RESUMEN
The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥â50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥â50% stage IIIA and treatment options in PD-L1 ≥â50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/prevención & control , Antígeno B7-H1/genética , Antígeno B7-H1/uso terapéutico , Estudios de Seguimiento , Receptores ErbB/genética , Carcinoma de Pulmón de Células no Pequeñas/patologíaRESUMEN
This case report describes the very rare simultaneous occurrence of rheumatoid arthritis and granulomatosis with polyangiitis with the only organ manifestation of life-threatening bilateral pulmonary cavities. Due to the acuteness of the vasculitis, treatment was primarily with cyclophosphamide infusions and high-dose glucocorticoids, and in the further course with high-dose methotrexate. Routine thoracic imaging also seems to be useful when conventional basic rheumatologic treatment is newly initiated, as treatment-decisive changes are seen with a relevant frequency. The occurrence of both autoimmune diseases might be due to common genetic predispositions.
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Artritis , Granulomatosis con Poliangitis , Anticuerpos Anticitoplasma de Neutrófilos , Artritis/tratamiento farmacológico , Ciclofosfamida/uso terapéutico , Glucocorticoides/uso terapéutico , Granulomatosis con Poliangitis/diagnóstico , Granulomatosis con Poliangitis/tratamiento farmacológico , Humanos , Metotrexato/uso terapéuticoRESUMEN
Acute COVID-19 pneumonia may result in persistent changes with various imaging and histopathological patterns, including organizing pneumonia and pulmonary fibrosis. In addition, SARS-CoV-2 infection is associated with increased risk of pulmonary vascular endothelialitis and thrombosis. Herein, current findings on pulmonary consequences of COVID-19 with implications for clinical management are summarized based on a selective literature review.
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COVID-19/complicaciones , Neumonía en Organización Criptogénica/complicaciones , Neumonía Viral/complicaciones , Fibrosis Pulmonar/complicaciones , Enfermedad Aguda , COVID-19/diagnóstico por imagen , COVID-19/terapia , Neumonía en Organización Criptogénica/diagnóstico por imagen , Neumonía en Organización Criptogénica/terapia , Estudios de Seguimiento , Humanos , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/terapia , Fibrosis Pulmonar/diagnóstico por imagen , Fibrosis Pulmonar/terapiaRESUMEN
The long-term sequelae of COVID-19 on are not yet predictable. Radiological and histopathological data on COVID-19 and observational studies after the SARS-CoV-1 pandemic 2003/2004 suggest that in a proportion of COVID-19 patients, functional limitations due to pulmonary fibrosis and other patterns of lung damage may persist. Systematic follow-up, based on prudent pulmonary function testing, is warranted for the correct diagnosis, graduation and treatment of the underlying pathology at an early stage. This review summarizes the potential spectrum of Post-COVID-19 pulmonary disease patterns and provides recommendations for the follow-up care of COVID-19 patients in the field of respiratory medicine.
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Infecciones por Coronavirus , Lesión Pulmonar , Pandemias , Neumonía Viral , Fibrosis Pulmonar , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Humanos , Lesión Pulmonar/terapia , Lesión Pulmonar/virología , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Guías de Práctica Clínica como Asunto , Fibrosis Pulmonar/terapia , Fibrosis Pulmonar/virología , Neumología , SARS-CoV-2RESUMEN
PURPOSE: To assess the sensitivity of radiologists and a CAD system for the detection of lung metastases on thin-section computed tomographic (CT) scans prior to pulmonary metastasectomy. MATERIALS AND METHODS: All patients scheduled for resection of lung metastases were eligible for this prospective single-center trial. 95 patients with 115 surgical procedures (pulmonary metastasectomy using thoracotomy) were included. An experienced radiologist examined the CT scans for pulmonary metastases and documented his findings. A commercial CAD system was used as a second reader; additional CAD findings were recorded. A comparison of the sensitivity of the radiologist alone and with CAD was performed. Intraoperatively surgeons tried to identify the documented lesions and resected them as well as additionally palpable lesions. The standard of reference consisted of surgery and histopathology. Follow-up information for radiologically detected lesions missed during surgery was sought. RESULTS: 693 lesions (262 metastases) were detected radiologically or surgically, 646 of them were resected. The sensitivity of radiologists without CAD was 67.5â% for all lesions (87.4â% for metastases). CAD highly significantly (pâ<â0.001) increased the sensitivity to 77.9â% (92.7â%). During surgery, 143 additional lesions (19 metastases) were detected. 49 radiologically detected lesions were not palpable during surgery: 4 metastases, 5 benign lesions, and 40 lesions of an unknown nature. CONCLUSION: CAD provides significant additional sensitivity for detecting lung metastases using MDCT compared to the performance of a radiologist alone. CT reveals a relevant number of non-palpable pulmonary lesions. KEY POINTS: · CAD significantly increased the sensitivity for the detection of lung metastases on CT.. · Surgical palpation of the lungs missed 8.5â% of all radiologically detected lesions.. · CT with CAD may increase the chance for complete metastasectomy.. CITATION FORMAT: · Meybaum C, Graff M, Fallenberg EM etâal. Contribution of CAD to the Sensitivity for Detecting Lung Metastases on Thin-Section CT - A Prospective Study with Surgical and Histopathological Correlation. Fortschr Röntgenstr 2020; 192: 65â-â73.
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Diagnóstico por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Correlación de Datos , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/cirugía , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
PURPOSE: Gaucher disease (GD) is an inherited lysosomal storage disorder. The Vertebral Disk Ratio (VDR) is a semi-quantitative imaging biomarker designed to diagnose and monitor GD. Computed from standard T1 MRI images, the VDR is derived from 2D segmentations. This study aimed to evaluate the 3D version of VDR, namely eVDR, and analyze the performances of two eVDR-derived response criteria for GD patients. METHODS: Three datasets were used: 8 longitudinal GD patients, 13 non-GD patients, and 2 longitudinal GD patients with known Bone Marrow Burden (BMB) scores. Two eVDR-derived response criteria were tested: 1) a parametric version (PeVDR) averaging all eVDR measures recorded for the 5 lumbar vertebrae; and 2) a non-parametric version (NPeVDR), considering all eVDR measures as independent and evaluating therapeutic response in a paired fashion. Analyses included assessment of reader variability in eVDR (3D) versus VDR (2D) and comparison with BMB response criteria. RESULTS: The repeatability of eVDR (3D) versus VDR (2D) demonstrated no difference in mean values but a lower variance (p < 0.004). The PeVDR intra-reader variability had a standard deviation < 0.1 with a coefficient of variation < 5%; the inter-reader variability featured a Limit of Agreement < 5% and a Bias < 3%. Observational comparison of eVDR and BMB scoring and sensitivity indicated a correlation between PeVDR and BMB, with an improved sensitivity with the NPeVDR version. CONCLUSIONS: Based on a standard MRI sequence, the eVDR imaging biomarker and its derived response criteria improved GD assessments and could help assessing other bone marrow diseases.
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Enfermedad de Gaucher/diagnóstico por imagen , Disco Intervertebral/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Adulto , Biomarcadores , Conjuntos de Datos como Asunto , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
This information provided by the Thoracic Imaging Section of the German Radiological Society is intended to give physicians recommendations on the use of thoracic imaging procedures in the context of the current COVID-19 pandemic. It represents the consensus of the authors based on the previous scientific knowledge and is intended to provide guidance for unified, structured CT reporting if COVID-19 pneumonia is suspected. The recommendations presented correspond to state of knowledge at the time of print and will be updated according to the results of ongoing and future scientific studies. KEY POINTS:: · COVID-19. · chest imaging. · German Radiological Society. CITATION FORMAT: · Vogel-Claussen J, Ley-Zaporozhan J, Agarwal P etâal. Recommendations of the Thoracic Imaging Section of the German Radiological Society for clinical application of chest imaging and structured CT reporting in the COVID-19 pandemic. Fortschr Röntgenstr 2020; DOI: 10.1055/a-1174-8378.
Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X , COVID-19 , Alemania , Humanos , Pandemias , Radiografía Torácica/normas , Radiología/normas , SociedadesRESUMEN
Substantial new data on the early detection of lung cancer with low-dose CT has become available since the last joint statement of the German Radiological Society and the German Respiratory Society was published in 2011. The German S3 guideline on lung cancer was revised in 2018 and now contains a weak recommendation regarding the early detection of lung cancer with low-dose CT in a quality-assured early detection program. These new developments required a change in the position of the involved professional societies. This joint statement describes the main features of a quality-assured program for the early detection of lung cancer with low-dose CT in Germany. KEY POINTS:: · New study data on early detection of lung cancer with low-dose CT and the new German S3 guideline on lung cancer required a new positioning of the involved professional societies.. · The involved professional societies strongly recommend that low-dose CT examinations for early detection of lung cancer should only be performed within a quality-assured program.. · The article describes some fundamentals of such a quality-assured early detection program.. CITATION FORMAT: · Wormanns D, Kauczor H, Antoch G etâal. Joint Statement of the German Radiological Society and the German Respiratory Society on a Quality-Assured Early Detection Program for Lung Cancer with Low-Dose CT. Fortschr Röntgenstr 2019; 191: 993â-â997.
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Neoplasias Pulmonares/diagnóstico por imagen , Garantía de la Calidad de Atención de Salud/normas , Dosis de Radiación , Tomografía Computarizada por Rayos X/métodos , Diagnóstico Precoz , Alemania , Humanos , Sociedades MédicasRESUMEN
Volumetric growth assessment of pulmonary lesions is crucial to both lung cancer screening and oncological therapy monitoring. While several methods for small pulmonary nodules have previously been presented, the segmentation of larger tumors that appear frequently in oncological patients and are more likely to be complexly interconnected with lung morphology has not yet received much attention. We present a fast, automated segmentation method that is based on morphological processing and is suitable for both small and large lesions. In addition, the proposed approach addresses clinical challenges to volume assessment such as variations in imaging protocol or inspiration state by introducing a method of segmentation-based partial volume analysis (SPVA) that follows on the segmentation procedure. Accuracy and reproducibility studies were performed to evaluate the new algorithms. In vivo interobserver and interscan studies on low-dose data from eight clinical metastasis patients revealed that clinically significant volume change can be detected reliably and with negligible computation time by the presented methods. In addition, phantom studies were conducted. Based on the segmentation performed with the proposed method, the performance of the SPVA volumetry method was compared with the conventional technique on a phantom that was scanned with different dosages and reconstructed with varying parameters. Both systematic and absolute errors were shown to be reduced substantially by the SPVA method. The method was especially successful in accounting for slice thickness and reconstruction kernel variations, where the median error was more than halved in comparison to the conventional approach.
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Algoritmos , Imagenología Tridimensional/métodos , Reconocimiento de Normas Patrones Automatizadas/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Radiografía Torácica/métodos , Nódulo Pulmonar Solitario/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Inteligencia Artificial , Humanos , Almacenamiento y Recuperación de la Información/métodos , Fantasmas de Imagen , Intensificación de Imagen Radiográfica/métodos , Radiografía Torácica/instrumentación , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/instrumentaciónRESUMEN
Owing to the rapid development of scanner technology, thoracic computed tomography (CT) offers new possibilities but also faces enormous challenges with respect to the quality of computer-assisted diagnosis and therapy planning. In the framework of the Virtual Institute for Computer Assistance in Clinical Radiology cooperative research project, a software application was developed to assist the radiologist in the analysis of thoracic CT data for the purpose of evaluating the response to tumor therapy. The application provides follow-up support for monitoring of tumor therapy by means of volumetric quantification of tumors and temporal registration. In addition, anatomically adequate three-dimensional visualization techniques for convenient examination of large data sets are included. With close cooperation between computer scientists and radiologists, the application was tested and optimized to achieve a high degree of usability. Several clinical studies were carried out, the results of which indicated that the application improves therapy monitoring with respect to accuracy and time required.
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Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Interpretación de Imagen Radiográfica Asistida por Computador , Tomografía Computarizada por Rayos X/métodos , Algoritmos , Humanos , Neoplasias Pulmonares/terapiaRESUMEN
Despite advances in therapy, the prognosis of lung cancer remains dismal due to the fact that most cases of lung cancer are diagnosed at advanced stages, when the chance of cure is poor. In cases detected at early stages prognosis is better. Unfortunately, early lung cancer usually causes no symptoms and is, consequently, rarely diagnosed. Therefore, screening for early asymptomatic lung cancer with diagnostic procedures appears promising particularly as risk factors for lung cancer are well known (cigarette smoking, occupational asbestos exposure and others) and screening could, therefore, focus on these risk groups. In the past, screening trials using analysis of sputum cytology and to some extent chest radiography have failed to demonstrate a reduction in lung-cancer mortality with screening, probably due to insufficient sensitivity of these tests for early lung cancer. During the last decade the introduction of spiral computed tomography (CT) has provided a technique with a much higher sensitivity for small lung cancers. Feasibility studies using low-radiation-dose CT demonstrated a high proportion of non-small-cell lung cancer at the initial examination (prevalence) with decreasing numbers of detected cancers at follow-up (incidence). The proportion of early-stage tumors was high both at prevalence and incidence examinations. The rate of invasive procedures for benign lesions was low; most indeterminate lesions could be classified with non-invasive diagnostic approaches. The proportion of interval cancers (cancers diagnosed by symptoms between two screening CT scans) was low. As, however, these one-arm feasibility trials are not appropriate to assess a potential mortality reduction through CT screening, prospective randomised multicenter trials were recently initiated in several countries to analyse the effect of CT screening on lung-cancer mortality.
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Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Humanos , Neoplasias Pulmonares/mortalidad , Tamizaje Masivo , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Fumar/efectos adversosAsunto(s)
Neoplasias Duodenales/complicaciones , Neoplasias Duodenales/diagnóstico , Tumores del Estroma Gastrointestinal/complicaciones , Tumores del Estroma Gastrointestinal/diagnóstico , Neoplasias Primarias Múltiples/complicaciones , Neoplasias Primarias Múltiples/diagnóstico , Neurofibromatosis 1/complicaciones , Tomografía de Emisión de Positrones , Somatostatinoma/complicaciones , Somatostatinoma/diagnóstico , Tomografía Computarizada por Rayos X , Femenino , Humanos , Persona de Mediana EdadRESUMEN
For resection of lung metastases computed tomography (CT) is needed to determine the operative strategy. A computer-aided detection (CAD) system, a software tool for automated detection of lung nodules, analyses the CT scans in addition to the radiologists and clearly marks lesions. The aim of this feasibility study was to evaluate the reliability of CAD in detecting lung metastases. Preoperative CT scans of 18 patients, who underwent surgery for suspected lung metastases, were analysed with CAD (September-December 2009). During surgery all suspected lesions were traced and resected. Histological examination was performed and results compared to radiologically suspicious nodes. Radiological analysis assisted by CAD detected 64 nodules (mean 3.6, range 1-7). During surgery 91 nodules (mean 5.0, range 1-11) were resected, resulting in 27 additionally palpated nodules. Histologically all these additional nodules were benign. In contrast, all 30 nodules shown to be metastases by histological studies were correctly described by CAD. The CAD system is a sensible and useful tool for finding pulmonary lesions. It detects more and smaller lesions than conventional radiological analysis. In this feasibility study we were able to show a greater reliability of the CAD analysis. A further and prospective study to confirm these data is ongoing.
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Diagnóstico por Computador , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Palpación , Interpretación de Imagen Radiográfica Asistida por Computador , Toracotomía , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Alemania , Humanos , Cuidados Intraoperatorios , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
Fibrous dysplasia is a common benign disorder of bone in which fibro-osseous tissue replaces bone spongiosa. Lesions have a typical appearance on computed tomography (CT) images and regularly show a markedly increased uptake in bone scintigraphy using (99m)Tc-labelled methylene diphosphonate ((99m)Tc-MDP) as radiotracer. The glucose avidity of these lesions depicted by positron emission tomography (PET) using the radiolabelled glucose derivative (18)F-fluoro-2-deoxy-glucose (FDG) is less well known since FDG-PET does not have a role in the assessment of this disease. However, single cases have been reported in which fibrous dysplasia was present in patients undergoing FDG-PET scanning for oncological reasons, and no significant FDG uptake was observed for lesions identified as fibrous dysplasia. We report on a 24-year-old man with known fibrous dysplasia who underwent combined FDG-PET/CT scanning because of suspected recurrence of testicular cancer. In contrast to prior reports, a markedly elevated uptake of FDG was seen in numerous locations that were identified as fibrous dysplasia by CT. Based on this result, we conclude that fibrous dysplasia may mimick malignancy in FDG-PET and that coregistered CT may help to resolve these equivocal findings.
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Glucemia/metabolismo , Displasia Fibrosa Poliostótica/diagnóstico , Procesamiento de Imagen Asistido por Computador , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Adulto , Carcinoma Embrionario/diagnóstico , Carcinoma Embrionario/tratamiento farmacológico , Carcinoma Embrionario/secundario , Carcinoma Embrionario/cirugía , Terapia Combinada , Diagnóstico Diferencial , Neoplasias Femorales/diagnóstico , Neoplasias Femorales/secundario , Fluorodesoxiglucosa F18 , Humanos , Masculino , Recurrencia Local de Neoplasia/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Sensibilidad y Especificidad , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/cirugíaRESUMEN
The purpose of this study was to assess the effectiveness of double reading to increase the sensitivity of lung nodule detection at standard-dose (SDCT) and low-dose multirow-detector CT (LDCT). SDCT (100 mAs effective tube current) and LDCT (20 mAs) of nine patients with pulmonary metastases were obtained within 5 min using four-row detector CT. Softcopy images reconstructed with 5-mm slice thickness were read by three radiologists independently. Images with 1.25-mm slice thickness served as the gold standard. Sensitivity was assessed for single readers and combinations. The effectiveness of double reading was expressed as the increase of sensitivity. Average sensitivity for detection of 390 nodules (size 3.9+/-3.2 mm) for single readers was 0.63 (SDCT) and 0.64 (LDCT). Double reading significantly increased sensitivity to 0.74 and 0.79, respectively. No significant difference between sensitivity at SDCT and LDCT was observed. The percentage of nodules detected by all three readers concordantly was 52% for SDCT and 47% for LDCT. Although double reading increased the detection rate of pulmonary nodules from 63% to 74-79%, a considerable proportion of nodules remained undetected. No difference between sensitivities at LDCT and SDCT for detection of small nodules was observed.
Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Medios de Contraste , Femenino , Humanos , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Interpretación de Imagen Radiográfica Asistida por Computador , Radiografía Torácica , Sensibilidad y EspecificidadRESUMEN
Small pulmonary nodules with diameters =10 mm are very frequent findings at CT examinations. Despite the traditional opinion that every pulmonary nodule should be considered malignant until proven otherwise, the vast majority of small lesions are benign, and therefore biopsy may not be necessary in all cases. During the last few years, several CT-based methods have been developed to differentiate between benign and malignant lesions non-invasively. A negative quantitative contrast-enhanced CT is a strong predictor for benignity. Repeat nodule volume measurements at short-term follow-up CT examinations can detect growth suggesting malignancy. Limitations and potential pitfalls of these methods must be observed to avoid false negative test results leading to delayed diagnosis and treatment of malignant tumours. An algorithm for diagnostic workup of incidentally detected small pulmonary nodules in subjects without known malignancy is proposed in this article.
Asunto(s)
Neoplasias Pulmonares/diagnóstico , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Algoritmos , Medios de Contraste/administración & dosificación , Diagnóstico Diferencial , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagen , Valor Predictivo de las PruebasRESUMEN
The aim of this study was to evaluate a computer-aided diagnosis (CAD) workstation with automatic detection of pulmonary nodules at low-dose spiral CT in a clinical setting for early detection of lung cancer. Eighty-eight consecutive spiral-CT examinations were reported by two radiologists in consensus. All examinations were reviewed using a CAD workstation with a self-developed algorithm for automatic detection of pulmonary nodules. The algorithm is designed to detect nodules with diameters of at least 5 mm. A total of 153 nodules were detected with at least one modality (radiologists in consensus, CAD, 85 nodules with diameter < 5 mm, 68 with diameter > or = 5 mm). The results of automatic nodule detection were compared to nodules detected with any modality as gold standard. Computer-aided diagnosis correctly identified 26 of 59 (38%) nodules with diameters > or = 5 mm detected by visual assessment by the radiologists; of these, CAD detected 44% (24 of 54) nodules without pleural contact. In addition, 12 nodules > or = 5 mm were detected which were not mentioned in the radiologist's report but represented real nodules. Sensitivity for detection of nodules > or = 5 mm was 85% (58 of 68) for radiologists and 38% (26 of 68) for CAD. There were 5.8+/-3.6 false-positive results of CAD per CT study. Computer-aided diagnosis improves detection of pulmonary nodules at spiral CT and is a valuable second opinion in a clinical setting for lung cancer screening despite of its still limited sensitivity.