Kim E Y, Bista A B, Kim T, Park S Y, Park K J, Kang D K, Sun J S
Department of Radiology, Ajou University School of Medicine, Suwon, South Korea.
Department of Radiology, B&B Hospital, Lalitpur, Nepal.
Clin Radiol. 2017 Sep;72(9):796.e1-796.e8. doi: 10.1016/j.crad.2017.03.022. Epub 2017 Apr 25.
To investigate the advantage of digital tomosynthesis (DTS) over chest radiography (CXR) and dual-energy subtraction radiography (DES) for pulmonary nodule detection according to the location and size of solid simulated pulmonary nodules (SPNs).
Ninety-six SPNs of variable sizes were inserted into eight different regions of a lung phantom. These regions were further classified into two groups of danger and non-danger zones based on anatomical location influencing the detection of pulmonary nodules. The 96 cases with inserted SPNs and an additional nodule-free 96 control cases all underwent CXR, DES, and DTS examinations. Three observers independently reviewed all the images. The jackknife alternative free-response receiver operating characteristic was used to analyse diagnostic performance for each technique.
DTS was superior to CXR and DES for detection of smaller SPNs, except in the retrodiaphragmatic and apical regions. DTS outperformed CXR and DES for detection of larger SPNs in the paramediastinal region. For 5- and 8-mm SPNs, DTS was superior to CXR and DES in the apical, paramediastinal and lateral pulmonary regions. In the retrodiaphragmatic region, the three techniques showed similar diagnostic performance regardless of the SPN size. DES was similar to DTS for detection of 8-mm SPN in the apical region. For 10- and 12-mm SPNs, CXR and DES showed similar diagnostic performance to DTS in the apical and lateral pulmonary regions; however, DTS was superior to CXR and DES in the paramediastinal region.
DTS significantly improved the capability to detect synthetic pulmonary nodules compared with CXR and DES, for detection of smaller nodules in the apical, paramediastinal, and lateral pulmonary regions, and larger nodules located in the paramediastinal region in a thoracic phantom.
根据实性模拟肺结节（SPN）的位置和大小，研究数字断层合成（DTS）在肺结节检测方面相对于胸部X线摄影（CXR）和双能减影X线摄影（DES）的优势。
将96个大小各异的SPN插入肺部模型的八个不同区域。根据影响肺结节检测的解剖位置，这些区域进一步分为危险区和非危险区两组。96例插入SPN的病例以及另外96例无结节的对照病例均接受了CXR、DES和DTS检查。三名观察者独立审查所有图像。采用留一法交替自由响应接收器操作特性分析每种技术的诊断性能。
在检测较小的SPN方面，除了膈后区和尖区，DTS优于CXR和DES。在检测纵隔旁区域较大的SPN方面，DTS优于CXR和DES。对于5毫米和8毫米的SPN，DTS在肺尖、纵隔旁和外侧区域优于CXR和DES。在膈后区，无论SPN大小，这三种技术的诊断性能相似。在肺尖区，DES在检测8毫米SPN方面与DTS相似。对于10毫米和12毫米的SPN，在肺尖和外侧区域，CXR和DES的诊断性能与DTS相似；然而，在纵隔旁区域，DTS优于CXR和DES。
与CXR和DES相比，DTS显著提高了检测合成肺结节的能力，在检测胸部模型中肺尖、纵隔旁和外侧区域的较小结节以及纵隔旁区域的较大结节方面表现出色。
