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Published online before print February 7, 2006, 10.1148/radiol.2383050167
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Pulmonary Nodules: Estimation of Malignancy at Thin-Section Helical CT—Effect of Computer-aided Diagnosis on Performance of Radiologists1

Kazuo Awai, MD, Kohei Murao, PhD, Akio Ozawa, BS, Yoshiharu Nakayama, MD, Takeshi Nakaura, MD, Duo Liu, MD, Koichi Kawanaka, MD, Yoshinori Funama, PhD, Shoji Morishita, MD and Yasuyuki Yamashita, MD

1 From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (K.A., Y.N., T.N., D.L., K.K., S.M., Y.Y.), and Department of Radiological Technology, School of Health Sciences (Y.F.), Kumamoto University, 1-1-1 Honjyo, Kumamoto 860-8556, Japan; and Bio-IT Business Development Group, Fujitsu, Chiba, Japan (K.M., A.O.). Received February 6, 2005; revision requested April 6; revision received May 10; final version accepted June 13. Address correspondence to K.A.


Figure 1
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  		Figure 1: Example of an estimation of the likelihood of malignancy of a pulmonary nodule on a transverse thin-section CT image. In the main window, the target nodule is indicated by the octagon. The pathologic diagnosis was well-differentiated adenocarcinoma. In the enlarged window at right are the results of the estimation. The last row shows the estimation of likelihood of malignancy.

 

Figure 2
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  		Figure 2: Diagram of computerized scheme for quantification of pulmonary nodules on thin-section helical CT images.

 

Figure 3
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  		Figure 3: Graph shows number of radiologists who incorrectly identified 33 nodules as malignant or benign without CAD system.

 

Figure 4
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  		Figure 4: Mean ROC curves for all observers who distinguished between benign and malignant nodules without and with CAD output and ROC curve for the CAD output alone. The mean Az values for all radiologists increased from 0.843 ± 0.097 without CAD output to 0.924 ± 0.043 with CAD output. The difference was significant (P = .021). The Az value for the CAD output alone was 0.795.

 

Figure 5
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  		Figure 5: Mean ROC curves for the 10 board-certified radiologists who distinguished between benign and malignant nodules without and with CAD output. The mean Az values obtained without and with the CAD output were 0.910 ± 0.052 and 0.943 ± 0.040, respectively. The difference was not significant (P = .190).

 

Figure 6
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  		Figure 6: Mean ROC curves for the nine radiology residents who distinguished between benign and malignant nodules without and with CAD output. The mean Az values without and with the CAD output were 0.768 ± 0.078 and 0.901 ± 0.036, respectively. The difference was significant (P = .009).

 




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