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Usefulness of an Artificial Neural Network for Differentiating Benign from Malignant Pulmonary Nodules on High-Resolution CT

Evaluation with Receiver Operating Characteristic Analysis

Yuichi Matsuki1, Katsumi Nakamura1, Hideyuki Watanabe1, Takatoshi Aoki1, Hajime Nakata1, Shigehiko Katsuragawa2 and Kunio Doi3

1 Department of Radiology, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Japan 807-8555.
2 Nippon Bunri University General Research Center, Nippon Bunri University, Ichiki 1727, Oita-shi, Japan 870-0397.
3 Kurt Rossmann Laboratories for Radiologic Image Research, Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637.



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Fig. 1. 54-year-old woman with lung cancer. High-resolution CT scan shows nodule with spiculation in whole margin and obvious pleural indentation.

 


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Fig. 2. 58-year-old man with organizing pneumonia. High-resolution CT scan shows nodule without spiculation or obvious pleural indentation.

 


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Fig. 3. Bar chart shows distribution of artificial neural network output that indicates likelihood of malignancy for malignant and benign nodules. Note that number of cases indicated equal to or more than 80% of likelihood of malignancy is 70. Sixty-seven cases (96%) were malignant, and only three cases (4%) were benign. Black bar = malignant, striped bar = benign.

 


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Fig. 4. Graph shows receiver operating characteristic curve of artificial neural network for differentiating benign from malignant nodules. Note that Az value of artificial neural network was 0.951, indicating high performance.

 


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Fig. 5. Graph shows average receiver operating characteristic curves for differentiating benign from malignant nodules without and with artificial neural network (ANN) output by attending radiologists. Note that observer performance with ANN output was significantly improved. Solid line = with ANN (Az = 0.985), dashed line = without ANN (Az = 0.933).

 


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Fig. 6. Graph shows average receiver operating characteristic curves for differentiating benign from malignant nodules without and with artificial neural network (ANN) output by radiology fellows. Note that observer performance with ANN output was significantly improved. Solid line = with ANN, (Az = 0.932), dashed line = without ANN (Az = 0.821).

 


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Fig. 7. Graph shows average receiver operating characteristic curves for differentiating benign from malignant nodules without and with artificial neural network (ANN) output by radiology residents. Note that observer performance with ANN output was significantly improved. Solid line = with ANN (Az = 0.961), dashed line = without ANN (Az = 0.759).

 


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Fig. 8. Graph shows comparison of average receiver operating characteristic (ROC) curves for all observers without and with artificial neural network (ANN) output and ROC curves for ANN output alone. Note that observer performance with ANN output was significantly higher than that without ANN or than that with ANN alone. Solid line = with ANN (Az = 0.959), dotted line = ANN alone (Az = 0.951), dashed line = without ANN (Az = 0.831).

 


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Fig. 9. Histogram shows number of cases affected (>30) due to artificial neural network output on benign nodules. Note that number of cases affected beneficially was significantly higher than number of cases affected detrimentally for benign nodules. Observers A—D are attending radiologists, observers E—H are radiology fellows, and observers I—K and L are radiology residents.

 


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Fig. 10. Histogram shows number of cases affected (>30) due to artificial neural network output on malignant nodules. Note that number of cases affected beneficially was significantly higher than number of cases affected detrimentally for malignant nodules. Observers A—D are attending radiologists, observers E—H are radiology fellows, and observers I—L are radiology residents.

 

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