title: Clinical results of CsI-detector-based dual-exposure dual energy in chest radiography.
abstract: The aim of this study was to compare the sensitivity and specificity of digital chest radiography alone with digital chest radiography combined with dual-energy chest radiography in the detection of small non-calcified pulmonary nodules. Standard and dual-energy radiographs were obtained with a flat-panel digital chest system. Four radiologists reviewed digital posteroanterior chest radiographs in random order either alone or in conjunction with dual-energy soft tissue and bone images. Twenty patients with a total of 59 pulmonary nodules (median 0.5 cm, range 0.3-2.5 cm) confirmed by computed tomography (HU < or =100) were included. A level of confidence for each diagnosis was documented using a rating scale of 1-5. Brunner and Langer's test was performed for statistical analysis. Subgroup analysis was performed for nodules greater than 1 cm, 1-0.5 cm, and <0.5 cm. For posteroanterior chest radiography, sensitivity was 33%, positive predictive value 83%, specificity 81%, and negative predictive value 30%. Review in conjunction with dual-energy images resulted in a sensitivity of 42%, positive predictive value 88%, specificity 85%, and negative predictive value 34%. The increase of nodule detection overall as well as for different size categories was significant (p<0.05). The increase of the confidence level rating was also significant (p<0.001). Dual energy added to standard posteroanterior chest radiography significantly improves the sensitivity, specificity, and confidence in detection of small non-calcified pulmonary nodules.
authors.affiliation: Department of Radiology, Charité, Campus Virchow-Klinikum, Humboldt University Medical School, Augustenburgerplatz 1, 13353 Berlin, Germany. jens.ricke@charite.de
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
authors.forename: Frank
authors.initials: F
authors.lastname: Fischbach
authors.forename: Torsten
authors.initials: T
authors.lastname: Freund
authors.forename: Ulf
authors.initials: U
authors.lastname: Teichgräber
authors.forename: Enrique Lopez
authors.initials: EL
authors.lastname: Hänninen
authors.forename: Rainer
authors.initials: R
authors.lastname: Röttgen
authors.forename: Ulrike
authors.initials: U
authors.lastname: Engert
authors.forename: Hermann
authors.initials: H
authors.lastname: Eichstädt
authors.forename: Roland
authors.initials: R
authors.lastname: Felix
mesh_terms: D006801:Humans; D008875:Middle Aged; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods; D013902:Radiography, Thoracic / Q000379:methods*; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*