Department of Radiology, Addenbrooke's Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, Box 219, Hills Road, Cambridge, CB2 0QQ, UK.
Pediatr Radiol. 2013 Jul;43(7):820-6. doi: 10.1007/s00247-012-2597-6. Epub 2013 Jan 24.
Maximum intensity projection (MIP) images might be useful in helping to differentiate small pulmonary nodules from adjacent vessels on thoracic multidetector CT (MDCT).
The aim was to evaluate the benefits of axial MIP images over axial source images for the paediatric chest in an interobserver variability study.
We included 46 children with extra-pulmonary solid organ malignancy who had undergone thoracic MDCT. Three radiologists independently read 2-mm axial and 10-mm MIP image datasets, recording the number of nodules, size and location, overall time taken and confidence.
There were 83 nodules (249 total reads among three readers) in 46 children (mean age 10.4 ± 4.98 years, range 0.3-15.9 years; 24 boys). Consensus read was used as the reference standard. Overall, three readers recorded significantly more nodules on MIP images (228 vs. 174; P < 0.05), improving sensitivity from 67% to 77.5% (P < 0.05) but with lower positive predictive value (96% vs. 85%, P < 0.005). MIP images took significantly less time to read (71.6 ± 43.7 s vs. 92.9 ± 48.7 s; P < 0.005) but did not improve confidence levels.
Using 10-mm axial MIP images for nodule detection in the paediatric chest enhances diagnostic performance, improving sensitivity and reducing reading time when compared with conventional axial thin-slice images. Axial MIP and axial source images are complementary in thoracic nodule detection.
最大密度投影（MIP）图像可能有助于在胸部多层 CT（MDCT）上区分小的肺结节和相邻的血管。
本研究旨在通过观察者间变异性研究评估轴向 MIP 图像相对于轴向源图像在儿科胸部的优势。
我们纳入了 46 例患有肺外实体恶性肿瘤的儿童，这些患儿均接受了胸部 MDCT 检查。3 名放射科医生分别独立阅读了 2mm 轴向和 10mm MIP 图像数据集，记录结节数量、大小和位置、总用时和信心水平。
46 例患儿中有 83 个结节（3 名观察者共 249 次阅读）（平均年龄 10.4±4.98 岁，范围 0.3-15.9 岁；24 名男孩）。以共识阅读作为参考标准。总体而言，3 名观察者在 MIP 图像上记录的结节数明显更多（228 个比 174 个；P<0.05），从而将敏感性从 67%提高到 77.5%（P<0.05），但阳性预测值降低（96%比 85%，P<0.005）。MIP 图像的阅读时间明显更短（71.6±43.7 秒比 92.9±48.7 秒；P<0.005），但并未提高信心水平。
与常规轴向薄层图像相比，在儿科胸部中使用 10mm 轴向 MIP 图像进行结节检测可提高诊断性能，改善敏感性并减少阅读时间。轴向 MIP 图像和轴向源图像在胸部结节检测中具有互补性。
