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Computer-Aided Detection of Solid Lung Nodules on Follow-Up MDCT Screening: Evaluation of Detection, Tracking, and Reading Time

Catherine Beigelman-Aubry1, Philippe Raffy2,3, Wenjie Yang1, Ronald A. Castellino2 and Philippe A. Grenier1

1 Department of Radiology, Pitié-Salpêtrière Hospital, Assistance Publique—Hôpitaux de Paris, University Pierre et Marie Curie, Paris VI, 47-83 bd de L'Hôpital, 75651 Paris, Cedex 13, France.
2 R2 Technology, Inc. (now Hologic), Santa Clara, CA.
3 Present address: Vital Images, Minnetonka, MN.


Figure 1
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  		Fig. 1A —77-year-old man with solid nodule with irregular margins containing air bronchograms with doubling time consistent with malignant lesion (cancer # 1). For CT examinations, t, t–1, and t–2, respectively, designate current, most recent prior examination, and second most recent prior examination. Numbers marked with C are automatically generated by computer-aided detection (CAD) system and indicate presence of nodule candidate. On baseline CT image acquired at time t–2 (not part of observer study), radiologist who generated official clinical report missed 4.3-mm nonspecific ground-glass opacity (green circle). CAD detected and marked this lesion on this and subsequent examinations (green circles, B and C).

 

Figure 2
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  		Fig. 1B —77-year-old man with solid nodule with irregular margins containing air bronchograms with doubling time consistent with malignant lesion (cancer # 1). For CT examinations, t, t–1, and t–2, respectively, designate current, most recent prior examination, and second most recent prior examination. Numbers marked with C are automatically generated by computer-aided detection (CAD) system and indicate presence of nodule candidate. On image from first follow-up CT at time t–1 (733 days), 2 years later, 9-mm solid nodule with irregular margins containing air bronchogram is present in same location with doubling time compatible with malignant lesion. Between A and B, CAD calculated volumetric growth, and doubling time was 142% and 571 days.

 

Figure 3
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  		Fig. 1C —77-year-old man with solid nodule with irregular margins containing air bronchograms with doubling time consistent with malignant lesion (cancer # 1). For CT examinations, t, t–1, and t–2, respectively, designate current, most recent prior examination, and second most recent prior examination. Numbers marked with C are automatically generated by computer-aided detection (CAD) system and indicate presence of nodule candidate. On image from second follow-up CT at time t (84 days), 3 months later, after antibiotic therapy, nodule appears slightly larger. Between B and C, CAD calculated volumetric growth, and doubling time was 23.8% and 269 days, again compatible with malignant lesion (biopsy-proven adenocarcinoma).

 

Figure 4
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  		Fig. 2A —58-year-old man with 9-mm solid nodule with irregular margins on surveillance CT scan obtained 15 months after baseline CT (cancer # 2). For CT examinations, t, t–1, and t–2, respectively, designate current, most recent prior examination, and second most recent prior examination. Numbers marked with C are automatically generated by computer-aided detection (CAD) system and indicate presence of nodule candidate. On baseline CT image acquired at time t–2 (not part of observer study), in retrospect, there is nonspecific thickening of lateral aspect of wall of emphysematous bulla, which was of questionable significance at that time.

 

Figure 5
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  		Fig. 2B —58-year-old man with 9-mm solid nodule with irregular margins on surveillance CT scan obtained 15 months after baseline CT (cancer # 2). For CT examinations, t, t–1, and t–2, respectively, designate current, most recent prior examination, and second most recent prior examination. Numbers marked with C are automatically generated by computer-aided detection (CAD) system and indicate presence of nodule candidate. On image from first follow-up CT at time t–1 (457 days), there is now an 8.6-mm irregular spiculated nodule at same location. CAD detected and marked this lesion on this and subsequent examination (C) (green circles, B and C).

 

Figure 6
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  		Fig. 2C —58-year-old man with 9-mm solid nodule with irregular margins on surveillance CT scan obtained 15 months after baseline CT (cancer # 2). For CT examinations, t, t–1, and t–2, respectively, designate current, most recent prior examination, and second most recent prior examination. Numbers marked with C are automatically generated by computer-aided detection (CAD) system and indicate presence of nodule candidate. Image from second follow-up CT at time t (119 days) shows slight increase in lesion size. Between B and C, CAD calculated volumetric growth, and doubling time was 48.6% and 208 days, compatible with malignant lesion (biopsy-proven adenocarcinoma).

 

Figure 7
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  		Fig. 3 —Histogram shows distribution of effective nodule diameters for 149 lung nodules ≥ 2 mm identified on 54 current CT examinations. CAD detection performance was studied on subset of 52 nodules ≥ 4 mm (green bars).

 

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