计算机辅助检测系统提高CT肺结节检出方式的研究

Study of Improve the Detection Mode of CT Pulmonary Nodules by Computer Aided Detection

目的:通过对比研究计算机辅助检测系统(CAD)作为第二阅读者、同步阅读者筛查肺结节的方式,探索到适合临床推广应用的CAD辅助方式。方法:纳入60例MDCT检查肺部有结节的体检者。4位放射科医生阅读图像3次并进行标记,同时采用计时器计算时间。第一次,医生无CAD辅助方式阅片;第二次,CAD辅助医生作为同步阅读者(CR)方式阅片;第三次,CAD辅助医生作为第二阅读者(SR)方式阅片。结节参照标准由3名主任医生共同拟定。分别使用χ2检验、秩和检验分析两种阅读方式灵敏度及阅片时间是否存在差异,P<0.05有统计学差异。结果:根据参照标准共检出253个结节。放射科医生使用CAD作为CR(87.75%,P<0.001)、SR(88.84%,P<0.001)方式检测肺结节灵敏度显著高于无CAD辅助方式阅片(68.58%)。CR和SR方式检测肺结节灵敏度之间没有显著差异(P=0.30)。放射科医生CR(97±38s)方式阅片时间明显少于无CAD辅助方式阅片(128±45s,P<0.001)及SR方式(169±53s,P<0.001)。结论 :CAD作为同步阅读者、第二阅读者方式在MDCT筛查肺结节中均可显著提高放射科医生检测肺结节的灵敏度,且同步阅读者方式工作效率高,可以作为医生检测肺结节的首选辅助方式。

Purpose： By comparing concurrent-reader and second-reader modes of computer-aided detection（CAD） for screening pulmonary nodules, to investigate a possible mode for CAD, which can be widely applied in the clinic. Methods： Sixty subjects diagnosed with lung nodules undergoing the rountine-dose screening CT examination were selected. Four radiologists independently interpreted these datasets three times and marked all detected nodules and recorded the reading time simultaneously. For the first time, these radiologists read these scans without CAD;The second time, CAD was refered as concurrent readers helped them reading scans. The last time, CAD was used as the second reader assisted these radiologists reading scans.The ground truth of nodules in the datasets was determined by three raiologists. χ2 test and rank-sum test were performed to test whether there was significant difference between the sensitivities of two reading modes, and statistical significances were defined as P〈0.05. Results： According to theground truth,these three radiologists found out 253 nodules. The sensitivities of pulmonary nodule detection with CR（87.75%, P0.001） and SR（88.84%, P0.001） were significantly higher than the sensitivity of pulmonary nodule detection without CAD（68.58%）. There was no significant diffrernce of sensitivity between CR and SR（P=0.30）. The reading time was significantly less in CR mode（97±38 s） than that in independently reading（128± 45 s, P〈0.001） and SR mode（169±53s, P〈0.01）. Conclusion： Two reading modes of CAD（CR, SR） can significantly increase the sensitivities of radiologists. The efficiency is higher by CR mode than that by SR mode. CR mode can be used as the first option to detect pulmonary nodules by radiologists.