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CT Colonography: Multiobserver Diagnostic Performance¹

¹ From the Mallinckrodt Institute of Radiology (E.G.M., T.K.P., R.A.M., C.V.S., P.W.B., J.P.H., D.M.B.) and Department of Internal Medicine, Gastroenterology Division (L.B.W., E.P.T.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (J.A.B.); and Department of General Internal Medicine, University of Vermont, Burlington (B.L.). Received October 2, 2001; revision requested November 16; final revision received June 6, 2002; accepted June 7. Supported in part by National Cancer Institute PLCO Cancer Screening Trial (N01-CN-25516), General Electric, Association of University Radiologists (GERRAF, EGM), and Washington University Siteman Cancer Center. Address correspondence to E.G.M. (e-mail: mcfarlandb@mir.wustl.edu).

PURPOSE: To prospectively evaluate multiobserver diagnostic performance and reader agreement for colorectal polyp detection in a well-characterized cohort of patients with increased number of polyps, compared with an average-risk patient, with colonoscopy as the reference standard.

MATERIALS AND METHODS: A cohort of 70 patients suspected of having polyps was examined with spiral computed tomographic (CT) colonography, with colonoscopy performed the same day. After air insufflation per rectum, supine and prone images were obtained with single–detector row CT (5-mm collimation, 8-mm table increment, 2-mm reconstruction interval). Images were analyzed independently by four experienced abdominal radiologists using two-dimensional multiplanar reformation followed by selective use of three-dimensional endoscopic volume-rendered images. Data were analyzed both per polyp and per patient.

RESULTS: Analysis per polyp demonstrated a pooled sensitivity of 0.68 for lesions 10 mm or larger (n = 40), with 75% agreement among the four readers. Analysis per patient demonstrated improved detection and agreement, with a pooled sensitivity of 0.88 for patients with polyps or cancers 10 mm or larger (n = 28), with 94% agreement. When sensitivity and receiver operating characteristic analyses were analyzed per polyp size threshold, results among readers converged and peaked at polyp diameters of approximately 10 mm.

CONCLUSION: In this patient cohort, diagnostic performance and interobserver agreement with single–detector row CT colonography was sufficient for detection of patients with lesions 10 mm or larger, with more variable results for smaller polyps.

© RSNA, 2002

Index terms: Colon, CT, 75.12115, 75.12117 • Colon neoplasms, 75.311 • Computed tomography (CT), image processing, 75.12115, 75.12117 • Diagnostic radiology, observer performance • Images, analysis, 75.12115, 75.12117

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