Effect of temporal subtraction images on radiologists' detection of lung cancer on CT: results of the observer performance study with use of film computed tomography images

Acad Radiol. 2004 Dec;11(12):1337-43. doi: 10.1016/j.acra.2004.08.010.


Rationale and objectives: To evaluate the effect of temporal subtraction images on the radiologists' detection of early primary lung cancer in computed tomography (CT) scans.

Materials and methods: Fourteen cases with primary lung cancer and 16 normal cases were used for this study from a database of low-dose CT images, which were obtained from a lung cancer screening program in Nagano, Japan. Images were obtained with a single-detector helical CT scanner using 10 mm collimation and 2:1 pitch. Each case had both previous and current CT scans. Temporal subtraction images were obtained by subtracting the warped previous images from the current images. Seven radiologists, including four attendings and three residents, provided their confidence levels for the presence or absence of lung cancers with use of film CT images without and with temporal subtraction images. Receiver operating characteristic analysis was used to compare their performance without and with temporal subtraction images.

Results: The mean Az values (area under the receiver operating characteristic curve) of seven observers without and with temporal subtraction images were 0.868 and 0.930, respectively. Diagnostic accuracy was significantly improved by using temporal subtraction images (P = .007). Temporal subtraction images were especially useful when a nodule was present near the pulmonary hilum, where radiologists tended to overlook it.

Conclusion: The temporal subtraction technique can significantly improve the sensitivity and specificity for detection of lung cancer on CT scans.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Diagnosis, Computer-Assisted
  • Female
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Male
  • Middle Aged
  • Observer Variation
  • ROC Curve
  • Radiographic Image Enhancement
  • Subtraction Technique
  • Tomography, Spiral Computed*