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Improved Classifications of Planar Whole-Body Bone Scans Using a Computer-Assisted Diagnosis System: A Multicenter, Multiple-Reader, Multiple-Case Study

¹ Department of Molecular and Clinical Medicine, Clinical Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; ² Competence Centre for Clinical Research, Lund University Hospital, Lund, Sweden; ³ EXINI Diagnostics AB, Lund, Sweden; and ⁴ Department of Clinical Sciences, Lund University, Malmö, Sweden

Correspondence: For correspondence or reprints contact: May Sadik, Department of Molecular and Clinical Medicine, Clinical Physiology, Sahlgrenska Academy at the University of Gothenburg, SE 413 45, Gothenburg, Sweden. E-mail: may.sadik{at}vgregion.se

The aim of this multicenter study was to investigate whether a computer-assisted diagnosis (CAD) system could improve performance and reduce interobserver variation in bone-scan interpretations of the presence or absence of bone metastases. Methods: The whole-body bone scans (anterior and posterior views) of 59 patients with breast or prostate cancer who had undergone scintigraphy for suspected bone metastatic disease were studied. The patients were selected to reflect the spectrum of pathology found in everyday clinical work. Thirty-five physicians working at 18 of the 30 nuclear medicine departments in Sweden agreed to participate. The physicians were asked to classify each case for the presence or absence of bone metastasis, without (baseline) and with the aid of the CAD system (1 y later), using a 4-point scale. The final clinical assessments, based on follow-up scans and other clinical data including the results of laboratory tests and available diagnostic images (such as MRI, CT, and radiographs from a mean follow-up period of 4.8 y), were used as the gold standard. Each physician's classification was pairwise compared with the classifications made by all the other physicians, resulting in 595 pairs of comparisons, both at baseline and after using the CAD system. Results: The physicians increased their sensitivity from 78% without to 88% with the aid of the CAD system (P < 0.001). The specificity did not change significantly with CAD. Percentage agreement and -values between paired physicians on average increased from 64% to 70% and from 0.48 to 0.55, respectively, with the CAD system. Conclusion: A CAD system improved physicians' sensitivity in detecting metastases and reduced interobserver variation in planar whole-body bone scans. The CAD system appears to have significant potential in assisting physicians in their clinical routine.

Key Words: diagnostic accuracy • radionuclide imaging • bone metastases • breast cancer • prostate cancer

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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