title: Detection of nodules showing ground-glass opacity in the lungs at low-dose multidetector computed tomography: phantom and clinical study.
abstract: OBJECTIVE
  To investigate the effect of the radiation dose (tube current second product) and the attenuation value of nodules with ground-glass opacity (GGO) on their detectability at multidetector computed tomography (MDCT).
  
  
  METHODS
  We scanned a chest CT phantom that included simulated GGO nodules with an MDCT scanner. The attenuation value of the simulated lung parenchyma was -900 Hounsfield units (HU); it was -800 and -650 HU for the simulated GGO nodules. We used a tube current second product of 180 mA as the standard and 21, 45, 60, and 90 mAs as the low-dose and performed receiver operating characteristic analysis to compare the performance of 5 radiologists in detecting GGO nodules at each milliampere. To assess the detectability of GGO nodules on human lung images, the observers were presented with 38 GGO nodules from 15 patients. The 5 radiologists independently reviewed chest CT images at 21 and 45 mAs.
  
  
  RESULTS
  In the phantom study, the Az value for GGO nodules with a CT number of -800 HU was significantly lower at 21 than 180 effective mA (0.86 vs. 0.96; P < 0.01). There was no statistically significant difference in the Az value of GGO nodules with a CT number of -650 HU, irrespective of milliamperes used (P = 0.165). In the clinical study, 39.5% and 25.8% of GGO were missed at 21 and 45 mAs, respectively.
  
  
  CONCLUSIONS
  At MDCT, GGO nodules with a CT number of -650 HU or less were difficult to detect at the lower milliampere settings (21 and 45 mAs).
authors.affiliation: Department of Radiological Sciences, School of Health Sciences, Kumamoto University, Kumamoto, Japan. funama@kumamoto-u.ac.jp
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Funama
authors.forename: Kazuo
authors.initials: K
authors.lastname: Awai
authors.forename: Duo
authors.initials: D
authors.lastname: Liu
authors.forename: Seitaro
authors.initials: S
authors.lastname: Oda
authors.forename: Yumi
authors.initials: Y
authors.lastname: Yanaga
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakaura
authors.forename: Koichi
authors.initials: K
authors.lastname: Kawanaka
authors.forename: Masamichi
authors.initials: M
authors.lastname: Shimamura
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*