Carin Meltzer1,2, Erika Fagman1,3, Jenny Vikgren1,3, David Molnar1,3, Eivind Borna4, Maral Mirzai Beni5, John Brandberg1,3, Bengt Bergman6,7, Magnus Båth5,8, Åse A Johnsson1,3. 1. Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden. 2. Department of Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Norway. 3. Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 4. Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden. 5. Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden. 6. Department of Respiratory Medicine, Sahlgrenska University Hospital, Sweden. 7. Department of Respiratory Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden. 8. Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Abstract
BACKGROUND: Digital tomosynthesis (DTS) might be a low-dose/low-cost alternative to computed tomography (CT). PURPOSE: To investigate DTS relative to CT for surveillance of incidental, solid pulmonary nodules. MATERIAL AND METHODS: Recruited from a population study, 106 participants with indeterminate solid pulmonary nodules on CT underwent surveillance with concurrently performed CT and DTS. Nodule size on DTS was assessed by manual diameter measurements and semi-automatic nodule segmentations were independently performed on CT. Measurement agreement was analyzed according to Bland-Altman with 95% limits of agreement (LoA). Detection of nodule volume change > 25% by DTS in comparison to CT was evaluated with receiver operating characteristics (ROC). RESULTS: A total of 81 nodules (76%) were assessed as measurable on DTS by two independent observers. Inter- and intra-observer LoA regarding change in average diameter were ± 2 mm. Calculation of relative volume change on DTS resulted in wide inter- and intra-observer LoA in the order of ± 100% and ± 50%. Comparing relative volume change between DTS and CT resulted in LoA of -58% to 67%. The area under the ROC curve regarding the ability of DTS to detect volumetric changes > 25% on CT was 0.58 (95% confidence interval [CI] = 0.40-0.76) and 0.50 (95% CI = 0.35-0.66) for the two observers. CONCLUSION: The results of the present study show that measurement variability limits the agreement between DTS and CT regarding nodule size change for small solid nodules.
BACKGROUND: Digital tomosynthesis (DTS) might be a low-dose/low-cost alternative to computed tomography (CT). PURPOSE: To investigate DTS relative to CT for surveillance of incidental, solid pulmonary nodules. MATERIAL AND METHODS: Recruited from a population study, 106 participants with indeterminate solid pulmonary nodules on CT underwent surveillance with concurrently performed CT and DTS. Nodule size on DTS was assessed by manual diameter measurements and semi-automatic nodule segmentations were independently performed on CT. Measurement agreement was analyzed according to Bland-Altman with 95% limits of agreement (LoA). Detection of nodule volume change > 25% by DTS in comparison to CT was evaluated with receiver operating characteristics (ROC). RESULTS: A total of 81 nodules (76%) were assessed as measurable on DTS by two independent observers. Inter- and intra-observer LoA regarding change in average diameter were ± 2 mm. Calculation of relative volume change on DTS resulted in wide inter- and intra-observer LoA in the order of ± 100% and ± 50%. Comparing relative volume change between DTS and CT resulted in LoA of -58% to 67%. The area under the ROC curve regarding the ability of DTS to detect volumetric changes > 25% on CT was 0.58 (95% confidence interval [CI] = 0.40-0.76) and 0.50 (95% CI = 0.35-0.66) for the two observers. CONCLUSION: The results of the present study show that measurement variability limits the agreement between DTS and CT regarding nodule size change for small solid nodules.
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Authors: G Bergström; G Berglund; A Blomberg; J Brandberg; G Engström; J Engvall; M Eriksson; U de Faire; A Flinck; M G Hansson; B Hedblad; O Hjelmgren; C Janson; T Jernberg; Å Johnsson; L Johansson; L Lind; C-G Löfdahl; O Melander; C J Östgren; A Persson; M Persson; A Sandström; C Schmidt; S Söderberg; J Sundström; K Toren; A Waldenström; H Wedel; J Vikgren; B Fagerberg; A Rosengren Journal: J Intern Med Date: 2015-06-19 Impact factor: 8.989