Are two-dimensional CT measurements of small noncalcified pulmonary nodules reliable?

PURPOSE To evaluate the intra- and interreader agreement of two-dimensional computed tomographic (CT) measurements of pulmonary nodules less than 2 cm in diameter. MATERIALS AND METHODS Three readers independently made three serial measurements of each of 54 pulmonary nodules measuring 3-18 mm that had been observed on standard-dose multisection CT images obtained in 24 patients who ranged in age from 36 to 81 years (mean age, 54.6 years). There were 14 women (58%), who ranged in age from 43 to 81 years (mean age, 58.9 years), and 10 men (42%), who ranged in age from 36 to 65 years (mean age, 48.5 years). The largest transverse cross-sectional diameter of each nodule was measured at picture archiving and communication system, or PACS, workstations by using high-spatial-resolution reconstructed CT images and identical window settings. Intra- and interreader agreement were determined by using methods described by Bland and Altman: the coefficient of repeatability for intrareader agreement, and methods derived from the 95% limits of agreement defined by Bland and Altman for interreader agreement. RESULTS The repeatability coefficients were 1.70, 1.32, and 1.51 mm for readers 1, 2, and 3, respectively. The 95% limits of agreement for the difference among readers were -1.73 and 1.73. CONCLUSION Two-dimensional CT measurements are not reliable in the evaluation of small noncalcified pulmonary nodules.

[1]  P. Buell,et al.  Asymptomatic solitary pulmonary nodules. Host survival, tumor size, and growth rate. , 1973, The Journal of thoracic and cardiovascular surgery.

[2]  D. Geddes,et al.  The natural history of lung cancer: a review based on rates of tumour growth. , 1979, British journal of diseases of the chest.

[3]  J M Bland,et al.  Statistical methods for assessing agreement between two methods of clinical measurement , 1986 .

[4]  Computed tomographic volumetric calculation reproducibility. , 1986, Investigative radiology.

[5]  T. Tong,et al.  Cancer statistics, 1993 , 1993, CA: a cancer journal for clinicians.

[6]  T. McLoud,et al.  Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. , 1996, AJR. American journal of roentgenology.

[7]  T. Turkington,et al.  FDG imaging of lung nodules: a phantom study comparing SPECT, camera-based PET, and dedicated PET. , 1999, Radiology.

[8]  D. Altman,et al.  Measuring agreement in method comparison studies , 1999, Statistical methods in medical research.

[9]  Binsheng Zhao,et al.  Small pulmonary nodules: volumetrically determined growth rates based on CT evaluation. , 2000, Radiology.

[10]  W. Heindel,et al.  Spiral CT of pulmonary nodules: interobserver variation in assessment of lesion size , 2000, European Radiology.

[11]  N. Müller,et al.  Lung nodule enhancement at CT: multicenter study. , 2000, Radiology.

[12]  C. Henschke.  Early lung cancer action project , 2000, Cancer.

[13]  Mark Tann,et al.  Volumetric growth rate of stage I lung cancer prior to treatment: serial CT scanning. , 2002, Radiology.

[14]  S. Halligan.  Reproducibility, repeatability, correlation and measurement error. , 2002, The British journal of radiology.

[15]  Theo Gasser,et al.  Assessing intrarater, interrater and test–retest reliability of continuous measurements , 2002, Statistics in medicine.

[16]  S. Swensen,et al.  Screening for lung cancer with low-dose spiral computed tomography. , 2000, American journal of respiratory and critical care medicine.