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Automated Assessment of COVID-19 Reporting and Data System and Chest CT Severity Scores in Patients Suspected of Having COVID-19 Using Artificial Intelligence.
Radiology. 2021 01; 298(1):E18-E28.R

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has spread across the globe with alarming speed, morbidity, and mortality. Immediate triage of patients with chest infections suspected to be caused by COVID-19 using chest CT may be of assistance when results from definitive viral testing are delayed. Purpose To develop and validate an artificial intelligence (AI) system to score the likelihood and extent of pulmonary COVID-19 on chest CT scans using the COVID-19 Reporting and Data System (CO-RADS) and CT severity scoring systems. Materials and Methods The CO-RADS AI system consists of three deep-learning algorithms that automatically segment the five pulmonary lobes, assign a CO-RADS score for the suspicion of COVID-19, and assign a CT severity score for the degree of parenchymal involvement per lobe. This study retrospectively included patients who underwent a nonenhanced chest CT examination because of clinical suspicion of COVID-19 at two medical centers. The system was trained, validated, and tested with data from one of the centers. Data from the second center served as an external test set. Diagnostic performance and agreement with scores assigned by eight independent observers were measured using receiver operating characteristic analysis, linearly weighted κ values, and classification accuracy. Results A total of 105 patients (mean age, 62 years ± 16 [standard deviation]; 61 men) and 262 patients (mean age, 64 years ± 16; 154 men) were evaluated in the internal and external test sets, respectively. The system discriminated between patients with COVID-19 and those without COVID-19, with areas under the receiver operating characteristic curve of 0.95 (95% CI: 0.91, 0.98) and 0.88 (95% CI: 0.84, 0.93), for the internal and external test sets, respectively. Agreement with the eight human observers was moderate to substantial, with mean linearly weighted κ values of 0.60 ± 0.01 for CO-RADS scores and 0.54 ± 0.01 for CT severity scores. Conclusion With high diagnostic performance, the CO-RADS AI system correctly identified patients with COVID-19 using chest CT scans and assigned standardized CO-RADS and CT severity scores that demonstrated good agreement with findings from eight independent observers and generalized well to external data. © RSNA, 2020 Supplemental material is available for this article.

Authors+Show Affiliations

From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.v.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.v.L., J.M., M.O., R.S., C. Schaefer-Prokop, S.S., E.T.S., C. Sital, J.T., K.V.V., C.d.V., W.X., B.d.W., M.P., B.v.G.); Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands (L.B.); Thirona, Nijmegen, the Netherlands (J.P.C., E.M.v.R.); Departments of Internal Medicine (T.D.) and Radiology (M.V.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School of Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.); Departments of Biomedical Physics and Engineering and Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (L.v.H., I.I.); Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (J.K.); Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.); Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, the Netherlands (T.v.R.V.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C. Schaefer-Prokop, S.S.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.L.S.).

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32729810

Citation

Lessmann, Nikolas, et al. "Automated Assessment of COVID-19 Reporting and Data System and Chest CT Severity Scores in Patients Suspected of Having COVID-19 Using Artificial Intelligence." Radiology, vol. 298, no. 1, 2021, pp. E18-E28.
Lessmann N, Sánchez CI, Beenen L, et al. Automated Assessment of COVID-19 Reporting and Data System and Chest CT Severity Scores in Patients Suspected of Having COVID-19 Using Artificial Intelligence. Radiology. 2021;298(1):E18-E28.
Lessmann, N., Sánchez, C. I., Beenen, L., Boulogne, L. H., Brink, M., Calli, E., Charbonnier, J. P., Dofferhoff, T., van Everdingen, W. M., Gerke, P. K., Geurts, B., Gietema, H. A., Groeneveld, M., van Harten, L., Hendrix, N., Hendrix, W., Huisman, H. J., Išgum, I., Jacobs, C., ... van Ginneken, B. (2021). Automated Assessment of COVID-19 Reporting and Data System and Chest CT Severity Scores in Patients Suspected of Having COVID-19 Using Artificial Intelligence. Radiology, 298(1), E18-E28. https://doi.org/10.1148/radiol.2020202439
Lessmann N, et al. Automated Assessment of COVID-19 Reporting and Data System and Chest CT Severity Scores in Patients Suspected of Having COVID-19 Using Artificial Intelligence. Radiology. 2021;298(1):E18-E28. PubMed PMID: 32729810.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Automated Assessment of COVID-19 Reporting and Data System and Chest CT Severity Scores in Patients Suspected of Having COVID-19 Using Artificial Intelligence. AU - Lessmann,Nikolas, AU - Sánchez,Clara I, AU - Beenen,Ludo, AU - Boulogne,Luuk H, AU - Brink,Monique, AU - Calli,Erdi, AU - Charbonnier,Jean-Paul, AU - Dofferhoff,Ton, AU - van Everdingen,Wouter M, AU - Gerke,Paul K, AU - Geurts,Bram, AU - Gietema,Hester A, AU - Groeneveld,Miriam, AU - van Harten,Louis, AU - Hendrix,Nils, AU - Hendrix,Ward, AU - Huisman,Henkjan J, AU - Išgum,Ivana, AU - Jacobs,Colin, AU - Kluge,Ruben, AU - Kok,Michel, AU - Krdzalic,Jasenko, AU - Lassen-Schmidt,Bianca, AU - van Leeuwen,Kicky, AU - Meakin,James, AU - Overkamp,Mike, AU - van Rees Vellinga,Tjalco, AU - van Rikxoort,Eva M, AU - Samperna,Riccardo, AU - Schaefer-Prokop,Cornelia, AU - Schalekamp,Steven, AU - Scholten,Ernst Th, AU - Sital,Cheryl, AU - Stöger,J Lauran, AU - Teuwen,Jonas, AU - Venkadesh,Kiran Vaidhya, AU - de Vente,Coen, AU - Vermaat,Marieke, AU - Xie,Weiyi, AU - de Wilde,Bram, AU - Prokop,Mathias, AU - van Ginneken,Bram, Y1 - 2020/07/30/ PY - 2020/7/31/pubmed PY - 2021/1/22/medline PY - 2020/7/31/entrez SP - E18 EP - E28 JF - Radiology JO - Radiology VL - 298 IS - 1 N2 - Background The coronavirus disease 2019 (COVID-19) pandemic has spread across the globe with alarming speed, morbidity, and mortality. Immediate triage of patients with chest infections suspected to be caused by COVID-19 using chest CT may be of assistance when results from definitive viral testing are delayed. Purpose To develop and validate an artificial intelligence (AI) system to score the likelihood and extent of pulmonary COVID-19 on chest CT scans using the COVID-19 Reporting and Data System (CO-RADS) and CT severity scoring systems. Materials and Methods The CO-RADS AI system consists of three deep-learning algorithms that automatically segment the five pulmonary lobes, assign a CO-RADS score for the suspicion of COVID-19, and assign a CT severity score for the degree of parenchymal involvement per lobe. This study retrospectively included patients who underwent a nonenhanced chest CT examination because of clinical suspicion of COVID-19 at two medical centers. The system was trained, validated, and tested with data from one of the centers. Data from the second center served as an external test set. Diagnostic performance and agreement with scores assigned by eight independent observers were measured using receiver operating characteristic analysis, linearly weighted κ values, and classification accuracy. Results A total of 105 patients (mean age, 62 years ± 16 [standard deviation]; 61 men) and 262 patients (mean age, 64 years ± 16; 154 men) were evaluated in the internal and external test sets, respectively. The system discriminated between patients with COVID-19 and those without COVID-19, with areas under the receiver operating characteristic curve of 0.95 (95% CI: 0.91, 0.98) and 0.88 (95% CI: 0.84, 0.93), for the internal and external test sets, respectively. Agreement with the eight human observers was moderate to substantial, with mean linearly weighted κ values of 0.60 ± 0.01 for CO-RADS scores and 0.54 ± 0.01 for CT severity scores. Conclusion With high diagnostic performance, the CO-RADS AI system correctly identified patients with COVID-19 using chest CT scans and assigned standardized CO-RADS and CT severity scores that demonstrated good agreement with findings from eight independent observers and generalized well to external data. © RSNA, 2020 Supplemental material is available for this article. SN - 1527-1315 UR - https://www.unboundmedicine.com/medline/citation/32729810/Automated_Assessment_of_COVID_19_Reporting_and_Data_System_and_Chest_CT_Severity_Scores_in_Patients_Suspected_of_Having_COVID_19_Using_Artificial_Intelligence_ L2 - https://pubs.rsna.org/doi/10.1148/radiol.2020202439?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -