Department of Radiology, Section of Breast Imaging, School of Medicine, University of Washington, Seattle, WA, USA.
AJR Am J Roentgenol. 2013 Jun;200(6):W683-9. doi: 10.2214/AJR.11.8394.
The purpose of this study was to compare the diagnostic accuracy and interpretation times of breast MRI with and without use of a computer-aided detection (CAD) system by novice and experienced readers.
A reader study was undertaken with 20 radiologists, nine experienced and 11 novice. Each radiologist participated in two reading sessions spaced 6 months apart that consisted of 70 cases (27 benign, 43 malignant), read with and without CAD assistance. Sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy as measured by the area under the receiver operating characteristic curve (AUC) were reported for each radiologist. Accuracy comparisons across use of CAD and experience level were examined. Time to interpret and report on each case was recorded.
CAD improved sensitivity for both experienced (AUC, 0.91 vs 0.84; 95% CI on the difference, 0.04, 0.11) and novice readers (AUC, 0.83 vs 0.77; 95% CI on the difference, 0.01, 0.10). The increase in sensitivity was statistically higher for experienced readers (p = 0.01). Diagnostic accuracy, measured by AUC, for novices without CAD was 0.77, for novices with CAD was 0.79, for experienced readers without CAD was 0.80, and for experienced readers with CAD was 0.83. An upward trend was noticed, but the differences were not statistically significant. There were no significant differences in interpretation times.
MRI sensitivity improved with CAD for both experienced readers and novices with no overall increase in time to evaluate cases. However, overall accuracy was not significantly improved. As the use of breast MRI with CAD increases, more attention to the potential contributions of CAD to the diagnostic accuracy of MRI is needed.
本研究旨在比较有和没有计算机辅助检测（CAD）系统辅助时，新手和有经验的读者对乳腺 MRI 的诊断准确性和解读时间。
一项 20 名放射科医师参与的读者研究，9 名有经验，11 名新手。每位放射科医师在相隔 6 个月的两次阅读中，分别对 70 例病例（27 例良性，43 例恶性）进行阅读，使用和不使用 CAD 辅助。报道了每位放射科医师的受试者工作特征曲线下面积（AUC）所测的敏感性、特异性、阴性预测值、阳性预测值和总准确性。对 CAD 使用和经验水平的准确性进行了比较。记录了每个病例的解读和报告时间。
CAD 提高了有经验（AUC，0.91 比 0.84；差异 95%置信区间，0.04，0.11）和新手读者（AUC，0.83 比 0.77；差异 95%置信区间，0.01，0.10）的敏感性。对于有经验的读者，敏感性的提高具有统计学意义（p = 0.01）。没有 CAD 的新手的 AUC 诊断准确性为 0.77，有 CAD 的新手为 0.79，没有 CAD 的有经验读者为 0.80，有 CAD 的有经验读者为 0.83。虽然注意到了上升趋势，但差异无统计学意义。解读时间没有显著差异。
对于有经验的读者和新手来说，CAD 可提高 MRI 的敏感性，而评估病例的总时间并没有明显增加。然而，整体准确性并没有显著提高。随着 CAD 辅助的乳腺 MRI 的应用增加，需要更加关注 CAD 对 MRI 诊断准确性的潜在贡献。
