A supervised 'lesion-enhancement' filter by use of a massive-training artificial neural network (MTANN) in computer-aided diagnosis (CAD)

Computer-aided diagnosis (CAD) has been an active area of study in medical image analysis. A filter for the enhancement of lesions plays an important role for improving the sensitivity and specificity in CAD schemes. The filter enhances objects similar to a model employed in the filter; e. g. a blob-enhancement filter based on the Hessian matrix enhances sphere-like objects. Actual lesions, however, often differ from a simple model; e. g. a lung nodule is generally modeled as a solid sphere, but there are nodules of various shapes and with internal inhomogeneities such as a nodule with spiculations and ground-glass opacity. Thus, conventional filters often fail to enhance actual lesions. Our purpose in this study was to develop a supervised filter for the enhancement of actual lesions (as opposed to a lesion model) by use of a massive-training artificial neural network (MTANN) in a CAD scheme for detection of lung nodules in CT. The MTANN filter was trained with actual nodules in CT images to enhance actual patterns of nodules. By use of the MTANN filter, the sensitivity and specificity of our CAD scheme were improved substantially. With a database of 69 lung cancers, nodule candidate detection by the MTANN filter achieved a 97% sensitivity with 6.7 false positives (FPs) per section, whereas nodule candidate detection by a difference-image technique achieved a 96% sensitivity with 19.3 FPs per section. Classification-MTANNs were applied for further reduction of the FPs. The classification-MTANNs removed 60% of the FPs with a loss of one true positive; thus, it achieved a 96% sensitivity with 2.7 FPs per section. Overall, with our CAD scheme based on the MTANN filter and classification-MTANNs, an 84% sensitivity with 0.5 FPs per section was achieved.