European Radiology

, Volume 24, Issue 11, pp 2700–2708 | Cite as

Persistent pulmonary subsolid nodules: model-based iterative reconstruction for nodule classification and measurement variability on low-dose CT

  • Hyungjin Kim
  • Chang Min Park
  • Seong Ho Kim
  • Sang Min Lee
  • Sang Joon Park
  • Kyung Hee Lee
  • Jin Mo Goo



To compare the pulmonary subsolid nodule (SSN) classification agreement and measurement variability between filtered back projection (FBP) and model-based iterative reconstruction (MBIR).


Low-dose CTs were reconstructed using FBP and MBIR for 47 patients with 47 SSNs. Two readers independently classified SSNs into pure or part-solid ground-glass nodules, and measured the size of the whole nodule and solid portion twice on both reconstruction algorithms. Nodule classification agreement was analyzed using Cohen’s kappa and compared between reconstruction algorithms using McNemar’s test. Measurement variability was investigated using Bland–Altman analysis and compared with the paired t-test.


Cohen’s kappa for inter-reader SSN classification agreement was 0.541–0.662 on FBP and 0.778–0.866 on MBIR. Between the two readers, nodule classification was consistent in 79.8 % (75/94) with FBP and 91.5 % (86/94) with MBIR (p = 0.027). Inter-reader measurement variability range was -5.0–2.1 mm on FBP and -3.3–1.8 mm on MBIR for whole nodule size, and was -6.5–0.9 mm on FBP and -5.5–1.5 mm on MBIR for solid portion size. Inter-reader measurement differences were significantly smaller on MBIR (p = 0.027, whole nodule; p = 0.011, solid portion).


MBIR significantly improved SSN classification agreement and reduced measurement variability of both whole nodules and solid portions between readers.

Key Points

Low-dose CT using MBIR algorithm improves reproducibility in the classification of SSNs.

MBIR would enable more confident clinical planning according to the SSN type.

Reduced measurement variability on MBIR allows earlier detection of potentially malignant nodules.


Lung neoplasms Multidetector computed tomography Computer-assisted image processing Iterative reconstruction Subsolid nodule 



Subsolid nodule


Iterative reconstruction


Computed tomography


Model-based iterative reconstruction


Filtered back projection


Ground-glass nodule


Volume CT dose index


Dose-length product


Size-specific dose estimate


Effective dose


International Commission on Radiological Protection


Picture archiving and communication system


Hounsfield unit


Confidence interval


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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Hyungjin Kim
    • 1
    • 2
  • Chang Min Park
    • 1
    • 2
    • 3
  • Seong Ho Kim
    • 1
    • 2
  • Sang Min Lee
    • 1
    • 2
  • Sang Joon Park
    • 1
    • 2
    • 3
  • Kyung Hee Lee
    • 1
    • 2
  • Jin Mo Goo
    • 1
    • 2
    • 3
  1. 1.Department of RadiologySeoul National University College of MedicineSeoulSouth Korea
  2. 2.Institute of Radiation MedicineSeoul National University Medical Research CenterSeoulSouth Korea
  3. 3.Cancer Research InstituteSeoul National UniversitySeoulSouth Korea

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