title: CsI-detector-based dual-exposure dual energy in chest radiography for lung nodule detection: results of an international multicenter trial.
abstract: To assess both sensitivity and specificity of digital chest radiography alone and in conjunction with dual-exposure dual-energy chest radiography for the detection and classification of pulmonary nodules. One hundred patients with a total of 149 lung nodules (3-45 mm; median, 11 mm) confirmed by CT were included in this study. Dual-exposure dual-energy chest radiographies of each patient were obtained using a CsI detector system. Experienced board-certified chest radiologists from four different medical centers in Europe reviewed standard chest radiographs alone and in conjunction with dual-energy images blinded and in random order. The reviewers rated the probability of presence, calcification and malignancy of all lung nodules on a five-point rating scale. Lesions detected were identified by applying a specific coordinate system to enable precise verification by the study leader. A receiver-operating characteristic (ROC) analysis was performed. In addition to the 149 true-positive CT proven lesions, 236 false-positive lung nodules were described in digital chest radiographies in conjunction with dual-energy chest radiographies. The cumulative sensitivity of chest radiography in conjunction with dual energy was 43%, specificity was 55%. For digital radiography alone, sensitivity was 35% and specifity was 83%. For the dual energy system, positive predictive value was 58%, and negative predictive value was 66% compared to the digital radiography with a positive predictive value of 59% and a negative predictive value of 65%. Areas under the curve in a ROC analysis resulted in 0.631 (95% confidence interval =0.61 to 0.65) for radiography with dual energy and 0.602 (95% confidence interval =0.58 to 0.63) for digital radiography alone. This difference was not statistically significant. For the detection of lesion calcification or the determination of malignancy, ROC analysis also failed to show significant differences. CsI-based flat-panel dual-exposure dual-energy imaging added to standard chest radiography did not show statistically significant improvement for the detection of pulmonary nodules, nor the identification of calcifications, nor the determination of malignancy.
authors.affiliation: Universitätsklinikum Magdeburg, Klinik für Radiologie und Nuklearmedizin, Leipzigerstr. 44, 39120, Magdeburg, Germany. ricarda.ruehl@medizin.uni-magdeburg.de
authors.forename: Ricarda
authors.initials: R
authors.lastname: Rühl
authors.forename: Magdalena M
authors.initials: MM
authors.lastname: Wozniak
authors.forename: Michael
authors.initials: M
authors.lastname: Werk
authors.forename: François
authors.initials: F
authors.lastname: Laurent
authors.forename: Georg
authors.initials: G
authors.lastname: Mager
authors.forename: Michel
authors.initials: M
authors.lastname: Montaudon
authors.forename: Andreas
authors.initials: A
authors.lastname: Pattermann
authors.forename: Antoine
authors.initials: A
authors.lastname: Scherrer
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Tasu
authors.forename: Maciej
authors.initials: M
authors.lastname: Pech
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002586:Cesium; D005260:Female; D006801:Humans; D038622:Internationality; D007454:Iodides; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D007454:Iodides; D002586:Cesium; C040050:cesium iodide