A JAFROC study of nodule detection performance in CT images of a thorax acquired during PET/CT

Purpose: Two types of CT images (modalities) are acquired in PET/CT: for attenuation correction (AC) and diagnosis. The purpose of the study was to compare nodule detection and localization performance between these two modalities. Methods: CT images, using both modalities, of an anthropomorphic chest phantom containing zero or more simulated spherical nodules of 5, 8, 10 and 12 mm diameters and contrasts −800, −630 and 100 HU were acquired. An observer performance study using nine observers interpreting 45 normal (zero nodules) images and 47 abnormal images (1–3 nodules; average 1.26) was conducted using the free-response receiver operating characteristic (FROC) paradigm. Data were analysed using an R software package implemented jackknife alternative FROC (JAFROC) analysis. Both empirical areas under the equally weighted AFROC curve (wAFROC) and under the highest rating inferred ROC (HR-ROC) curve were used as figures of merit (FOM). To control the probability of Type I error test alpha was set at 0.05. Results: Nodule detection as measured by either FOM was significantly better on the diagnostic quality images (2nd modality), irrespective of the method of analysis, [reader averaged inter-modality wAFROC FOM difference = −0.07 (−0.11,−0.04); reader averaged inter-modality HR-ROC FOM difference = −0.05 (−0.09, −0.01)]. Conclusion: Nodule detection was statistically worse on images acquired for AC; suggesting that images acquired for AC should not be used to evaluate pulmonary pathology. - Highlights: • An evaluation of lesion detection performance in CT images of different qualities is proposed. • JAFROC analysis showed that images acquired for attenuation correction are statistically poorer for lesion detection. • This study suggests that images acquired for attenuation correction should not be used to evaluate pulmonary pathology.