 2010 Jun;20(6):1289-96. doi: 10.1007/s00330-009-1667-0. Epub 2009 Nov 21.
To retrospectively analyze the performance of a commercial computer-aided diagnosis (CAD) software in the detection of pulmonary nodules in original and energy-subtracted (ES) chest radiographs.
Original and ES chest radiographs of 58 patients with 105 pulmonary nodules measuring 5-30 mm and images of 25 control subjects with no nodules were randomized. Five blinded readers evaluated firstly the original postero-anterior images alone and then together with the subtracted radiographs. In a second phase, original and ES images were analyzed by a commercial CAD program. CT was used as reference standard. CAD results were compared to the readers' findings. True-positive (TP) and false-positive (FP) findings with CAD on subtracted and non-subtracted images were compared.
Depending on the reader's experience, CAD detected between 11 and 21 nodules missed by readers. Human observers found three to 16 lesions missed by the CAD software. CAD used with ES images produced significantly fewer FPs than with non-subtracted images: 1.75 and 2.14 FPs per image, respectively (p = 0.029). The difference for the TP nodules was not significant (40 nodules on ES images and 34 lesions in non-subtracted radiographs, p = 0.142).
CAD can improve lesion detection both on energy subtracted and non-subtracted chest images, especially for less experienced readers. The CAD program marked less FPs on energy-subtracted images than on original chest radiographs.
回顾性分析一款商用计算机辅助诊断（CAD）软件在原始和能量减影（ES）胸部 X 线片中检测肺结节的性能。
将 58 例 105 个直径 5-30mm 的肺结节患者的原始和 ES 胸部 X 线片与 25 例无结节的对照者 X 线片随机分组。5 位盲法读片者首先单独评估原始后前位 X 线片，然后再与减影 X 线片一起评估。在第二阶段，使用商业 CAD 程序分析原始和 ES 图像。以 CT 作为参考标准。将 CAD 结果与读片者的发现进行比较。比较减影和非减影图像上 CAD 的真阳性（TP）和假阳性（FP）结果。
根据读片者的经验，CAD 检测到读片者漏诊的 11-21 个结节。观察者用肉眼发现了 CAD 软件漏诊的 3-16 个病变。CAD 与 ES 图像联合使用比与非减影图像相比产生的 FP 显著减少：分别为每幅图像 1.75 和 2.14 个 FP（p = 0.029）。TP 结节的差异无统计学意义（ES 图像上有 40 个结节，非减影 X 线片上有 34 个病变，p = 0.142）。
CAD 可以改善能量减影和非减影胸部图像上的病灶检测，尤其是对经验较少的读片者。CAD 程序在能量减影图像上标记的 FP 比原始胸部 X 线片少。
