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

Objectives

To 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 methods

A 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.

Results

CAD 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.

Conclusion

Considering 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.

Keywords:

• CT chest examinations
• pulmonary nodules
• lung carcinoma
• computer-assisted diagnosis

Acknowledgments

We would like to thank Dr Talat Waseem MD, Registrar at Ittefaq Hospital, Lahore and Mr Muhammad Islam, Department of Community Health Services, Aga Khan Hospital for statistical analysis. We would also like to thank Mr Zafar Jamil, senior technologist CT Section, Radiology Department, Aga Khan Hospital for his technical support.

Disclosure

There are no conflicts of interest. All authors contributed equally to the work. No funding was received for this study.