title: Bone suppression increases the visibility of invasive pulmonary aspergillosis in chest radiographs.
abstract: OBJECTIVE
  Chest radiographs (CXR) are an important diagnostic tool for the detection of invasive pulmonary aspergillosis (IPA) in critically ill patients, but their diagnostic value is limited by a poor sensitivity. By using advanced image processing, the aim of this study was to increase the value of chest radiographs in the diagnostic work up of neutropenic patients who are suspected of IPA.
  
  
  METHODS
  The frontal CXRs of 105 suspected cases of IPA were collected from four institutions. Radiographs could contain single or multiple sites of infection. CT was used as reference standard. Five radiologists and two residents participated in an observer study for the detection of IPA on CXRs with and without bone suppressed images (ClearRead BSI 3.2; Riverain Technologies). The evaluation was performed separately for the right and left lung, resulting in 78 diseased cases (or lungs) and 132 normal cases (or lungs). For each image, observers scored the likelihood of focal infectious lesions being present on a continuous scale (0-100). The area under the receiver operating characteristics curve (AUC) served as the performance measure. Sensitivity and specificity were calculated by considering only the lungs with a suspiciousness score of greater than 50 to be positive.
  
  
  RESULTS
  The average AUC for only CXRs was 0.815. Performance significantly increased, to 0.853, when evaluation was aided with BSI (p = 0.01). Sensitivity increased from 49% to 66% with BSI, while specificity decreased from 95% to 90%.
  
  
  CONCLUSIONS
  The detection of IPA in CXRs can be improved when their evaluation is aided by bone suppressed images. BSI improved the sensitivity of the CXR examination, outweighing a small loss in specificity.
authors.affiliation: Dept. Of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Steven
authors.initials: S
authors.lastname: Schalekamp
authors.affiliation: Dept. Of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Bram
authors.initials: B
authors.lastname: van Ginneken
authors.affiliation: Dept. Of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Inge A H
authors.initials: IA
authors.lastname: van den Berk
authors.affiliation: Dept. Of Radiology, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Ieneke J C
authors.initials: IJ
authors.lastname: Hartmann
authors.affiliation: Dept. Of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Miranda M
authors.initials: MM
authors.lastname: Snoeren
authors.affiliation: Dept. Of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Arlette E
authors.initials: AE
authors.lastname: Odink
authors.affiliation: Dept. Of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Winnifred
authors.initials: W
authors.lastname: van Lankeren
authors.affiliation: Dept. Of Radiology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Sjoert A H
authors.initials: SA
authors.lastname: Pegge
authors.affiliation: Dept. Of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Schijf
authors.affiliation: Dept. Of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Nico
authors.initials: N
authors.lastname: Karssemeijer
authors.affiliation: Dept. Of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands; Dept. Of Radiology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Cornelia M
authors.initials: CM
authors.lastname: Schaefer-Prokop
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods*; D012680:Sensitivity and Specificity; D055815:Young Adult