title: Optimal presentation modes for detecting brain tumor progression.
abstract: OBJECTIVE
  A common task in radiology interpretation is visual comparison of images. The purpose of this study was to compare traditional side-by-side and in-place (flicker) image presentation modes with advanced methods for detecting primary brain tumors on MR imaging.
  
  
  METHODS
  We identified 66 patients with gliomas and 3 consecutive brain MR imaging examinations (a "triplet"). A display application that presented images in side-by-side mode with or without flicker display as well as display of image subtraction or automated change detection information (also with and without flicker display) was used by 3 board-certified neuroradiologists. They identified regions of brain tumor progression by using this display application. Each case was reviewed using all modes (side-by-side presentation with and without flicker, subtraction with and without flicker, and change detection with and without flicker), with results compared via a panel rating.
  
  
  RESULTS
  Automated change detection with or without flicker (P < .0027) as well as subtraction with or without flicker (P < .0027) were more sensitive to tumor progression than side-by-side presentation in cases where all 3 raters agreed. Change detection afforded the highest interrater agreement, followed by subtraction. Clinically determined time to progression was longer for cases rated as nonprogressing by using subtraction images and change-detection images both with and without flicker display mode compared with side-by-side presentation.
  
  
  CONCLUSIONS
  Automated change detection and image subtraction, with and without flicker display mode, are superior to side-by-side image comparison.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. bje@mayo.edu
authors.forename: B J
authors.initials: BJ
authors.lastname: Erickson
authors.forename: C P
authors.initials: CP
authors.lastname: Wood
authors.forename: T J
authors.initials: TJ
authors.lastname: Kaufmann
authors.forename: J W
authors.initials: JW
authors.lastname: Patriarche
authors.forename: J
authors.initials: J
authors.lastname: Mandrekar
mesh_terms: D000368:Aged; D000465:Algorithms; D001932:Brain Neoplasms / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity