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Disagreement of diameter and volume measurements for pulmonary nodule size estimation in CT lung cancer screening
  1. Marjolein A Heuvelmans1,
  2. Joan E Walter1,
  3. Rozemarijn Vliegenthart1,
  4. Peter M A van Ooijen1,
  5. Geertruida H De Bock2,
  6. Harry J de Koning3,
  7. Matthijs Oudkerk1
  1. 1Center for Medical Imaging – North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  3. 3Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr Marjolein A Heuvelmans, Center for Medical Imaging – North East Netherlands, University Medical Center Groningen, Groningen 9713 GZ, Netherlands; m.a.heuvelmans{at}


We studied 2240 indeterminate solid nodules (volume 50–500mm3) to determine the correlation of diameter and semi-automated volume measurements for pulmonary nodule size estimation. Intra-nodular diameter variation, defined as maximum minus minimum diameter through the nodule’s center, varied by 2.8 mm (median, IQR:2.2–3.7 mm), so above the 1.5 mm cutoff for nodule growth used in Lung CT Screening Reporting and Data System (Lung-RADS). Using mean or maximum axial diameter to assess nodule volume led to a substantial mean overestimation of nodule volume of 47.2% and 85.1%, respectively, compared to semi-automated volume. Thus, size of indeterminate nodules is poorly represented by diameter.

Trial registration number Pre-results, ISRCTN63545820.

  • imaging/CT MRI etc
  • lung cancer

Statistics from


  • Contributors MAH, GHDB, HJdK and MO: involvement in the conception, hypothesis delineation and design of the study. MAH, RV, GHDB, HJdK and MO: acquisition of the data or the analysis and interpretation of such information. MAH, JEW, RV, PMAvO, GHDB, HJdK and MO: writing the article or substantial involvement in its revision prior to submission.

  • Competing interests Siemens Germany provided four digital workstations and LungCARE for the performance of 3D measurements of the nodules. Roche diagnostics provided a grant for the performance of proteomics research. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Ethics approval The Dutch Healthcare Committee and the Medical Ethic Boards of each participating centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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