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Effect of Slab Thickness on the CT Detection of Pulmonary Nodules: Use of Sliding Thin-Slab Maximum Intensity Projection and Volume Rendering

¹ Department of Radiology, Kantonsspital Graubuenden, Chur, Switzerland.
² Department of Radiology, University Hospital Basel, Peterplatz 1, Basel 4003, Switzerland.
³ Biostatistics Unit, University of Zurich, Zurich, Switzerland.

OBJECTIVE. The objective of this study was to evaluate the detection rates of pulmonary nodules on CT as a function of slab thickness using sliding thin-slab maximum intensity projection (MIP) and volume rendering (VR).

SUBJECTS AND METHODS. Eighty-eight oncology patients (33 women, 55 men; mean age, 59 years; age range, 18–81 years) who routinely underwent chest CT examinations were prospectively included. Two radiologists independently evaluated each CT examination for the presence of pulmonary nodules using MIP and VR, with each image reconstructed using three different slab thicknesses (5, 8, 11 mm). The standard of reference was the maximum number of detected nodules, which were classified by localization and size, judged to be true-positives by a consensus panel. Interreader agreement was assessed by kappa value on a nodule-by-nodule basis. Sensitivities for both reconstruction techniques and for the three slab thicknesses were calculated using the proportion procedure for survey data with the patient as the primary sample unit and were compared using the Wilcoxon's signed rank test with Bonferroni correction for both readers separately.

RESULTS. One thousand fifty-eight true-positive nodules were detected. Interreader agreement was fair to moderate. Sensitivity for pulmonary nodules was superior for 8-mm MIP (reader 1, 84%; reader 2, 81%) and was significantly better than the sensitivities of all other tested techniques for both readers (p < 0.001 each) independent of nodule localization and size (except for one reader's analysis of 8-mm MIP versus 11-mm MIP for nodules > 8 mm). A higher sensitivity was achieved using MIP than VR.

CONCLUSION. MIP with a slab thickness of 8 mm is superior in the detection of pulmonary nodules to all other tested techniques.

Keywords: CT technique • lung cancer • lung nodules • maximum intensity projection • slab thickness • volume rendering

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