title: Computer-aided diagnosis improves detection of small intracranial aneurysms on MRA in a clinical setting.
abstract: OBJECTIVE
  MRA is widely accepted as a noninvasive diagnostic tool for the detection of intracranial aneurysms, but detection is still a challenging task with rather low detection rates. Our aim was to examine the performance of a computer-aided diagnosis algorithm for detecting intracranial aneurysms on MRA in a clinical setting.
  
  
  METHODS
  Aneurysm detectability was evaluated retrospectively in 48 subjects with and without computer-aided diagnosis by 6 readers using a clinical 3D viewing system. Aneurysms ranged from 1.1 to 6.0 mm (mean = 3.12 mm, median = 2.50 mm). We conducted a multireader, multicase, double-crossover design, free-response, observer-performance study on sets of images from different MRA scanners by using DSA as the reference standard. Jackknife alternative free-response operating characteristic curve analysis with the figure of merit was used.
  
  
  RESULTS
  For all readers combined, the mean figure of merit improved from 0.655 to 0.759, indicating a change in the figure of merit attributable to computer-aided diagnosis of 0.10 (95% CI, 0.03-0.18), which was statistically significant (F(1,47) = 7.00, P = .011). Five of the 6 radiologists had improved performance with computer-aided diagnosis, primarily due to increased sensitivity.
  
  
  CONCLUSIONS
  In conditions similar to clinical practice, using computer-aided diagnosis significantly improved radiologists' detection of intracranial DSA-confirmed aneurysms of ≤6 mm.
authors.affiliation: From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.) International Clinical Research Center (I.L.Š.-B., D.H., A.H.), St. Anne's University Hospital Brno, Brno, Czech Republic Department of Radiology (I.L.Š.-B., M.R.), Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
authors.forename: I L
authors.initials: IL
authors.lastname: Štepán-Buksakowska
authors.affiliation: Department of Radiology (J.M.A.), Mayo Clinic, Jacksonville, Florida.
authors.forename: J M
authors.initials: JM
authors.lastname: Accurso
authors.affiliation: From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.).
authors.forename: F E
authors.initials: FE
authors.lastname: Diehn
authors.affiliation: From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.).
authors.forename: J
authors.initials: J
authors.lastname: Huston
authors.affiliation: From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.).
authors.forename: T J
authors.initials: TJ
authors.lastname: Kaufmann
authors.affiliation: From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.).
authors.forename: P H
authors.initials: PH
authors.lastname: Luetmer
authors.affiliation: From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.).
authors.forename: C P
authors.initials: CP
authors.lastname: Wood
authors.affiliation: Department of Information Services (X.Y., D.J.B.), Mayo Clinic, Rochester, Minnesota.
authors.forename: X
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Information Services (X.Y., D.J.B.), Mayo Clinic, Rochester, Minnesota.
authors.forename: D J
authors.initials: DJ
authors.lastname: Blezek
authors.affiliation: Division of Biomedical Statistics and Informatics (R.C., C.H.).
authors.forename: R
authors.initials: R
authors.lastname: Carter
authors.affiliation: Division of Biomedical Statistics and Informatics (R.C., C.H.).
authors.forename: C
authors.initials: C
authors.lastname: Hagen
authors.affiliation: International Clinical Research Center (I.L.Š.-B., D.H., A.H.), St. Anne's University Hospital Brno, Brno, Czech Republic Department of Neurosurgery (D.H., A.H.), Masaryk Hospital, Ústí nad Labem, Czech Republic Department of Neurosurgery (D.H.), Central Military Hospital, Prague, Czech Republic.
authors.forename: D
authors.initials: D
authors.lastname: Hořínek
authors.affiliation: International Clinical Research Center (I.L.Š.-B., D.H., A.H.), St. Anne's University Hospital Brno, Brno, Czech Republic Department of Neurosurgery (D.H., A.H.), Masaryk Hospital, Ústí nad Labem, Czech Republic.
authors.forename: A
authors.initials: A
authors.lastname: Hejčl
authors.affiliation: Department of Radiology (I.L.Š.-B., M.R.), Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Roček
authors.affiliation: From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.) bje@mayo.edu.
authors.forename: B J
authors.initials: BJ
authors.lastname: Erickson
mesh_terms: D000465:Algorithms; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D011859:Radiography; D012189:Retrospective Studies