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Are Two-dimensional CT Measurements of Small Noncalcified Pulmonary Nodules Reliable?¹

¹ From the Department of Radiology (M.P.R., M.B., L.A., C.L., G.F.) and Clinical Investigation Center 9201 (A.B.), Assistance Publique des Hôpitaux de Paris/INSERM, Georges Pompidou European University Hospital, 20 Rue Leblanc, 75015 Paris, France. Received January 31, 2003; revision requested April 21; final revision received October 2; accepted November 17. Address correspondence to M.P.R. (e-mail: marie-pierre.revel@hop.egp.ap-hop-paris.fr).

View larger version (16K): [in a new window]   Figure 1a. Scatterplots show SDs versus mean nodule sizes for (a) reader 1, (b) reader 2, and (c) reader 3. Evaluating the magnitude of the SD of repeated measurements is a way of evaluating the measurement error for each reader. All three scatterplots show that the SD is not dependent on nodule size; in particular, it does not increase with nodule size. This lack of any clear graphic relationship authorized us to use the repeatability coefficient, as defined by the British Standards Institution (7), in this study.

View larger version (16K): [in a new window]   Figure 1b. Scatterplots show SDs versus mean nodule sizes for (a) reader 1, (b) reader 2, and (c) reader 3. Evaluating the magnitude of the SD of repeated measurements is a way of evaluating the measurement error for each reader. All three scatterplots show that the SD is not dependent on nodule size; in particular, it does not increase with nodule size. This lack of any clear graphic relationship authorized us to use the repeatability coefficient, as defined by the British Standards Institution (7), in this study.

View larger version (17K): [in a new window]   Figure 1c. Scatterplots show SDs versus mean nodule sizes for (a) reader 1, (b) reader 2, and (c) reader 3. Evaluating the magnitude of the SD of repeated measurements is a way of evaluating the measurement error for each reader. All three scatterplots show that the SD is not dependent on nodule size; in particular, it does not increase with nodule size. This lack of any clear graphic relationship authorized us to use the repeatability coefficient, as defined by the British Standards Institution (7), in this study.

View larger version (16K): [in a new window]   Figure 2a. (a-c) Scatterplots illustrate agreement of the measurements for all possible pairs of readers. The poor agreement among the three readers is demonstrated by points lying outside the line of equality.

View larger version (17K): [in a new window]   Figure 2b. (a-c) Scatterplots illustrate agreement of the measurements for all possible pairs of readers. The poor agreement among the three readers is demonstrated by points lying outside the line of equality.

View larger version (17K): [in a new window]   Figure 2c. (a-c) Scatterplots illustrate agreement of the measurements for all possible pairs of readers. The poor agreement among the three readers is demonstrated by points lying outside the line of equality.