Can computer assisted diagnosis (CAD) be used as a screening tool in the detection of pulmonary nodules when using 64-slice multidetector computed tomography?

Abstract

ObjectivesTo evaluate (1) whether or not the addition of computer-assisted diagnosis (CAD) to 64-slice multidetector computed tomography (CT) can be used as a screening tool for detection of pulmonary nodules in routine CT chest examinations and (2) whether or not to advocate the incorporation of CAD as a screening tool into our daily practice.Materials and methodsA retrospective cross-sectional analysis of 109 consecutive patients who had all undergone routine contrast-enhanced CT chest examinations for indications other than lung cancer at the Radiology Department of Aga Khan University Hospital, Karachi, between November 2010 and January 2011. All examinations were evaluated in terms of the detection of pulmonary nodules by a consultant radiologist and CAD (ImageChecker CT Algorithm R2 Technology) software. The ability of CAD software to detect pulmonary nodules was evaluated against the reference standard. In addition, a chest radiologist also calculated the number of pulmonary nodules. The sensitivity and specificity of the CAD software were calculated against the reference standard by using a 2 × 2 table. The Mann–Whitney U test was applied to compare the performances of CAD and the radiologist.ResultsCAD detected 610 pulmonary nodules while the radiologist detected only 113. The reference standard declared 198 pulmonary nodules to be true nodules. CAD detected 95% of all true nodules (189/198), whereas the radiologist detected only 57% (113/198). In the detection of true pulmonary nodules, CAD had 98% sensitivity compared with the radiologist who had 57% sensitivity; the statistical difference between their performances had a P value <0.001.ConclusionConsidering the high sensitivity of CAD to detect nearly all true pulmonary nodules, we advocate its application as a screening tool in all CT chest examinations for the early detection of pulmonary nodules and lung carcinoma.

Role of Computer Aided Diagnosis (CAD) in the detection of pulmonary nodules on 64 row multi detector computed tomography

“…CT has been the main imaging modality for detection, characterization, and follow-up of pulmonary nodules, which are major radiologic findings of varied benign and neoplastic etiology. [ 5 6 7 ] CAD has been proposed as a solution for interpretation of the ever-expanding amount of radiologic information as early as in 1989. Since then, the majority of CAD for pulmonary nodules have been designed for and tested on conventional CT with a slice thickness of 5–10 mm.…”

“…In addition, CAD can also be applied to various oncological settings for identifying metastatic lung nodules as well as monitoring the therapy. [ 3 4 5 6 7 ] An important feature of CAD is its ability to calculate size, volume, and density of nodules in one click, which is extremely important in screening lung cancer and also in assessing prognosis and response to therapy in metastatic workup cases. Thus, it saves lot of RAD's time, especially junior RADs of less experience; CAD increases RAD sensitivity.…”