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Inherent Variability of CT Lung Nodule Measurements In Vivo Using Semiautomated Volumetric Measurements

Lawrence R. Goodman1, Meltem Gulsun1,2, Lacey Washington1, Paul G. Nagy1,3 and Kelly L. Piacsek4

1 Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226-3596.
2 Present address: Department of Radiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.
3 Present address: Department of Radiology, University of Maryland Medical System, Baltimore, MD 21201.
4 GE Healthcare, Waukesha, WI 53188.


Figure 1
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  		Fig. 1A —Multiple volumetric measurements of small right upper lobe nodule detected incidentally. Axial CT scan obtained at initial examination (time 1 = T1) shows nodule and background area (circle) chosen for semiautomated volumetric evaluation.

 

Figure 2
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  		Fig. 1B —Multiple volumetric measurements of small right upper lobe nodule detected incidentally. Volume measurements of nodule shown in A at T1 (top image), T2 (middle image), and T3 (bottom image). All measurements were taken by a single observer (mean, 64.7 mm3; range, 59–69 mm3; effective diameter, < 5 mm).

 

Figure 3
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  		Fig. 2 —Left lower lobe nodule against pleural surface (circle). First attempt at segmentation failed, but subsequent attempts were successful.

 

Figure 4
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  		Fig. 3 —Ground-glass vague nodule. Representative axial image from a single scan at time 1 (T1). Three observers obtained identical values at T1; however, at T1, T2, and T3, average volumes for three reviewers were 99, 75, and 21 mm3, respectively.

 

Figure 5
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  		Fig. 4 —Bar graph shows distribution of nodules by volume (mm3) and estimated diameter (mm) based on mean of all nodule volume measurements.

 

Figure 6
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  		Fig. 5 —Graph shows change in confidence limits with changing nodule size for all nodules (gray), calcified or contrast-enhanced nodules (white), and all others (black).

 

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