Abstract
PurposeTo assess the effect of computer-aided detection (CAD) of brain metastasis (BM) on radiologists’ diagnostic performance in interpreting three-dimensional brain magnetic resonance (MR) imaging using follow-up imaging and consensus as the reference standard.Materials and methodsThe institutional review board approved this retrospective study. The study cohort consisted of 110 consecutive patients with BM and 30 patients without BM. The training data set included MR images of 80 patients with 450 BM nodules. The test set included MR images of 30 patients with 134 BM nodules and 30 patients without BM. We developed a CAD system for BM detection using template-matching and K-means clustering algorithms for candidate detection and an artificial neural network for false-positive reduction. Four reviewers (two neuroradiologists and two radiology residents) interpreted the test set images before and after the use of CAD in a sequential manner. The sensitivity, false positive (FP) per case, and reading time were analyzed. A jackknife free-response receiver operating characteristic (JAFROC) method was used to determine the improvement in the diagnostic accuracy.ResultsThe sensitivity of CAD was 87.3% with an FP per case of 302.4. CAD significantly improved the diagnostic performance of the four reviewers with a figure-of-merit (FOM) of 0.874 (without CAD) vs. 0.898 (with CAD) according to JAFROC analysis (p < 0.01). Statistically significant improvement was noted only for less-experienced reviewers (FOM without vs. with CAD, 0.834 vs. 0.877, p < 0.01). The additional time required to review the CAD results was approximately 72 sec (40% of the total review time).ConclusionCAD as a second reader helps radiologists improve their diagnostic performance in the detection of BM on MR imaging, particularly for less-experienced reviewers.
Highlights
Metastatic brain tumors are the most common brain tumors in adults [1]
computer-aided detection (CAD) significantly improved the diagnostic performance of the four reviewers with a figure-of-merit (FOM) of 0.874 vs. 0.898 according to jackknife free-response receiver operating characteristic (JAFROC) analysis (p < 0.01)
Growing evidence suggests that stereotactic radiosurgery can be safely used for patients with up to 10 brain metastasis (BM) nodules [9, 10]
Summary
Metastatic brain tumors are the most common brain tumors in adults [1]. Brain metastasis (BM) carries a dismal prognosis, with a median survival of only 1 month if left untreated [2]. With the use of whole-brain radiation therapy (WBRT), which has been the primary treatment modality of BM for over 50 years [3], the prognosis of patients with BM remains poor, with a median survival of 4 to 6 months [4]. Growing evidence suggests that stereotactic radiosurgery can be safely used for patients with up to 10 BM nodules [9, 10]. The accurate determination of the number, size, and location of metastatic lesions on brain imaging has become crucial for selecting the most appropriate treatment method
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