Observer performance in the detection and classification of malignant hepatic nodules and masses with CT image-space denoising and iterative reconstruction

Joel Garland Fletcher, Lifeng Yu, Zhoubo Li, Armando Manduca, Daniel J. Blezek, David M. Hough, Sudhakar K Venkatesh, Gregory C. Brickner, Joseph C. Cernigliaro, Amy K. Hara, Jeff L. Fidler, David S. Lake, Maria Shiung, David Lewis, Shuai Leng, Kurt E. Augustine, Rickey E. Carter, David R. Holmes III, Cynthia H McCollough

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine if lower-dose computed tomographic (CT) scans obtained with adaptive image-based noise reduction (adaptive nonlocal means [ANLM]) or iterative reconstruction (sinogram-affirmed iterative reconstruction [SAFIRE]) result in reduced observer performance in the detection of malignant hepatic nodules and masses compared with routine-dose scans obtained with filtered back projection (FBP). Materials and Methods: This study was approved by the institutional review board and was compliant with HIPAA. Informed consent was obtained from patients for the retrospective use of medical records for research purposes. CT projection data from 33 abdominal and 27 liver or pancreas CT examinations were collected (median volume CT dose index, 13.8 and 24.0 mGy, respectively). Hepatic malignancy was defined by progression or regression or with histopathologic findings. Lower-dose data were created by using a validated noise insertion method (10.4 mGy for abdominal CT and 14.6 mGy for liver or pancreas CT) and images reconstructed with FBP, ANLM, and SAFIRE. Four readers evaluated routine-dose FBP images and all lower-dose images, circumscribing liver lesions and selecting diagnosis. The jack-knife free-response receiver operating characteristic figure of merit (FOM) was calculated on a per-malignant nodule or permass basis. Noninferiority was defined by the lower limit of the 95% confidence interval (CI) of the difference between lower-dose and routine-dose FOMs being less than -0.10. Results: Twenty-nine patients had 62 malignant hepatic nodules and masses. Estimated FOM differences between lower-dose FBP and lower-dose ANLM versus routine-dose FBP were noninferior (difference: -0.041 [95% CI: -0.090, 0.009] and -0.003 [95% CI: -0.052, 0.047], respectively). In patients with dedicated liver scans, lower-dose ANLM images were noninferior (difference: +0.015 [95% CI: -0.077, 0.106]), whereas lower-dose FBP images were not (difference -0.049 [95% CI: -0.140, 0.043]). In 37 patients with SAFIRE reconstructions, the three lower-dose alternatives were found to be noninferior to the routine-dose FBP. Conclusion: At moderate levels of dose reduction, lower-dose FBP images without ANLM or SAFIRE were noninferior to routine-dose images for abdominal CT but not for liver or pancreas CT.

Original languageEnglish (US)
Pages (from-to)465-478
Number of pages14
JournalRadiology
Volume276
Issue number2
DOIs
StatePublished - Aug 1 2015

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Liver
Confidence Intervals
Pancreas
Noise
Health Insurance Portability and Accountability Act
Research Ethics Committees
Informed Consent
ROC Curve
Medical Records
Biomedical Research
Neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Observer performance in the detection and classification of malignant hepatic nodules and masses with CT image-space denoising and iterative reconstruction. / Fletcher, Joel Garland; Yu, Lifeng; Li, Zhoubo; Manduca, Armando; Blezek, Daniel J.; Hough, David M.; Venkatesh, Sudhakar K; Brickner, Gregory C.; Cernigliaro, Joseph C.; Hara, Amy K.; Fidler, Jeff L.; Lake, David S.; Shiung, Maria; Lewis, David; Leng, Shuai; Augustine, Kurt E.; Carter, Rickey E.; Holmes III, David R.; McCollough, Cynthia H.

In: Radiology, Vol. 276, No. 2, 01.08.2015, p. 465-478.

Research output: Contribution to journalArticle

Fletcher, Joel Garland ; Yu, Lifeng ; Li, Zhoubo ; Manduca, Armando ; Blezek, Daniel J. ; Hough, David M. ; Venkatesh, Sudhakar K ; Brickner, Gregory C. ; Cernigliaro, Joseph C. ; Hara, Amy K. ; Fidler, Jeff L. ; Lake, David S. ; Shiung, Maria ; Lewis, David ; Leng, Shuai ; Augustine, Kurt E. ; Carter, Rickey E. ; Holmes III, David R. ; McCollough, Cynthia H. / Observer performance in the detection and classification of malignant hepatic nodules and masses with CT image-space denoising and iterative reconstruction. In: Radiology. 2015 ; Vol. 276, No. 2. pp. 465-478.
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abstract = "Purpose: To determine if lower-dose computed tomographic (CT) scans obtained with adaptive image-based noise reduction (adaptive nonlocal means [ANLM]) or iterative reconstruction (sinogram-affirmed iterative reconstruction [SAFIRE]) result in reduced observer performance in the detection of malignant hepatic nodules and masses compared with routine-dose scans obtained with filtered back projection (FBP). Materials and Methods: This study was approved by the institutional review board and was compliant with HIPAA. Informed consent was obtained from patients for the retrospective use of medical records for research purposes. CT projection data from 33 abdominal and 27 liver or pancreas CT examinations were collected (median volume CT dose index, 13.8 and 24.0 mGy, respectively). Hepatic malignancy was defined by progression or regression or with histopathologic findings. Lower-dose data were created by using a validated noise insertion method (10.4 mGy for abdominal CT and 14.6 mGy for liver or pancreas CT) and images reconstructed with FBP, ANLM, and SAFIRE. Four readers evaluated routine-dose FBP images and all lower-dose images, circumscribing liver lesions and selecting diagnosis. The jack-knife free-response receiver operating characteristic figure of merit (FOM) was calculated on a per-malignant nodule or permass basis. Noninferiority was defined by the lower limit of the 95{\%} confidence interval (CI) of the difference between lower-dose and routine-dose FOMs being less than -0.10. Results: Twenty-nine patients had 62 malignant hepatic nodules and masses. Estimated FOM differences between lower-dose FBP and lower-dose ANLM versus routine-dose FBP were noninferior (difference: -0.041 [95{\%} CI: -0.090, 0.009] and -0.003 [95{\%} CI: -0.052, 0.047], respectively). In patients with dedicated liver scans, lower-dose ANLM images were noninferior (difference: +0.015 [95{\%} CI: -0.077, 0.106]), whereas lower-dose FBP images were not (difference -0.049 [95{\%} CI: -0.140, 0.043]). In 37 patients with SAFIRE reconstructions, the three lower-dose alternatives were found to be noninferior to the routine-dose FBP. Conclusion: At moderate levels of dose reduction, lower-dose FBP images without ANLM or SAFIRE were noninferior to routine-dose images for abdominal CT but not for liver or pancreas CT.",
author = "Fletcher, {Joel Garland} and Lifeng Yu and Zhoubo Li and Armando Manduca and Blezek, {Daniel J.} and Hough, {David M.} and Venkatesh, {Sudhakar K} and Brickner, {Gregory C.} and Cernigliaro, {Joseph C.} and Hara, {Amy K.} and Fidler, {Jeff L.} and Lake, {David S.} and Maria Shiung and David Lewis and Shuai Leng and Augustine, {Kurt E.} and Carter, {Rickey E.} and {Holmes III}, {David R.} and McCollough, {Cynthia H}",
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T1 - Observer performance in the detection and classification of malignant hepatic nodules and masses with CT image-space denoising and iterative reconstruction

AU - Fletcher, Joel Garland

AU - Yu, Lifeng

AU - Li, Zhoubo

AU - Manduca, Armando

AU - Blezek, Daniel J.

AU - Hough, David M.

AU - Venkatesh, Sudhakar K

AU - Brickner, Gregory C.

AU - Cernigliaro, Joseph C.

AU - Hara, Amy K.

AU - Fidler, Jeff L.

AU - Lake, David S.

AU - Shiung, Maria

AU - Lewis, David

AU - Leng, Shuai

AU - Augustine, Kurt E.

AU - Carter, Rickey E.

AU - Holmes III, David R.

AU - McCollough, Cynthia H

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Purpose: To determine if lower-dose computed tomographic (CT) scans obtained with adaptive image-based noise reduction (adaptive nonlocal means [ANLM]) or iterative reconstruction (sinogram-affirmed iterative reconstruction [SAFIRE]) result in reduced observer performance in the detection of malignant hepatic nodules and masses compared with routine-dose scans obtained with filtered back projection (FBP). Materials and Methods: This study was approved by the institutional review board and was compliant with HIPAA. Informed consent was obtained from patients for the retrospective use of medical records for research purposes. CT projection data from 33 abdominal and 27 liver or pancreas CT examinations were collected (median volume CT dose index, 13.8 and 24.0 mGy, respectively). Hepatic malignancy was defined by progression or regression or with histopathologic findings. Lower-dose data were created by using a validated noise insertion method (10.4 mGy for abdominal CT and 14.6 mGy for liver or pancreas CT) and images reconstructed with FBP, ANLM, and SAFIRE. Four readers evaluated routine-dose FBP images and all lower-dose images, circumscribing liver lesions and selecting diagnosis. The jack-knife free-response receiver operating characteristic figure of merit (FOM) was calculated on a per-malignant nodule or permass basis. Noninferiority was defined by the lower limit of the 95% confidence interval (CI) of the difference between lower-dose and routine-dose FOMs being less than -0.10. Results: Twenty-nine patients had 62 malignant hepatic nodules and masses. Estimated FOM differences between lower-dose FBP and lower-dose ANLM versus routine-dose FBP were noninferior (difference: -0.041 [95% CI: -0.090, 0.009] and -0.003 [95% CI: -0.052, 0.047], respectively). In patients with dedicated liver scans, lower-dose ANLM images were noninferior (difference: +0.015 [95% CI: -0.077, 0.106]), whereas lower-dose FBP images were not (difference -0.049 [95% CI: -0.140, 0.043]). In 37 patients with SAFIRE reconstructions, the three lower-dose alternatives were found to be noninferior to the routine-dose FBP. Conclusion: At moderate levels of dose reduction, lower-dose FBP images without ANLM or SAFIRE were noninferior to routine-dose images for abdominal CT but not for liver or pancreas CT.

AB - Purpose: To determine if lower-dose computed tomographic (CT) scans obtained with adaptive image-based noise reduction (adaptive nonlocal means [ANLM]) or iterative reconstruction (sinogram-affirmed iterative reconstruction [SAFIRE]) result in reduced observer performance in the detection of malignant hepatic nodules and masses compared with routine-dose scans obtained with filtered back projection (FBP). Materials and Methods: This study was approved by the institutional review board and was compliant with HIPAA. Informed consent was obtained from patients for the retrospective use of medical records for research purposes. CT projection data from 33 abdominal and 27 liver or pancreas CT examinations were collected (median volume CT dose index, 13.8 and 24.0 mGy, respectively). Hepatic malignancy was defined by progression or regression or with histopathologic findings. Lower-dose data were created by using a validated noise insertion method (10.4 mGy for abdominal CT and 14.6 mGy for liver or pancreas CT) and images reconstructed with FBP, ANLM, and SAFIRE. Four readers evaluated routine-dose FBP images and all lower-dose images, circumscribing liver lesions and selecting diagnosis. The jack-knife free-response receiver operating characteristic figure of merit (FOM) was calculated on a per-malignant nodule or permass basis. Noninferiority was defined by the lower limit of the 95% confidence interval (CI) of the difference between lower-dose and routine-dose FOMs being less than -0.10. Results: Twenty-nine patients had 62 malignant hepatic nodules and masses. Estimated FOM differences between lower-dose FBP and lower-dose ANLM versus routine-dose FBP were noninferior (difference: -0.041 [95% CI: -0.090, 0.009] and -0.003 [95% CI: -0.052, 0.047], respectively). In patients with dedicated liver scans, lower-dose ANLM images were noninferior (difference: +0.015 [95% CI: -0.077, 0.106]), whereas lower-dose FBP images were not (difference -0.049 [95% CI: -0.140, 0.043]). In 37 patients with SAFIRE reconstructions, the three lower-dose alternatives were found to be noninferior to the routine-dose FBP. Conclusion: At moderate levels of dose reduction, lower-dose FBP images without ANLM or SAFIRE were noninferior to routine-dose images for abdominal CT but not for liver or pancreas CT.

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