Computer-aided detection improves brain metastasis identification on non-enhanced CT in less experienced radiologists.

ABSTRACT

BACKGROUND: Brain metastases (BMs) are the most common intracranial tumors causing neurological complications associated with significant morbidity and mortality. PURPOSE: To evaluate the effect of computer-aided detection (CAD) on the performance of observers in detecting BMs on non-enhanced computed tomography (NECT). MATERIAL AND METHODS: Three less experienced and three experienced radiologists interpreted 30 NECT scans with 89 BMs in 25 cases to detect BMs with and without the assistance of CAD. The observers' sensitivity, number of false positives (FPs), positive predictive value (PPV), and reading time with and without CAD were compared using paired t-tests. The sensitivity of CAD and the observers were compared using a one-sample t-test. RESULTS: With CAD, less experienced radiologists' sensitivity significantly increased from 27.7% ± 4.6% to 32.6% ± 4.8% (P = 0.007), while the experienced radiologists' sensitivity did not show a significant difference (from 33.3% ± 3.5% to 31.9% ± 3.7%; P = 0.54). There was no significant difference between conditions with CAD and without CAD for FPs (less experienced radiologists 23.0 ± 10.4 and 25.0 ± 9.3; P = 0.32; experienced radiologists 18.3 ± 7.4 and 17.3 ± 6.7; P = 0.76) and PPVs (less experienced radiologists 57.9% ± 8.3% and 50.9% ± 7.0%; P = 0.14; experienced radiologists 61.8% ± 12.7% and 64.0% ± 12.1%; P = 0.69). There were no significant differences in reading time with and without CAD (85.0 ± 45.6 s and 73.7 ± 36.7 s; P = 0.09). The sensitivity of CAD was 47.2% (with a PPV of 8.9%), which was significantly higher than that of any radiologist (P < 0.001). CONCLUSION: CAD improved BM detection sensitivity on NECT without increasing FPs or reading time among less experienced radiologists, but this was not the case among experienced radiologists.