title: Statistical validation based on parametric receiver operating characteristic analysis of continuous classification data.
abstract: OBJECTIVE
  The accuracy of diagnostic test and imaging segmentation is important in clinical practice because it has a direct impact on therapeutic planning. Statistical validations of classification accuracy was conducted based on parametric receiver operating characteristic analysis, illustrated on three radiologic examples,
  
  
  METHODS
  Two parametric models were developed for diagnostic or imaging data. Example 1: A semi-automated fractional segmentation algorithm was applied to magnetic resonance imaging of nine cases of brain tumors. The tumor and background pixel data were assumed to have bi-beta distributions. Fractional segmentation was validated against an estimated composite pixel-wise gold standard based on multi-reader manual segmentations. Example 2: The predictive value of 100 cases of spiral computed tomography of ureteral stone sizes, distributed as bi-normal after a non-linear transformation, under two treatment options received. Example 3: One hundred eighty cases had prostate-specific antigen levels measured in a prospective clinical trial. Radical prostatectomy was performed in all to provide a binary gold standard of local and advanced cancer stages. Prostate-specific antigen level was transformed and modeled by bi-normal distributions. In all examples, areas under the receiver operating characteristic curves were computed. RESULTS. The areas under the receiver operating characteristic curves were: Example 1: Fractional segmentation of magnetic resonance imaging of brain tumors: meningiomas (0.924-0.984); astrocytomas (0.786-0.986); and other low-grade gliomas (0.896-0.983). Example 3: Ureteral stone size for treatment planning (0.813). Example 2: Prostate-specific antigen for staging prostate cancer (0.768).
  
  
  CONCLUSIONS
  All clinical examples yielded fair to excellent accuracy. The validation metric area under the receiver operating characteristic curves may be generalized to evaluating the performances of several continuous classifiers related to imaging.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115 USA.
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Zou
authors.forename: Simon K
authors.initials: SK
authors.lastname: Warfield
authors.forename: Julia R
authors.initials: JR
authors.lastname: Fielding
authors.forename: Clare M C
authors.initials: CM
authors.lastname: Tempany
authors.forename: M Wells
authors.initials: MW
authors.lastname: William
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kaus
authors.forename: Ferenc A
authors.initials: FA
authors.lastname: Jolesz
authors.forename: Ron
authors.initials: R
authors.lastname: Kikinis
mesh_terms: D000465:Algorithms; D001932:Brain Neoplasms / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000601:surgery; D012372:ROC Curve; D014057:Tomography, X-Ray Computed; D014514:Ureteral Calculi / Q000000981:diagnostic imaging*
chemical_list: D017430:Prostate-Specific Antigen