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KMID : 0880420180190030516
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Korean Journal of Radiology
2018 Volume.19 No. 3 p.516 ~ p.525
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Nodule Classification on Low-Dose Unenhanced CT and Standard-Dose Enhanced CT: Inter-Protocol Agreement and Analysis of Interchangeability
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Lee Kyung-Hee
Lee Kyung-Won
Park Ji-Hoon
Han Kyung-Hwa
Kim Ji-Hang
Lee Sang-Min
Park Chang-Min
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Abstract
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Objective: To measure inter-protocol agreement and analyze interchangeability on nodule classification between low-dose unenhanced CT and standard-dose enhanced CT.
Materials and Methods: From nodule libraries containing both low-dose unenhanced and standard-dose enhanced CT, 80 solid and 80 subsolid (40 part-solid, 40 non-solid) nodules of 135 patients were selected. Five thoracic radiologists categorized each nodule into solid, part-solid or non-solid. Inter-protocol agreement between low-dose unenhanced and standard-dose enhanced images was measured by pooling κ values for classification into two (solid, subsolid) and three (solid, part-solid, non-solid) categories. Interchangeability between low-dose unenhanced and standard-dose enhanced CT for the classification into two categories was assessed using a pre-defined equivalence limit of 8 percent.
Results: Inter-protocol agreement for the classification into two categories {κ, 0.96 (95% confidence interval [CI], 0.94?0.98)} and that into three categories (κ, 0.88 [95% CI, 0.85?0.92]) was considerably high. The probability of agreement between readers with standard-dose enhanced CT was 95.6% (95% CI, 94.5?96.6%), and that between low-dose unenhanced and standard?dose enhanced CT was 95.4% (95% CI, 94.7?96.0%). The difference between the two proportions was 0.25% (95% CI, ?0.85?1.5%), wherein the upper bound CI was markedly below 8 percent.
Conclusion: Inter-protocol agreement for nodule classification was considerably high. Low-dose unenhanced CT can be used interchangeably with standard-dose enhanced CT for nodule classification.
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KEYWORD
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Pulmonary nodules, Classification, Subsolid nodule, Ground-glass nodule, Computed tomography, Low-dose CT
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