Computer-aided diagnosis improves detection of small intracranial aneurysms on MRA in a clinical setting

• Published in: American journal of neuroradiology : AJNR 2014-10, Vol.35 (10), p.1897-1902
• Main Authors: Štepán-Buksakowska, I L, Accurso, J M, Diehn, F E, Huston, J, Kaufmann, T J, Luetmer, P H, Wood, C P, Yang, X, Blezek, D J, Carter, R, Hagen, C, Hořínek, D, Hejčl, A, Roček, M, Erickson, B J
• Format: Article
• Language: English
• Subjects: Algorithms; Brain; Diagnosis, Computer-Assisted - methods; Female; Humans; Intracranial Aneurysm - diagnostic imaging; Magnetic Resonance Angiography - methods; Male; Radiography; Retrospective Studies
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a3996

MRA is widely accepted as a noninvasive diagnostic tool for the detection of intracranial aneurysms, but detection is still a challenging task with rather low detection rates. Our aim was to examine the performance of a computer-aided diagnosis algorithm for detecting intracranial aneurysms on MRA in a clinical setting. Aneurysm detectability was evaluated retrospectively in 48 subjects with and without computer-aided diagnosis by 6 readers using a clinical 3D viewing system. Aneurysms ranged from 1.1 to 6.0 mm (mean = 3.12 mm, median = 2.50 mm). We conducted a multireader, multicase, double-crossover design, free-response, observer-performance study on sets of images from different MRA scanners by using DSA as the reference standard. Jackknife alternative free-response operating characteristic curve analysis with the figure of merit was used. For all readers combined, the mean figure of merit improved from 0.655 to 0.759, indicating a change in the figure of merit attributable to computer-aided diagnosis of 0.10 (95% CI, 0.03-0.18), which was statistically significant (F(1,47) = 7.00, P = .011). Five of the 6 radiologists had improved performance with computer-aided diagnosis, primarily due to increased sensitivity. In conditions similar to clinical practice, using computer-aided diagnosis significantly improved radiologists' detection of intracranial DSA-confirmed aneurysms of ≤6 mm.