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Tayal A, Gupta N, Pahwa B. Letter: Association Between Pseudoprogression of Vestibular Schwannoma After Radiosurgery and Radiological Features of Solid and Cystic Components. Neurosurgery 2024:00006123-990000000-01105. [PMID: 38529998 DOI: 10.1227/neu.0000000000002932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/07/2024] [Indexed: 03/27/2024] Open
Affiliation(s)
- Anish Tayal
- University College of Medical Sciences and G.T.B. Hospital, Delhi, India
| | - Namrata Gupta
- Kasturba Medical College Manipal, Udupi, Karnataka, India
| | - Bhavya Pahwa
- University College of Medical Sciences and G.T.B. Hospital, Delhi, India
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Huang CY, Peng SJ, Yang HC, Wu HM, Chen CJ, Wang MC, Hu YS, Lin CJ, Shiau CY, Guo WY, Chung WY, Pan DHC, Lee CC. Association Between Pseudoprogression of Vestibular Schwannoma After Radiosurgery and Radiological Features of Solid and Cystic Components. Neurosurgery 2023; 93:1383-1392. [PMID: 37432016 DOI: 10.1227/neu.0000000000002599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/16/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The pathophysiology of vestibular schwannoma (VS) pseudoprogression after Gamma Knife radiosurgery (GKRS) remains unclear. Radiological features in pretreatment magnetic resonance images may help predict VS pseudoprogression. This study used VS radiological features quantified using an automated segmentation algorithm to predict pseudoprogression after GKRS treatment. METHODS This is a retrospective study comprising 330 patients with VS who received GKRS. After image preprocessing and T2W/contrast-enhanced T1-weighted image (CET1W) image generation, with fuzzy C-means clustering, VSs were segmented into solid and cystic components and classified as solid and cystic. Relevant radiological features were then extracted. The response to GKRS was classified into "nonpseudoprogression" and "pseudoprogression/fluctuation". The Z test for two proportions was used to compare solid and cystic VS for the likelihood of pseudoprogression/fluctuation. Logistic regression was used to assess the correlation between clinical variables and radiological features and response to GKRS. RESULTS The likelihood of pseudoprogression/fluctuation after GKRS was significantly higher for solid VS compared with cystic VS (55% vs 31%, P < .001). For the entire VS cohort, multivariable logistic regression revealed that a lower mean tumor signal intensity (SI) in T2W/CET1W images was associated with pseudoprogression/fluctuation after GKRS ( P = .001). For the solid VS subgroup, a lower mean tumor SI in T2W/CET1W images ( P = .035) was associated with pseudoprogression/fluctuation after GKRS. For the cystic VS subgroup, a lower mean SI of the cystic component in T2W/CET1W images ( P = .040) was associated with pseudoprogression/fluctuation after GKRS. CONCLUSION Pseudoprogression is more likely to occur in solid VS compared with cystic VS. Quantitative radiological features in pretreatment magnetic resonance images were associated with pseudoprogression after GKRS. In T2W/CET1W images, solid VS with a lower mean tumor SI and cystic VS with a lower mean SI of cystic component were more likely to have pseudoprogression after GKRS. These radiological features can help predict the likelihood of pseudoprogression after GKRS.
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Affiliation(s)
- Chih-Ying Huang
- Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei , Taiwan
| | - Huai-Che Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center, Houston , Texas , USA
| | - Mao-Che Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei , Taiwan
| | - Yong-Sin Hu
- Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
| | - Chung-Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
| | - Cheng-Ying Shiau
- Cancer Center, Taipei Veterans General Hospital, Taipei , Taiwan
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
| | - Wen-Yuh Chung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei , Taiwan
| | - David Hung-Chi Pan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei , Taiwan
| | - Cheng-Chia Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan
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Truong LUF, Kleiber JC, Durot C, Brenet E, Barbe C, Hoeffel C, Bazin A, Labrousse M, Dubernard X. The study of predictive factors for the evolution of vestibular schwannomas. Eur Arch Otorhinolaryngol 2023; 280:1661-1670. [PMID: 36114332 DOI: 10.1007/s00405-022-07651-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The primary objective was to determine whether the analysis of textural heterogeneity of vestibular schwannomas on MRI at diagnosis was predictive of their radiological evolutivity. The secondary objective was to determine whether some clinical or radiological factors could also be predictive of growth. METHODS We conducted a pilot, observational and retrospective study of patients with a vestibular schwannoma, initially monitored, between April 2001 and November 2019 within the Oto-Neurosurgical Institute of Champagne Ardenne, Texture analysis was performed on gadolinium injected T1 and CISS T2 MRI sequences and six parameters were extracted: mean greyscale intensity, standard deviation of the greyscale histogram distribution, entropy, mean positive pixels, skewness and kurtosis, which were analysed by the Lasso method, using statistically penalised Cox models. Extrameatal location, tumour necrosis, perceived hearing loss < 2 years with objectified tone audiometry asymmetry, tinnitus at diagnosis, were investigated by the Log-Rank test to obtain univariate survival analyses. RESULTS 78 patients were included and divided into 2 groups: group A comprising 39 "stable patients", and B comprising the remaining 39 "progressive patients". Independent analysis of the texture factors did not predict the growth potential of vestibular schwannomas. Among the clinical or radiological signs of interest, hearing loss < 2 years was identified as a prognostic factor for tumour progression with a significant trend (p = 0.05). CONCLUSIONS This study did not identify an association between texture analysis and vestibular schwannomas growth. Decreased hearing in the 2 years prior to diagnosis appears to predict potential radiological progression.
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Affiliation(s)
- Le-Uyen France Truong
- Department of Oto-Rhino-Laryngology and Head and neck surgery of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
| | - Jean Charles Kleiber
- Department of Neurosurgery of the CHU of Reims, Hôpital Maison Blanche, 45 rue Cognacq-Jay, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Carole Durot
- Department of Radiology of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Esteban Brenet
- Department of Oto-Rhino-Laryngology and Head and neck surgery of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Coralie Barbe
- Research and Public Health Unit of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Christine Hoeffel
- Department of Radiology of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Arnaud Bazin
- Department of Neurosurgery of the CHU of Reims, Hôpital Maison Blanche, 45 rue Cognacq-Jay, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Marc Labrousse
- Department of Oto-Rhino-Laryngology and Head and neck surgery of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Xavier Dubernard
- Department of Oto-Rhino-Laryngology and Head and neck surgery of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France.
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France.
- Service d'ORL et Chirurgie cervico-faciale, CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France.
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Pseudoprogression of Vestibular Schwannoma after Stereotactic Radiosurgery with Cyberknife ®: Proposal for New Response Criteria. Cancers (Basel) 2023; 15:cancers15051496. [PMID: 36900290 PMCID: PMC10000564 DOI: 10.3390/cancers15051496] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
(1) Background: Transient increase in volume of vestibular schwannomas (VS) after stereotactic radiosurgery (SRS) is common and complicates differentiation between treatment-related changes (pseudoprogression, PP) and tumor recurrence (progressive disease, PD). (2) Methods: Patients with unilateral VS (n = 63) underwent single fraction robotic-guided SRS. Volume changes were classified according to existing RANO criteria. A new response type, PP, with a >20% transient increase in volume was defined and divided into early (within the first 12 months) and late (>12 months) occurrence. (3) Results: The median age was 56 (range: 20-82) years, the median initial tumor volume was 1.5 (range: 0.1-8.6) cm3. The median radiological and clinical follow-up time was 66 (range: 24-103) months. Partial response was observed in 36% (n = 23), stable disease in 35% (n = 22) and PP in 29% (n = 18) of patients. The latter occurred early (16%, n = 10) or late (13%, n = 8). Using these criteria, no case of PD was observed. (4) Conclusion: Any volume increase after SRS for vs. assumed to be PD turned out to be early or late PP. Therefore, we propose modifying RANO criteria for SRS of VS, which may affect the management of vs. during follow-up in favor of further observation.
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Application of artificial intelligence to stereotactic radiosurgery for intracranial lesions: detection, segmentation, and outcome prediction. J Neurooncol 2023; 161:441-450. [PMID: 36635582 DOI: 10.1007/s11060-022-04234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Rapid evolution of artificial intelligence (AI) prompted its wide application in healthcare systems. Stereotactic radiosurgery served as a good candidate for AI model development and achieved encouraging result in recent years. This article aimed at demonstrating current AI application in radiosurgery. METHODS Literatures published in PubMed during 2010-2022, discussing AI application in stereotactic radiosurgery were reviewed. RESULTS AI algorithms, especially machine learning/deep learning models, have been administered to different aspect of stereotactic radiosurgery. Spontaneous tumor detection and automated lesion delineation or segmentation were two of the promising application, which could be further extended to longitudinal treatment follow-up. Outcome prediction utilized machine learning algorithms with radiomic-based analysis was another well-established application. CONCLUSIONS Stereotactic radiosurgery has taken a lead role in AI development. Current achievement, limitation, and further investigation was summarized in this article.
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Sümer E, Tek E, Türe OA, Şengöz M, Dinçer A, Özcan A, Pamir MN, Özduman K, Ozturk-Isik E. The effect of tumor shape irregularity on Gamma Knife treatment plan quality and treatment outcome: an analysis of 234 vestibular schwannomas. Sci Rep 2022; 12:21809. [PMID: 36528740 PMCID: PMC9759589 DOI: 10.1038/s41598-022-25422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
The primary aim of Gamma Knife (GK) radiosurgery is to deliver high-dose radiation precisely to a target while conforming to the target shape. In this study, the effects of tumor shape irregularity (TSI) on GK dose-plan quality and treatment outcomes were analyzed in 234 vestibular schwannomas. TSI was quantified using seven different metrics including volumetric index of sphericity (VioS). GK treatment plans were created on a single GK-Perfexion/ICON platform. The plan quality was measured using selectivity index (SI), gradient index (GI), Paddick's conformity index (PCI), and efficiency index (EI). Correlation and linear regression analyses were conducted between shape irregularity features and dose plan indices. Machine learning was employed to identify the shape feature that predicted dose plan quality most effectively. The treatment outcome analysis including tumor growth control and serviceable hearing preservation at 2 years, were conducted using Cox regression analyses. All TSI features correlated significantly with the dose plan indices (P < 0.0012). With increasing tumor volume, vestibular schwannomas became more spherical (P < 0.05) and the dose plan indices varied significantly between tumor volume subgroups (P < 0.001 and P < 0.01). VioS was the most effective predictor of GK indices (P < 0.001) and we obtained 89.36% accuracy (79.17% sensitivity and 100% specificity) for predicting PCI. Our results indicated that TSI had significant effects on the plan quality however did not adversely affect treatment outcomes.
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Affiliation(s)
- Esra Sümer
- grid.11220.300000 0001 2253 9056Institute of Biomedical Engineering, Boğaziçi University, Kandilli Campus, Rasathane Cad, 34684 Üsküdar, Istanbul Turkey
| | - Ece Tek
- grid.411117.30000 0004 0369 7552Department of Radiation Oncology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - O. Artunç Türe
- grid.411117.30000 0004 0369 7552Department of Radiation Oncology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Meriç Şengöz
- grid.411117.30000 0004 0369 7552Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Alp Dinçer
- grid.411117.30000 0004 0369 7552Department of Radiology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Alpay Özcan
- grid.11220.300000 0001 2253 9056Department of Electrical and Electronics Engineering, Boğaziçi University, Istanbul, Turkey
| | - M. Necmettin Pamir
- grid.411117.30000 0004 0369 7552Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Koray Özduman
- grid.411117.30000 0004 0369 7552Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Esin Ozturk-Isik
- grid.11220.300000 0001 2253 9056Institute of Biomedical Engineering, Boğaziçi University, Kandilli Campus, Rasathane Cad, 34684 Üsküdar, Istanbul Turkey
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Thielhelm TP, Nourbakhsh A, Welford SM, Mellon EA, Bracho O, Ivan ME, Telischi F, Fernandez-Valle C, Dinh CT. RAD51 Inhibitor and Radiation Toxicity in Vestibular Schwannoma. Otolaryngol Head Neck Surg 2022; 167:860-868. [PMID: 35230908 PMCID: PMC9433467 DOI: 10.1177/01945998221083506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the RAD51 response (DNA repair) to radiation-induced DNA damage in patient-derived vestibular schwannoma (VS) cells and investigate the utility of RAD51 inhibitor (RI-1) in enhancing radiation toxicity. STUDY DESIGN Basic and translational science. SETTING Tertiary academic facility. METHODS VS tumors (n = 10) were cultured on 96-well plates and 16-well slides, exposed to radiation (0, 6, 12, or 18 Gy), and treated with RI-1 (0, 5, or 10 µM). Immunofluorescence was performed at 6 hours for γ-H2AX (DNA damage marker), RAD51 (DNA repair protein), and p21 (cell cycle arrest protein). Viability assays were performed at 96 hours, and capillary Western blotting was utilized to determine RAD51 expression in naïve VS tumors (n = 5). RESULTS VS tumors expressed RAD51. In cultured VS cells, radiation initiated dose-dependent increases in γ-H2AX and p21 expression. VS cells upregulated RAD51 to repair DNA damage following radiation. Addition of RI-1 reduced RAD51 expression in a dose-dependent manner and was associated with increased γ-H2AX levels and decreased viability in a majority of cultured VS tumors. CONCLUSION VS may evade radiation injury by entering cell cycle arrest and upregulating RAD51-dependent repair of radiation-induced double-stranded breaks in DNA. Although there was variability in responses among individual primary VS cells, RAD51 inhibition with RI-1 reduced RAD51-dependent DNA repair to enhance radiation toxicity in VS cells. Further investigations are warranted to understand the mechanisms of radiation resistance in VS and determine whether RI-1 is an effective radiosensitizer in patients with VS.
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Affiliation(s)
- Torin P. Thielhelm
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL
| | - Aida Nourbakhsh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL
| | - Scott M. Welford
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Eric A. Mellon
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Olena Bracho
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL
| | - Michael E. Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Fred Telischi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL
| | - Cristina Fernandez-Valle
- Burnett School of Biomedical Sciences, University of Central Florida, College of Medicine, Orlando, FL
| | - Christine T. Dinh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL
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Itoyama T, Nakaura T, Hamasaki T, Takezaki T, Uentani H, Hirai T, Mukasa A. Whole Tumor Radiomics Analysis for Risk Factors Associated With Rapid Growth of Vestibular Schwannoma in Contrast-Enhanced T1-Weighted Images. World Neurosurg 2022; 166:e572-e582. [PMID: 35863640 DOI: 10.1016/j.wneu.2022.07.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the features associated with rapid growth of vestibular schwannoma using radiomics analysis on magnetic resonance imaging (MRI) together with clinical factors. METHODS From August 2005 to February 2019, 67 patients with vestibular schwannoma underwent contrast-enhanced T1-weighted MRI at least twice as part of their diagnosis. After excluding 3 cases with an extremely short follow-up period of 15 days or less, 64 patients were finally enrolled in this study. Ninety-three texture features were extracted from the tumor image data using 3D Slicer software (http://www.slicer.org/). We determined the texture features that significantly affected maximal tumor diameter growth of more than 2 mm/year using Random Forest and Bounty. We also analyzed age and tumor size as clinical factors. We calculated the areas under the curve (AUCs) using receiver operating characteristic analysis for prediction models using texture, clinical, and mixed factors by Random Forest and 5-fold cross-validation. RESULTS Two texture features, low minimum signal and high inverse difference moment normalized (Idmn), were significantly associated with rapid growth of vestibular schwannoma. The mixed model of texture features and clinical factors offered the highest AUC (0.69), followed by the pure texture (0.67), and pure clinical (0.63) models. The minimum signal was the most important variable followed by tumor size, Idmn, and age. CONCLUSIONS Our radiomics analysis found that texture features were significantly associated with the rapid growth of vestibular schwannoma in contrast-enhanced T1-weighted images. The mixed model offered a higher diagnostic performance than the pure texture or clinical models.
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Affiliation(s)
- Takashi Itoyama
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Kumamoto University Hospital, Kumamoto, Japan
| | - Tadashi Hamasaki
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan.
| | - Tatsuya Takezaki
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Hiroyuki Uentani
- Department of Diagnostic Radiology, Kumamoto University Hospital, Kumamoto, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Kumamoto University Hospital, Kumamoto, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
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Machine Learning in the Management of Lateral Skull Base Tumors: A Systematic Review. JOURNAL OF OTORHINOLARYNGOLOGY, HEARING AND BALANCE MEDICINE 2022. [DOI: 10.3390/ohbm3040007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The application of machine learning (ML) techniques to otolaryngology remains a topic of interest and prevalence in the literature, though no previous articles have summarized the current state of ML application to management and the diagnosis of lateral skull base (LSB) tumors. Subsequently, we present a systematic overview of previous applications of ML techniques to the management of LSB tumors. Independent searches were conducted on PubMed and Web of Science between August 2020 and February 2021 to identify the literature pertaining to the use of ML techniques in LSB tumor surgery written in the English language. All articles were assessed in regard to their application task, ML methodology, and their outcomes. A total of 32 articles were examined. The number of articles involving applications of ML techniques to LSB tumor surgeries has significantly increased since the first article relevant to this field was published in 1994. The most commonly employed ML category was tree-based algorithms. Most articles were included in the category of surgical management (13; 40.6%), followed by those in disease classification (8; 25%). Overall, the application of ML techniques to the management of LSB tumor has evolved rapidly over the past two decades, and the anticipated growth in the future could significantly augment the surgical outcomes and management of LSB tumors.
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Jung IH, Chang KW, Park SH, Jung HH, Chang JH, Chang JW, Chang WS. Pseudoprogression and peritumoral edema due to intratumoral necrosis after Gamma knife radiosurgery for meningioma. Sci Rep 2022; 12:13663. [PMID: 35953695 PMCID: PMC9372131 DOI: 10.1038/s41598-022-17813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
Peritumoral cerebral edema is reported to be a side effect that can occur after stereotactic radiosurgery. We aimed to determine whether intratumoral necrosis (ITN) is a risk factor for peritumoral edema (PTE) when gamma knife radiosurgery (GKRS) is performed in patients with meningioma. In addition, we propose the concept of pseudoprogression: a temporary volume expansion that can occur after GKRS in the natural course of meningioma with ITN. This retrospective study included 127 patients who underwent GKRS for convexity meningioma between January 2019 and December 2020. Risk factors for PTE and ITN were investigated using logistic regression analysis. Analysis of variance was used to determine whether changes in tumor volume were statistically significant. After GKRS, ITN was observed in 34 (26.8%) patients, and PTE was observed in 10 (7.9%) patients. When postoperative ITN occurred after GKRS, the incidence of postoperative PTE was 18.970-fold (p = 0.009) greater. When a 70% dose volume ≥ 1 cc was used, the possibility of ITN was 5.892-fold (p < 0.001) higher. On average, meningiomas with ITN increased in volume by 128.5% at 6 months after GKRS and then decreased to 94.6% at 12 months. When performing GKRS in meningioma, a 70% dose volume ≥ 1 cc is a risk factor for ITN. At 6 months after GKRS, meningiomas with ITN may experience a transient volume expansion and PTE, which are characteristics of pseudoprogression. These characteristics typically improve at 12 months following GKRS.
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Affiliation(s)
- In-Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
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Byun J, Kim JH, Song SW, Kim YH, Hong CK, Kim JH. Fate of Residual Tumor After Subtotal Resection of a Previously Irradiated Vestibular Schwannoma: Long-Term Follow-Up of a Single-Institutional Series. World Neurosurg 2022; 163:e207-e214. [PMID: 35342030 DOI: 10.1016/j.wneu.2022.03.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The fate of residual tumor after salvage surgery for recurrent vestibular schwannoma (VS) after radiosurgery has not been elucidated so far. We reviewed our surgical series of salvage surgery for recurrent VS, with focus on the natural history of the residual tumor after salvage surgery. METHODS This study enrolled 14 patients who underwent salvage surgical resection in our institute and were followed up for >12 months. RESULTS The study included 3 men and 11 women with a median age of 55 years (range: 16-70 years). The median pre-stereotactic radiosurgery tumor volume was 6591 mm3. All patients were treated using gamma knife radiosurgery. The median duration from gamma knife radiosurgery to surgery was 52 months (range: 10-116 months). Solid tumor growth and cyst formation were observed in 6 (42.9%) and 8 (57.1%) patients, respectively. Subtotal resection and partial resection were performed in 13 (92.8%) patients, and gross total resection was achieved in only one (7.2%) patient. Postoperative facial paresis and surgical complication occurred in 5 (35.7%) and 2 (14.3%) patients, respectively. After salvage resection for irradiated VS, no patient showed tumor progression or recurrence during the follow-up period (13 subtotal/partial resections and 1 total resection). In addition, 2 patients in the subtotal resection group showed residual tumor shrinkage after salvage surgery during the follow-up period. CONCLUSIONS The behavior of residual tumors after salvage surgery for irradiated VS was stable. Adjuvant treatment for these residual tumors may not be necessary.
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Affiliation(s)
- Joonho Byun
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Jong Hyun Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Woo Song
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ki Hong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ganz JC. Vestibular Schwannomas. PROGRESS IN BRAIN RESEARCH 2022; 268:133-162. [PMID: 35074078 DOI: 10.1016/bs.pbr.2021.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vestibular Schwannomas are well treated by GKNS. This can be used alone for tumors up to 20cm3. For larger tumors subtotal, intracapsular resection followed by GKNS a few months later would seem to give the best results. While there remain disagreements relating to optimal treatment for VSs among colleagues using different techniques, there are indications that these are becoming less confrontational. The evidence in this chapter suggests that early GKNS intervention results in better hearing preservation and tumor control in small tumors. The evidence in favor of "wait and see" depends on series reporting on changes in tumor size using suboptimal measurements. It is more important to record the fate of hearing, and this would seem to be better preserved following early GKNS. The results of GKNS for NF2 are by no means as good as could be wished but would seem to be superior to those of microsurgery. The importance of screening of family members cannot be over emphasized.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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13
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Fouard O, Daisne JF, Wanet M, Regnier M, Gustin T. Long-term volumetric analysis of vestibular schwannomas following stereotactic radiotherapy: Practical implications for follow-up. Clin Transl Radiat Oncol 2022; 33:1-6. [PMID: 34977365 PMCID: PMC8688865 DOI: 10.1016/j.ctro.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022] Open
Abstract
Pseudoprogression may be a late phenomenon after radiosurgery. Loss of central contrast enhancement is not predictive of tumor control. No decision of salvage therapy should be made until the 6th year post-treatment.
Background and purpose Transient tumor swelling is a well-known phenomenon following radiotherapy for vestibular schwannomas (VS). We analyzed the long-term volumetric changes of VS after LINAC radiosurgery, in order to determine a time interval during which a true tumor progression can be distinguished from a pseudoprogression. Methods Among 63 patients with VS treated by one fraction or fractionated radiotherapy, we selected 52 of them who had a minimal follow-up of 5 years. Maximal axial diameter and three-dimensional tumor volume were measured on each MRI scan. Volume changes were interpreted using different error margins ranging from 10 to 20%. Patients were categorized according to the tumor evolution pattern over time. Results Median follow-up was 83 months. One tumor (1.9%) remained stable and 26.9% had continuous shrinkage. Applying an error margin of 13%, a transient tumor enlargement was observed in 63.5% of patients, with a first peak at 6–12 months and a late peak at 3–4 years. A true progression was suspected in 4 (7.7%) patients, tumor regrowth starting after the 3rd or 4th year post-treatment. Only one patient required salvage radiotherapy. Conclusion Transient swelling of VS following radiotherapy is generally an early phenomenon but may occur late. In the first 5 years, a true tumor progression cannot be differentiated from a pseudoprogression. A significant tumor expansion observed on 3 sequential MRI scans after the 3rd year may be suggestive of treatment failure. Long-term follow-up is therefore mandatory and no decision of salvage treatment should be made until the 6th year.
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Affiliation(s)
- O Fouard
- Neurosurgery Department, CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - J F Daisne
- Radiation Oncology Department, CHU UCL Namur Site Sainte-Elisabeth, Université Catholique de Louvain, Namur, Belgium.,Radiation Oncology Department, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Oncology and Leuven Cancer Institute, Katholieke Universiteit Leuven, Leuven, Belgium
| | - M Wanet
- Radiation Oncology Department, CHU UCL Namur Site Sainte-Elisabeth, Université Catholique de Louvain, Namur, Belgium
| | - M Regnier
- Scientific Support Unit, CHU UCL Namur, Université catholique de Louvain, Namur, Belgium
| | - T Gustin
- Neurosurgery Department, CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
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14
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Cesme DH, Alkan A, Sari L, Kaya A, Yurtsever I, Alkan G, Seyithanoglu MH, Hatiboglu MA. The Effectiveness of Diffusion Tensor Imaging in Determining Radiological Response after Radiosurgery in Patients with Vestibular Schwannoma. Curr Med Imaging 2021; 17:602-607. [PMID: 33504315 DOI: 10.2174/1573405617666210127160848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/09/2020] [Accepted: 11/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effectiveness of Diffusion Tensor Imaging (DTI) in demonstrating functional changes in the tumor in determining the response to treatment after radiosurgery in patients with vestibular schwannoma (VS) is not clear yet. OBJECTIVE The study aimed to determine the change in total tumor volume (TTV) in terms of radiological response in patients who had VS and were treated with radiosurgery and investigated the relationship between the TTV, follow-up times and DTI parameters. METHODS Thirty-one patients were assessed using DTI and MRI. TTV, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were calculated. Patients were divided into three groups: those who responded to the treatment (group 1) (n=11), those who did not (group 0) (n=9) and those who remained stable (group 2) (n=11). RESULTS The mean duration of follow-up was 28.81±14 months. ADC values increased in patients with VS after radiosurgery (p=0.004). There was no statistical difference in the FA values. A significant reduction in TTV after radiosurgery was detected in group 1 (p=0.003). ADC values increased significantly after radiosurgery in group 2 (p=0.04). Although there were no significant differences, ADC values after radiosurgery increased in group 1 and group 0. CONCLUSIONS ADC values continuously increase due to radiation damage in the period before the tumor volume shrinks after radiosurgery. We think that it is not appropriate to diagnose inadequate treatment or progression only when TTV is evaluated in terms of response to treatment in the early period after radiosurgery.
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Affiliation(s)
- Dilek Hacer Cesme
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Lutfullah Sari
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Kaya
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ismail Yurtsever
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Gokberk Alkan
- Department of Otorhinolaryngology Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Mustafa Aziz Hatiboglu
- Department of Neurosurgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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15
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Radiomics-Based Prediction of Long-Term Treatment Response of Vestibular Schwannomas Following Stereotactic Radiosurgery. Otol Neurotol 2021; 41:e1321-e1327. [PMID: 33492808 DOI: 10.1097/mao.0000000000002886] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) is one of the treatment modalities for vestibular schwannomas (VSs). However, tumor progression can still occur after treatment. Currently, it remains unknown how to predict long-term SRS treatment outcome. This study investigates possible magnetic resonance imaging (MRI)-based predictors of long-term tumor control following SRS. STUDY DESIGN Retrospective cohort study. SETTING Tertiary referral center. PATIENTS Analysis was performed on a database containing 735 patients with unilateral VS, treated with SRS between June 2002 and December 2014. Using strict volumetric criteria for long-term tumor control and tumor progression, a total of 85 patients were included for tumor texture analysis. INTERVENTION(S) All patients underwent SRS and had at least 2 years of follow-up. MAIN OUTCOME MEASURE(S) Quantitative tumor texture features were extracted from conventional MRI scans. These features were supplied to a machine learning stage to train prediction models. Prediction accuracy, sensitivity, specificity, and area under the receiver operating curve (AUC) are evaluated. RESULTS Gray-level co-occurrence matrices, which capture statistics from specific MRI tumor texture features, obtained the best prediction scores: 0.77 accuracy, 0.71 sensitivity, 0.83 specificity, and 0.93 AUC. These prediction scores further improved to 0.83, 0.83, 0.82, and 0.99, respectively, for tumors larger than 5 cm. CONCLUSIONS Results of this study show the feasibility of predicting the long-term SRS treatment response of VS tumors on an individual basis, using MRI-based tumor texture features. These results can be exploited for further research into creating a clinical decision support system, facilitating physicians, and patients to select a personalized optimal treatment strategy.
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Cesme DH, Alkan A, Gultekin MA, Sari L, Alkan G, Kaya A, Mayadagli A, Akdur K, Uysal O, Hatiboglu MA. Diffusion Tensor Imaging Features of the Auditory Pathways in Patients With Vestibular Schwannoma After Gamma Knife Radiosurgery. Cureus 2021; 13:e14143. [PMID: 33927945 PMCID: PMC8075324 DOI: 10.7759/cureus.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective In this study, we aimed to investigate whether there is any change in diffusion tensor imaging (DTI) parameters in ipsilateral and contralateral auditory pathways after Gamma Knife radiosurgery (GKR) in patients with vestibular schwannoma (VS) and the relationship between radiosurgery variables. Methods Sixty-six patients were evaluated with MRI and DTI before and after GKR. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were measured from the bilateral lateral lemniscus (LL), inferior colliculus (IC), medial geniculate body (MGB), and Heschl's gyrus (HG). Results There was no significant difference in ADC and FA values obtained from bilateral LL, IC, and MGB before and after radiosurgery. However, there was a significant difference between pretreatment and post-radiosurgery contralateral HG ADC values. The ADC values obtained from the contralateral HG and IC positively correlated with the duration after radiosurgery. As the duration after radiosurgery increases, the difference between the ADC values obtained from ipsilateral and contralateral HG also increases. Conclusion The high ADC values in the contralateral HG after radiosurgery may indicate microstructural alterations such as demyelination and axonal loss. Radiation exposure doses to the brainstem and cochlea are the most important factors that can cause microstructural damage to the auditory pathways. When planning radiosurgery, extreme care should be taken to prevent the harmful effects of radiation on the auditory pathways.
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Affiliation(s)
- Dilek H Cesme
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, TUR
| | - Alpay Alkan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, TUR
| | - Mehmet Ali Gultekin
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, TUR
| | - Lutfullah Sari
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, TUR
| | - Gokberk Alkan
- Otorhinolaryngology, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, TUR
| | - Ahmet Kaya
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, TUR
| | - Alpaslan Mayadagli
- Radiation Oncology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, TUR
| | - Kerime Akdur
- Radiation Oncology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, TUR
| | - Omer Uysal
- Biostatistics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, TUR
| | - Mustafa A Hatiboglu
- Neurosurgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, TUR
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Lee CC, Lee WK, Wu CC, Lu CF, Yang HC, Chen YW, Chung WY, Hu YS, Wu HM, Wu YT, Guo WY. Applying artificial intelligence to longitudinal imaging analysis of vestibular schwannoma following radiosurgery. Sci Rep 2021; 11:3106. [PMID: 33542422 PMCID: PMC7862268 DOI: 10.1038/s41598-021-82665-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) has been applied with considerable success in the fields of radiology, pathology, and neurosurgery. It is expected that AI will soon be used to optimize strategies for the clinical management of patients based on intensive imaging follow-up. Our objective in this study was to establish an algorithm by which to automate the volumetric measurement of vestibular schwannoma (VS) using a series of parametric MR images following radiosurgery. Based on a sample of 861 consecutive patients who underwent Gamma Knife radiosurgery (GKRS) between 1993 and 2008, the proposed end-to-end deep-learning scheme with automated pre-processing pipeline was applied to a series of 1290 MR examinations (T1W+C, and T2W parametric MR images). All of which were performed under consistent imaging acquisition protocols. The relative volume difference (RVD) between AI-based volumetric measurements and clinical measurements performed by expert radiologists were + 1.74%, - 0.31%, - 0.44%, - 0.19%, - 0.01%, and + 0.26% at each follow-up time point, regardless of the state of the tumor (progressed, pseudo-progressed, or regressed). This study outlines an approach to the evaluation of treatment responses via novel volumetric measurement algorithm, and can be used longitudinally following GKRS for VS. The proposed deep learning AI scheme is applicable to longitudinal follow-up assessments following a variety of therapeutic interventions.
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Affiliation(s)
- Cheng-Chia Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Kai Lee
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Chun Wu
- Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Yu-Wei Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Wen-Yuh Chung
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Yong-Sin Hu
- Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Te Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan.
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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18
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George-Jones NA, Chkheidze R, Moore S, Wang J, Hunter JB. MRI Texture Features are Associated with Vestibular Schwannoma Histology. Laryngoscope 2020; 131:E2000-E2006. [PMID: 33300608 DOI: 10.1002/lary.29309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/17/2020] [Accepted: 11/29/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS To determine if commonly used radiomics features have an association with histological findings in vestibular schwannomas (VS). STUDY DESIGN Retrospective case-series. METHODS Patients were selected from an internal database of those who had a gadolinium-enhanced T1-weighted MRI scan captured prior to surgical resection of VS. Texture features from the presurgical magnetic resonance image (MRI) were extracted, and pathologists examined the resected tumors to assess for the presence of mucin, lymphocytes, necrosis, and hemosiderin and used a validated computational tool to determine cellularity. Sensitivity, specificity, and positive likelihood ratios were also computed for selected features using the Youden index to determine the optimal cut-off value. RESULTS A total of 45 patients were included. We found significant associations between multiple MRI texture features and the presence of mucin, lymphocytes, hemosiderin, and cellularity. No significant associations between MRI texture features and necrosis were identified. We were able to identify significant positive likelihood ratios using Youden index cut-off values for mucin (2.3; 95% CI 1.2-4.3), hemosiderin (1.5; 95% CI 1.04-2.1), lymphocytes (3.8; 95% CI 1.2-11.7), and necrosis (1.5; 95% CI 1.1-2.2). CONCLUSIONS MRI texture features are associated with underlying histology in VS. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2000-E2006, 2021.
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Affiliation(s)
- Nicholas A George-Jones
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Rati Chkheidze
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Samantha Moore
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Jing Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
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Yang HC, Wu CC, Lee CC, Huang HE, Lee WK, Chung WY, Wu HM, Guo WY, Wu YT, Lu CF. Prediction of pseudoprogression and long-term outcome of vestibular schwannoma after Gamma Knife radiosurgery based on preradiosurgical MR radiomics. Radiother Oncol 2020; 155:123-130. [PMID: 33161011 DOI: 10.1016/j.radonc.2020.10.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE Gamma Knife radiosurgery (GKRS) is a safe and effective treatment modality with a long-term tumor control rate over 90% for vestibular schwannoma (VS). However, numerous tumors may undergo a transient pseudoprogression during 6-18 months after GKRS followed by a long-term volume reduction. The aim of this study is to determine whether the radiomics analysis based on preradiosurgical MRI data could predict the pseudoprogression and long-term outcome of VS after GKRS. MATERIALS AND METHODS A longitudinal dataset of patients with VS treated by single GKRS were retrospectively collected. Overall 336 patients with no previous craniotomy for tumor removal and a median of 65-month follow-up period after radiosurgery were finally included in this study. In total 1763 radiomic features were extracted from the multiparameteric MRI data before GKRS followed by the machine-learning classification. RESULTS We constructed a two-level machine-learning model to predict the long-term outcome and the occurrence of transient pseudoprogression after GKRS separately. The prediction of long-term outcome achieved an accuracy of 88.4% based on five radiomic features describing the variation of T2-weighted intensity and inhomogeneity of contrast enhancement in tumor. The prediction of transient pseudoprogression achieved an accuracy of 85.0% based on another five radiomic features associated with the inhomogeneous hypointensity pattern of contrast enhancement and the variation of T2-weighted intensity. CONCLUSION The proposed machine-learning model based on the preradiosurgical MR radiomics provides a potential to predict the pseudoprogression and long-term outcome of VS after GKRS, which can benefit the treatment strategy in clinical practice.
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Affiliation(s)
- Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Chun Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taiwan
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Huai-En Huang
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Department of Medical Imaging, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Wei-Kai Lee
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Yuh Chung
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu-Mei Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taiwan
| | - Wan-Yuo Guo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taiwan
| | - Yu-Te Wu
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan.
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Prediction of Vestibular Schwannoma Enlargement After Radiosurgery Using Tumor Shape and MRI Texture Features. Otol Neurotol 2020; 42:e348-e354. [DOI: 10.1097/mao.0000000000002938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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