PT  - JOURNAL ARTICLE
AU  - B.J. Erickson
AU  - C.P. Wood
AU  - T.J. Kaufmann
AU  - J.W. Patriarche
AU  - J. Mandrekar
TI  - Optimal Presentation Modes for Detecting Brain Tumor Progression
AID  - 10.3174/ajnr.A2596
DP  - 2011 Oct 01
TA  - American Journal of Neuroradiology
PG  - 1652--1657
VI  - 32
IP  - 9
4099  - http://www.ajnr.org/content/32/9/1652.short
4100  - http://www.ajnr.org/content/32/9/1652.full
SO  - Am. J. Neuroradiol.2011 Oct 01; 32
AB  - BACKGROUND AND PURPOSE: A common task in radiology interpretation is visual comparison of images. The purpose of this study was to compare traditional side-by-side and in-place (flicker) image presentation modes with advanced methods for detecting primary brain tumors on MR imaging. MATERIALS AND METHODS: We identified 66 patients with gliomas and 3 consecutive brain MR imaging examinations (a “triplet”). A display application that presented images in side-by-side mode with or without flicker display as well as display of image subtraction or automated change detection information (also with and without flicker display) was used by 3 board-certified neuroradiologists. They identified regions of brain tumor progression by using this display application. Each case was reviewed using all modes (side-by-side presentation with and without flicker, subtraction with and without flicker, and change detection with and without flicker), with results compared via a panel rating. RESULTS: Automated change detection with or without flicker (P < .0027) as well as subtraction with or without flicker (P < .0027) were more sensitive to tumor progression than side-by-side presentation in cases where all 3 raters agreed. Change detection afforded the highest interrater agreement, followed by subtraction. Clinically determined time to progression was longer for cases rated as nonprogressing by using subtraction images and change-detection images both with and without flicker display mode compared with side-by-side presentation. CONCLUSIONS: Automated change detection and image subtraction, with and without flicker display mode, are superior to side-by-side image comparison. AAanaplastic astrocytomaAUCarea under the receiver operating characteristic curveBxbiopsy onlyCchange detection images presented side-by-side onlyC+Fchange detection with flickerCFchange detection images also allowing flicker display modeFLAIRfluid-attenuated inversion recoveryFNfalse-negativeFPfalse-positiveGBMglioblastoma multiformeGTRgross total resectionLCLlower confidence intervalLGGlow-grade gliomaNnormal side-by-side display onlyN+Fside-by-side plus flickerNFnormal side-by-side mode with flickerRECISTresponse evaluation criteria in solid tumorsSsubtraction images with side-by-side displaySFsubtraction images with flicker display modeSTRsubtotal resectionTNtrue-negativeTPtrue-positiveTTPtime to progressionUCLupper confidence interval