title: Lung, liver and lymph node metastases in follow-up MSCT: comprehensive volumetric assessment of lesion size changes.
abstract: OBJECTIVE
  To investigate measurement accuracy in terms of precision and inter-rater variability in the simultaneous volumetric assessment of lung, liver and lymph node metastasis size change over time in comparison to RECIST 1.1.
  
  
  METHODS
  Three independent readers evaluated multislice CT data from clinical follow-up studies (chest/abdomen) in 50 patients with metastases. A total of 117 lung, 77 liver and 97 lymph node metastases were assessed manually (RECIST 1.1) and by volumetry with semi-automated software. The quality of segmentation and need for manual adjustments were recorded. Volumes were converted to effective diameters to allow comparison to RECIST. For statistical assessment of precision and interobserver agreement, the Wilcoxon-signed rank test and Bland-Altman plots were utilized.
  
  
  RESULTS
  The quality of segmentation after manual correction was acceptable to excellent in 95 % of lesions and manual corrections were applied in 21 - 36 % of all lesions, most predominantly in lymph nodes. Mean precision was 2.6 - 6.3 % (manual) with 0.2 - 1.5 % (effective) relative measurement deviation (p <.001). Inter-reader median variation coefficients ranged from 9.4 - 12.8 % (manual) and 2.9 - 8.2 % (volumetric) for different lesion types (p < .001). The limits of agreement were ± 9.8 to ± 11.2 % for volumetric assessment.
  
  
  CONCLUSIONS
  Superior precision and inter-rater variability of volumetric over manual measurement of lesion change over time was demonstrated in a whole body setting.
authors.affiliation: Klinik für Diagnostische Radiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel. a.wulff@rad.uni-kiel.de
authors.forename: A M
authors.initials: AM
authors.lastname: Wulff
authors.forename: H
authors.initials: H
authors.lastname: Bolte
authors.forename: S
authors.initials: S
authors.lastname: Fischer
authors.forename: S
authors.initials: S
authors.lastname: Freitag-Wolf
authors.forename: G
authors.initials: G
authors.lastname: Soza
authors.forename: C
authors.initials: C
authors.lastname: Tietjen
authors.forename: J
authors.initials: J
authors.lastname: Biederer
authors.forename: M
authors.initials: M
authors.lastname: Heller
authors.forename: M
authors.initials: M
authors.lastname: Fabel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*