title: CT triage for lung malignancy: coronal multiplanar reformation versus images in three orthogonal planes.
abstract: BACKGROUND
  Generation of multiplanar reformation (MPR) images has become automatic on most modern computed tomography (CT) scanners, potentially increasing the workload of the reporting radiologists. It is not always clear if this increases diagnostic performance in all clinical tasks.
  
  
  OBJECTIVE
  To assess detection performance using only coronal multiplanar reformations (MPR) when triaging patients for lung malignancies with CT compared to images in three orthogonal planes, and to evaluate performance comparison of novice and experienced readers.
  
  
  METHODS
  Retrospective study of 63 patients with suspicion of lung cancer, scanned on 64-slice multidetector computed tomography (MDCT) with images reconstructed in three planes. Coronal images were presented to four readers, two novice and two experienced. Readers decided whether the patients were suspicious for malignant disease, and indicated their confidence on a five-point scale. Sensitivity and specificity on per-patient basis was calculated with regards to a reference standard of histological diagnosis, and compared with the original report using McNemar's test. Receiver operating characteristic (ROC) curves were plotted to compare the performance of the four readers, using the area under the curve (AUC) as figure of merit.
  
  
  RESULTS
  No statistically significant difference of sensitivity and specificity was found for any of the readers when compared to the original reports. ROC analysis yielded AUCs in the range of 0.92-0.93 for all readers with no significant difference. Inter-rater agreement was substantial (kappa = 0.72).
  
  
  CONCLUSIONS
  Sensitivity and specificity were comparable to diagnosis using images in three planes. No significant difference was found between experienced and novice readers.
authors.affiliation: Department of Radiology, Hospital of South West Jutland, Esbjerg, Denmark Martin.Weber.Kusk@Rsyd.dk.
authors.forename: Martin Weber
authors.initials: MW
authors.lastname: Kusk
authors.affiliation: Department of Radiology, Odense University Hospital, Odense, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Karstoft
authors.affiliation: Department of Radiology, Odense University Hospital, Odense, Denmark.
authors.forename: Bo Redder
authors.initials: BR
authors.lastname: Mussmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014218:Triage / Q000379:methods*
keywords: Computed tomography (CT); computer applications – detection; lung; neoplasms – primary; observer performance; thorax