University Hospital and University of Bern, Berne, Switzerland.
AJR Am J Roentgenol. 2013 May;200(5):1006-13. doi: 10.2214/AJR.12.8877.
The objective of our study was to compare the effect of dual-energy subtraction and bone suppression software alone and in combination with computer-aided detection (CAD) on the performance of human observers in lung nodule detection.
One hundred one patients with from one to five lung nodules measuring 5-29 mm and 42 subjects with no nodules were retrospectively selected and randomized. Three independent radiologists marked suspicious-appearing lesions on the original chest radiographs, dual-energy subtraction images, and bone-suppressed images before and after postprocessing with CAD. Marks of the observers and CAD marks were compared with CT as the reference standard. Data were analyzed using nonparametric tests and the jackknife alternative free-response receiver operating characteristic (JAFROC) method.
Using dual-energy subtraction alone (p = 0.0198) or CAD alone (p = 0.0095) improved the detection rate compared with using the original conventional chest radiograph. The combination of bone suppression and CAD provided the highest sensitivity (51.6%) and the original nonenhanced conventional chest radiograph alone provided the lowest (46.9%; p = 0.0049). Dual-energy subtraction and bone suppression provided the same false-positive (p = 0.2702) and true-positive (p = 0.8451) rates. Up to 22.9% of lesions were found only by the CAD program and were missed by the readers. JAFROC showed no difference in the performance between modalities (p = 0.2742-0.5442).
Dual-energy subtraction and the electronic bone suppression program used in this study provided similar detection rates for pulmonary nodules. Additionally, CAD alone or combined with bone suppression can significantly improve the sensitivity of human observers for pulmonary nodule detection.
我们研究的目的是比较双能减影和骨抑制软件单独及联合计算机辅助检测（CAD）对肺结节检测中观察者性能的影响。
回顾性选择 101 例 1-5 个直径 5-29mm 的肺结节患者和 42 例无结节的对照者，将可疑病变的标记放在原始胸部平片、双能减影图像和骨抑制图像上，由 3 位独立观察者进行。在 CAD 后处理前后，观察者的标记和 CAD 标记与 CT 参考标准进行比较。采用非参数检验和刀切法替代自由响应接收者操作特性（JAFROC）方法进行数据分析。
与原始常规胸部平片相比，双能减影（p = 0.0198）或 CAD （p = 0.0095）单独使用可提高检测率。骨抑制与 CAD 联合应用可提供最高的敏感性（51.6%），而原始非增强常规胸部平片单独应用的敏感性最低（46.9%；p = 0.0049）。双能减影和骨抑制提供相同的假阳性（p = 0.2702）和真阳性（p = 0.8451）率。高达 22.9%的病变仅被 CAD 程序发现，而被观察者遗漏。JAFROC 显示不同模式之间的性能无差异（p = 0.2742-0.5442）。
在本研究中使用的双能减影和电子骨抑制程序为肺结节的检测提供了相似的检出率。此外，CAD 单独或联合骨抑制可显著提高观察者对肺结节检测的敏感性。
