Improved detection of lung cancer arising in diffuse lung diseases on chest radiographs using temporal subtraction 1

Abstract

Rationale and objectives The purpose of this study was to evaluate the usefulness of temporal subtraction for the detection of lung cancer arising in pneumoconiosis, idiopathic pulmonary fibrosis, and pulmonary emphysema. Materials and methods Fifteen cases of lung cancer arising in diffuse lung diseases, including three cases of pneumoconiosis, six of idiopathic pulmonary fibrosis, and six of pulmonary emphysema, were evaluated. Pathologic proof was obtained by surgery or transbronchial lung biopsy. The average interval between previous and current radiographs was 356 days (range, 31–947days). All chest radiographs were obtained with a computed radiography system, and temporal subtraction images were produced by subtracting of a previous image from a current one with a nonlinear image-warping technique. The effect of the temporal subtraction image was evaluated by observer performance study with receiver operating characteristic analysis. Results The average observer performance with temporal subtraction was significantly improved (Az = 0.935) compared with that without temporal subtraction (Az = 0.857, P < .0001). Conclusion The temporal subtraction technique is useful for the detection of lung cancer arising in pneumoconiosis, idiopathic pulmonary fibrosis, and pulmonary emphysema.