Evaluation of the Diagnostic Value of Pulmonary Nodules Based on Two AI Software
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摘要: 目的：探讨两种AI软件在≥5 mm肺结节中的临床应用价值。方法：选取2021年6月至2021年10月延安大学附属医院体检肺结节患者92例（共483个结节）。AI软件检测到的结节由影像学医师进行评估并记录其个数及结节类型；人工阅片由两名高年资影像学医师进行视觉评估，并以此作为识别结节的金标准。计算两个软件的检出率、假阳性率和假阴性率，评价两种AI软件的结节诊断价值；卡方检验和Fisher精确检验来比较不同软件与金标准之间的差异；最后，评价两种AI软件联合对肺结节的诊断价值。结果：软件A和软件B结节检出率为92.1％ 和87.0％；软件A与人工阅片的吻合度一般（Kappa=0.213），软件B与人工阅片的吻合度较弱（Kappa=0.150）；软件A相比人工阅片对实性结节和钙化结节的检出有统计学差异；软件B相比人工阅片纯磨玻璃结节的检出有统计学差异；联合两种AI软件结节的检出率为97.1％，两种软件的联合与人工阅片比，结节类型的检出没有统计学差异。两种AI软件联合与人工阅片的吻合度较好（Kappa=0.439）。结论：两种AI软件联合会提高结节诊断及分类分析的能力；推荐联合诊断的方法用于临床，也为进一步提升AI软件数据集的同质化管理提供佐证。Abstract: Objective: To explore the clinical value of two kinds of AI detection software in ≥5 mm pulmonary nodules. Methods: A total of 92 patients with pulmonary nodules (483 nodules) were selected from the affiliated Hospital of Yan'an University between June and October 2021. The nodules detected by AI software were evaluated and the number and type of nodules were recorded by two senior radiologists. Two senior imaging doctors then evaluated the manual film reading, which was used as the gold standard for nodule recognition. Subsequently, the detection rate and false positive and negative rates of the two software were calculated, and the nodule detection value of the two AI software was evaluated. Additionally, the chi-square and Fisher precision tests were used to compare the differences between the different software and the gold standard. Finally, the diagnostic value of the combination of the two kinds of AI software for pulmonary nodules was calculated. Results: The detection rates of software A and software B nodules were 92.1% and 87.0%, respectively. Moreover, the coincidence degree between software A and manual reading was general (Kappa=0.213), while that between software B and manual reading was weak (Kappa=0.150). There was also a significant difference in the detection of solid nodules and calcified nodules between software A and manual reading, as well as between software B and pure ground glass nodules. The detection rate of nodules with the combined two kinds of AI software was 97.1%. However, compared with manual reading, there was no significant difference in the detection of nodule types. The combination of the two AI software had a good agreement with manual reading (Kappa=0.439). Conclusion: The combination of two kinds of AI software improved the ability of nodule detection and classification analysis. Furthermore, the method of joint diagnosis is recommended for clinical use and it provides evidence for further improving the homogenization management of AI data sets.
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Keywords:
- artificial intelligence /
- CT /
- pulmonary nodules /
- detection
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表 1 两种软件及两种软件联合对肺结节的检出情况
Table 1 The detection of pulmonary nodules by two separate kinds of software and their combined effect
阅片方法 检出情况 检出率/％ 假阳性率/％ 假阴性率/％ 软件A 92.1 3.52 7.87 软件B 87.0 2.69 13.0 软件A联合软件B 97.1 1.04 2.91 
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表 2 两种AI软件及两种AI软件的联合对结节检出率的差异
Table 2 The differences in nodule detection rate between the two artificial intelligence software and their combined effect
软件 N（％） 统计检验 $\chi^2 $ P Kappa 软件A-人工阅片 445（92.1） 25.519 0.000 0.213 软件B-人工阅片 420（87.0） 16.472 0.000 0.150 软件A联合软件B-人工阅片 469（97.1） 102.697 0.000 0.439
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表 3 两种AI软件对不同类型结节的检出情况
Table 3 The detection of different types of nodules by the two artificial intelligence software
变量 N 结节检测软件 P 软件A（％） 软件B（％） 实性结节 295 279（94.6） 254（86.1） 0.030 部分实性结节 6 6（100.0） 3（50.0） 0.000 纯磨玻璃结节 68 56（82.4） 63（92.6） 0.079 钙化结节 114 104（91.2） 100（87.7） 0.098
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表 4 两种AI软件及两种AI软件联合识别不同类型结节的差异
Table 4 The differences between the two artificial intelligence software and their combined effect in identifying different types of nodules
变量 实性结节 部分实性结节 纯磨玻璃结节 钙化结节 $\chi^2 $ P $\chi^2 $ P $\chi^2 $ P $\chi^2 $ P 软件A-人工阅片 10.693 0.001 － 0.538 0.030 0.862 14.809 0.000 软件B-人工阅片 0.800 0.371 － 0.182 6.741 0.009 0.556 0.456 软件A联合软件B-人工阅片 0.381 0.537 － 0.464 0.271 0.603 0.000 1.000 注：－为Fisher确切概率法没有相应的统计量。
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