title: Efficacy of computer-aided detection as a second reader for 6-9-mm lesions at CT colonography: multicenter prospective trial.
abstract: OBJECTIVE
  To assess the effect of computer-aided detection (CAD) as a second reader on the sensitivity and specificity of computed tomographic (CT) colonography in detecting 6-9-mm colorectal cancer (CRC) lesions.
  
  
  METHODS
  Individuals with clinical indications for colonoscopy--either for symptoms or as part of participating in a surveillance program or CRC screening--were prospectively enrolled at one of 10 academic centers between July 2007 and May 2009. Institutional review board approval was obtained at each clinical site, and all participants provided written informed consent. All participants underwent CT colonography and colonoscopy on the same day. Experienced readers interpreted the CT colonography images unassisted and then reviewed all colorectal lesion-like structures pinpointed by the CAD algorithm. Segmental unblinding of CT colonoscopy findings at colonoscopy was utilized. The sensitivity and specificity of unassisted and CAD-assisted reading in identifying individuals with 6-9-mm lesions were calculated and compared by means of pairwise analysis.
  
  
  RESULTS
  A total of 618 participants (mean age, 57.9 years; 54.5% male) were included in the final analysis. Of these participants, 464 (75.1%) had no lesions 6 mm or larger, and 52 (8.4%) had 6-9-mm lesions. The sensitivity of CT colonography with unassisted reading and that with CAD-assisted reading in identifying individuals with 6-9-mm lesions was 65.4% (95% confidence interval [CI]: 50.9%, 78.0%) and 76.9% (95% CI: 63.2%, 87.5%; P = .016), respectively. No significant change in specificity was observed: The specificity of CT colonography with unassisted and that with CAD-assisted reading was 91.8% (95% CI: 88.9%, 94.1%) and 90.9% (95% CI: 88.0%, 93.4%; P = .063), respectively. Evaluation of CAD candidates required an additional 1.6 minutes (25th-75th percentile: 1.0 minute to 3.4 minutes).
  
  
  CONCLUSIONS
  The addition of CAD to reading performed by experienced readers resulted in a significant benefit in the detection of 6-9-mm polyps at CT colonography in this cohort.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120376/-/DC1.
authors.affiliation: Radiology Unit, Institute for Cancer Research and Treatment, Candiolo, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Regge
authors.forename: Patrizia
authors.initials: P
authors.lastname: Della Monica
authors.forename: Giovanni
authors.initials: G
authors.lastname: Galatola
authors.forename: Cristiana
authors.initials: C
authors.lastname: Laudi
authors.forename: Antonella
authors.initials: A
authors.lastname: Zambon
authors.forename: Loredana
authors.initials: L
authors.lastname: Correale
authors.forename: Roberto
authors.initials: R
authors.lastname: Asnaghi
authors.forename: Brunella
authors.initials: B
authors.lastname: Barbaro
authors.forename: Claudia
authors.initials: C
authors.lastname: Borghi
authors.forename: Delia
authors.initials: D
authors.lastname: Campanella
authors.forename: Maria Carla
authors.initials: MC
authors.lastname: Cassinis
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ferrari
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferraris
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Franco
authors.initials: F
authors.lastname: Iafrate
authors.forename: Gabriella
authors.initials: G
authors.lastname: Iussich
authors.forename: Andrea
authors.initials: A
authors.lastname: Laghi
authors.forename: Roberto
authors.initials: R
authors.lastname: Massara
authors.forename: Emanuele
authors.initials: E
authors.lastname: Neri
authors.forename: Lapo
authors.initials: L
authors.lastname: Sali
authors.forename: Silvia
authors.initials: S
authors.lastname: Venturini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gandini
mesh_terms: D000465:Algorithms; D023881:Colonography, Computed Tomographic / Q000379:methods*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010363:Pattern Recognition, Automated / Q000379:methods*; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity