Diagnostic performance of artificial intelligence for pediatric pulmonary nodule detection in computed tomography of the chest

Purpose: To test the performance of a commercially available adult pulmonary nodule detection artificial intel-ligence (AI) tool in pediatric CT chests.Methods: 30 consecutive chest CTs with or without contrast of patients ages 12-18 were included. Images were retrospectively reconstructed at 3 mm and 1 mm slice thickness. AI for detection of lung nodules in adults (Syngo CT Lung Computer Aided Detection (CAD)) was evaluated. 3 mm axial images were retrospectively reviewed by two pediatric radiologists (reference read) who determined the location, type, and size of nodules. Lung CAD results at 3 mm and 1 mm slice thickness were compared to reference read by two other pediatric radiologists. Sensitivity (Sn) and positive predictive value (PPV) were analyzed.Results: The radiologists identified 109 nodules. At 1 mm, CAD detected 70 nodules; 43 true positive (Sn = 39 %), 26 false positive (PPV = 62 %), and 1 nodule which had not been identified by radiologists. At 3 mm, CAD detected 60 nodules; 28 true positive (Sn = 26 %), 30 false positive (PPV = 48 %) and 2 nodules which had not been identified by radiologists. There were 103 solid nodules (47 measuring < 3 mm) and 6 subsolid nodules (5 measuring < 5 mm). When excluding 52 nodules (solid < 3 mm and subsolid < 5 mm) based on algorithm conditions, the Sn increased to 68 % at 1 mm and 49 % at 3 mm but there was no significant change in the PPV measuring 60 % at 1 mm and 48 % at 3 mm.Conclusion: The adult Lung CAD showed low sensitivity in pediatric patients, but better performance at thinner slice thickness and when smaller nodules were excluded.