计算机辅助检测作为 CT 结肠成像数据的第二和同时阅读者时的增量获益：多观察者研究。
Incremental benefit of computer-aided detection when used as a second and concurrent reader of CT colonographic data: multiobserver study.
机构信息
Department of Specialist Radiology, University College Hospital, Podium Level 2, 235 Euston Road, London NW1 2BU, England.
出版信息
Radiology. 2011 Feb;258(2):469-76. doi: 10.1148/radiol.10100354. Epub 2010 Nov 17.
PURPOSE
To quantify the changes in reader performance levels, if any, during interpretation of computed tomographic (CT) colonographic data when a computer-aided detection (CAD) system is used as a second or concurrent reader.
MATERIALS AND METHODS
After institutional review board approval was obtained, 16 experienced radiologists searched for polyps in 112 patients, 56 of whom had 132 polyps. Each case was interpreted on three separate occasions by using an unassisted (without CAD), second-read CAD, or concurrent CAD reading paradigm. The reading paradigm and case order were randomized, with a minimal interval of 1 month between consecutive interpretations. The readers' findings were compared with the reference-truth interpretation. The mean per-patient sensitivity and mean per-patient specificity with CAD were compared with those achieved with unassisted reading. An increase in per-patient sensitivity was considered to be clinically more important than an equivalent decrease in specificity.
RESULTS
The mean per-patient sensitivity for identification of patients with polyps of any size increased significantly with use of second-read CAD (mean increase, 7.0%; 95% confidence interval [CI]: 4.0%, 9.8%) and concurrent CAD (mean increase, 4.5%; 95% CI: 0.8%, 8.2%). The mean per-patient specificity did not decrease significantly with use of second-read CAD (mean decrease, -2.5%; 95% CI: -5.2%, 0.1%) or concurrent CAD (mean decrease, -2.2%; 95% CI: -4.6%, 0.2%). With analysis restricted to patients with polyps 6 mm or larger, the benefit in sensitivity with second-read CAD remained (mean increase, 7.1%; 95% CI: 3.0%, 11.1%), whereas the increase with concurrent CAD was not significant (mean increase, 4.2%; 95% CI: -0.5%, 8.9%). Use of second-read CAD significantly increased the per-polyp sensitivity for polyps 6 mm or larger (mean increase, 9.0%; 98.3% CI: 4.9%, 12.8%) and polyps 5 mm or smaller (mean increase, 5.9%; 98.3% CI: 3.2%, 9.1%), but use of concurrent CAD increased the per-polyp sensitivity for only those polyps 5 mm or smaller (mean increase, 4.8%; 98.3% CI: 2.2%, 7.9%).
CONCLUSION
Use of second-read CAD significantly improves readers' per-patient and per-polyp detection. Concurrent CAD is less effective.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100354/-/DC1.
目的
定量评估在使用计算机辅助检测（CAD）系统作为第二或同时阅读者时，阅读者在解释 CT 结肠成像数据时的阅读水平变化情况。
材料和方法
本研究经机构审查委员会批准，纳入 112 名患者的 16 名经验丰富的放射科医生，其中 56 名患者有 132 个息肉。每个病例均通过未辅助（无 CAD）、第二读 CAD 或同时 CAD 阅读范例进行三次独立的解读。阅读范例和病例顺序随机化，连续两次解读之间的最小间隔为 1 个月。将读者的发现与参考真实解读进行比较。比较 CAD 辅助阅读时的平均每位患者敏感度和平均每位患者特异性，与未辅助阅读时的结果进行比较。如果敏感度的提高可以被认为是具有临床意义的，则认为比特异性的同等下降更重要。
结果
在使用第二读 CAD（平均增加 7.0%；95%置信区间 [CI]：4.0%，9.8%）和同时 CAD（平均增加 4.5%；95% CI：0.8%，8.2%）时，识别任何大小息肉的患者的平均每位患者敏感度显著增加。使用第二读 CAD（平均降低 2.5%；95% CI：-5.2%，0.1%）或同时 CAD（平均降低 2.2%；95% CI：-4.6%，0.2%）时，平均每位患者特异性没有显著降低。在对直径≥6mm的息肉进行分析时，第二读 CAD 的敏感度获益仍然存在（平均增加 7.1%；95% CI：3.0%，11.1%），而同时 CAD 的获益不显著（平均增加 4.2%；95% CI：-0.5%，8.9%）。使用第二读 CAD 显著提高了直径≥6mm（平均增加 9.0%；98.3% CI：4.9%，12.8%）和直径≤5mm（平均增加 5.9%；98.3% CI：3.2%，9.1%）的息肉的每位患者敏感度，但使用同时 CAD 仅提高了直径≤5mm的息肉的每位患者敏感度（平均增加 4.8%；98.3% CI：2.2%，7.9%）。
结论
使用第二读 CAD 可显著提高读者的每位患者和每位息肉的检出率。同时 CAD 的效果较差。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100354/-/DC1.
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