Relevance of apparent diffusion coefficient features for a radiomics-based prediction of response to induction chemotherapy in sinonasal cancer

Imaging Analytics using Artificial Intelligence in Oncology: A Comprehensive Review

The present era has seen a surge in artificial intelligence-related research in oncology, mainly using deep learning, because of powerful computer hardware, improved algorithms and the availability of large amounts of data from open-source domains and the use of transfer learning. Here we discuss the multifaceted role of deep learning in cancer care, ranging from risk stratification, the screening and diagnosis of cancer, to the prediction of genomic mutations, treatment response and survival outcome prediction, through the use of convolutional neural networks. Another role of artificial intelligence is in the generation of automated radiology reports, which is a boon in high-volume centres to minimise report turnaround time. Although a validated and deployable deep-learning model for clinical use is still in its infancy, there is ongoing research to overcome the barriers for its universal implementation and we also delve into this aspect. We also briefly describe the role of radiomics in oncoimaging. Artificial intelligence can provide answers pertaining to cancer management at baseline imaging, saving cost and time. Imaging biobanks, which are repositories of anonymised images, are also briefly described. We also discuss the commercialisation and ethical issues pertaining to artificial intelligence. The latest generation generalist artificial intelligence model is also briefly described at the end of the article. We believe this article will not only enrich knowledge, but also promote research acumen in the minds of readers to take oncoimaging to another level using artificial intelligence and also work towards clinical translation of such research.

Computer Vision-Radiomics & Pathognomics

The role of computer vision in extracting radiographic (radiomics) and histopathologic (pathognomics) features is an extension of molecular biomarkers that have been foundational to our understanding across the spectrum of head and neck disorders. Especially within head and neck cancers, machine learning and deep learning applications have yielded advances in the characterization of tumor features, nodal features, and various outcomes. This review aims to overview the landscape of radiomic and pathognomic applications, informing future work to address gaps. Novel methodologies will be needed to potentially engineer ways of integrating multidimensional data inputs to examine disease features to guide prognosis comprehensively and ultimately clinical management.

Machine Learning-Based MRI Radiogenomics for Evaluation of Response to Induction Chemotherapy in Head and Neck Squamous Cell Carcinoma

RATIONALE AND OBJECTIVES

To develop and validate a radiogenomics model integrating clinical data, radiomics-based machine learning (RBML) classifiers, and transcriptomics data for predicting the response to induction chemotherapy (IC) in patients with head and neck squamous cell carcinoma (HNSCC).

MATERIALS AND METHODS

Radiomics features derived from T2-weighted, pre- and post-contrast-enhanced T1-weighted MRI sequences, clinical data, and RNA sequencing data of 150 patients with HNSCC were included in the study. Analysis of variance or recursive feature elimination was used to reduce radiomics features. Three RBML classifiers were developed to distinguish non-responders from responders. Weighted correlation network analysis (WGCNA) was performed to identify the correlation between clinical data or radiomics features and molecular features; subsequently, protein interaction and functional enrichment analyses were performed. The predictive performance of the radiogenomics model integrating significant clinical variables, RBML classifiers, and molecular features was evaluated using receiver operating characteristic curve analysis.

RESULTS

Five radiomics features and two conventional MRI findings significantly stratified HNSCC patients into responders and non-responders. On WGCNA analysis, 809 genes showed a significant correlation with two radiomics features. Functional enrichment analysis suggested that our proposed radiomics features could reflect the T cell-mediated immune response and immune infiltration of HNSCC. The radiogenomics model showed the highest area under the curve (0.88[95%CI 0.75-0.96]) for predicting IC response, which was better than MRI findings(p = 0.0407) or molecular features(p = 0.004) alone, but showed no significant difference with that of RBML model (p = 0.2254) in test cohort.

CONCLUSION

Merging imaging phenotypes with transcriptomic data improved the prediction of IC response in HNSCC.

A Novel Data Augmentation Method for Radiomics Analysis Using Image Perturbations

Radiomics extracts hundreds of features from medical images to quantitively characterize a region of interest (ROI). When applying radiomics, imbalanced or small dataset issues are commonly addressed using under or over-sampling, the latter being applied directly to the extracted features. Aim of this study is to propose a novel balancing and data augmentation technique by applying perturbations (erosion, dilation, contour randomization) to the ROI in cardiac computed tomography images. From the perturbed ROIs, radiomic features are extracted, thus creating additional samples. This approach was tested addressing the clinical problem of distinguishing cardiac amyloidosis (CA) from aortic stenosis (AS) and hypertrophic cardiomyopathy (HCM). Twenty-one CA, thirty-two AS and twenty-one HCM patients were included in the study. From each original and perturbed ROI, 107 radiomic features were extracted. The CA-AS dataset was balanced using the perturbation-based method along with random over-sampling, adaptive synthetic (ADASYN) and the synthetic minority oversampling technique (SMOTE). The same methods were tested to perform data augmentation dealing with CA and HCM. Features were submitted to robustness, redundancy, and relevance analysis testing five feature selection methods (p-value, least absolute shrinkage and selection operator (LASSO), semi-supervised LASSO, principal component analysis (PCA), semi-supervised PCA). Support vector machine performed the classification tasks, and its performance were evaluated by means of a 10-fold cross-validation. The perturbation-based approach provided the best performances in terms of f1 score and balanced accuracy in both CA-AS (f1 score: 80%, AUC: 0.91) and CA-HCM (f1 score: 86%, AUC: 0.92) classifications. These results suggest that ROI perturbations represent a powerful approach to address both data balancing and augmentation issues.

Developments and future prospects of personalized medicine in head and neck squamous cell carcinoma diagnoses and treatments

BACKGROUND

Precision healthcare has entered a new era because of the developments in personalized medicine, especially in the diagnosis and treatment of head and neck squamous cell carcinoma (HNSCC). This paper explores the dynamic landscape of personalized medicine as applied to HNSCC, encompassing both current developments and future prospects.

RECENT FINDINGS

The integration of personalized medicine strategies into HNSCC diagnosis is driven by the utilization of genetic data and biomarkers. Epigenetic biomarkers, which reflect modifications to DNA that can influence gene expression, have emerged as valuable indicators for early detection and risk assessment. Treatment approaches within the personalized medicine framework are equally promising. Immunotherapy, gene silencing, and editing techniques, including RNA interference and CRISPR/Cas9, offer innovative means to modulate gene expression and correct genetic aberrations driving HNSCC. The integration of stem cell research with personalized medicine presents opportunities for tailored regenerative approaches. The synergy between personalized medicine and technological advancements is exemplified by artificial intelligence (AI) and machine learning (ML) applications. These tools empower clinicians to analyze vast datasets, predict patient responses, and optimize treatment strategies with unprecedented accuracy.

CONCLUSION

The developments and prospects of personalized medicine in HNSCC diagnosis and treatment offer a transformative approach to managing this complex malignancy. By harnessing genetic insights, biomarkers, immunotherapy, gene editing, stem cell therapies, and advanced technologies like AI and ML, personalized medicine holds the key to enhancing patient outcomes and ushering in a new era of precision oncology.

Predicting peritumoral edema development after gamma knife radiosurgery of meningiomas using machine learning methods: a multicenter study

OBJECTIVES

Edema is a complication of gamma knife radiosurgery (GKS) in meningioma patients that leads to a variety of consequences. The aim of this study is to construct radiomics-based machine learning models to predict post-GKS edema development.

METHODS

In total, 445 meningioma patients who underwent GKS in our institution were enrolled and partitioned into training and internal validation datasets (8:2). A total of 150 cases from multicenter data were included as the external validation dataset. In each case, 1132 radiomics features were extracted from each pre-treatment MRI sequence (contrast-enhanced T1WI, T2WI, and ADC maps). Nine clinical features and eight semantic features were also generated. Nineteen random survival forest (RSF) and nineteen neural network (DeepSurv) models with different combinations of radiomics, clinical, and semantic features were developed with the training dataset, and evaluated with internal and external validation. A nomogram was derived from the model achieving the highest C-index in external validation.

RESULTS

All the models were successfully validated on both validation datasets. The RSF model incorporating clinical, semantic, and ADC radiomics features achieved the best performance with a C-index of 0.861 (95% CI: 0.748-0.975) in internal validation, and 0.780 (95% CI: 0.673-0.887) in external validation. It stratifies high-risk and low-risk cases effectively. The nomogram based on the predicted risks provided personalized prediction with a C-index of 0.962 (95%CI: 0.951-0.973) and satisfactory calibration.

CONCLUSION

This RSF model with a nomogram could represent a non-invasive and cost-effective tool to predict post-GKS edema risk, thus facilitating personalized decision-making in meningioma treatment.

CLINICAL RELEVANCE STATEMENT

The RSF model with a nomogram built in this study represents a handy, non-invasive, and cost-effective tool for meningioma patients to assist in better counselling on the risks, appropriate individual treatment decisions, and customized follow-up plans.

KEY POINTS

• Machine learning models were built to predict post-GKS edema in meningioma. The random survival forest model with clinical, semantic, and ADC radiomics features achieved excellent performance. • The nomogram based on the predicted risks provides personalized prediction with a C-index of 0.962 (95%CI: 0.951-0.973) and satisfactory calibration and shows the potential to assist in better counselling, appropriate treatment decisions, and customized follow-up plans. • Given the excellent performance and convenient acquisition of the conventional sequence, we envision that this non-invasive and cost-effective tool will facilitate personalized medicine in meningioma treatment.

Enhancing head and neck tumor management with artificial intelligence: Integration and perspectives

Head and neck tumors (HNTs) constitute a multifaceted ensemble of pathologies that primarily involve regions such as the oral cavity, pharynx, and nasal cavity. The intricate anatomical structure of these regions poses considerable challenges to efficacious treatment strategies. Despite the availability of myriad treatment modalities, the overall therapeutic efficacy for HNTs continues to remain subdued. In recent years, the deployment of artificial intelligence (AI) in healthcare practices has garnered noteworthy attention. AI modalities, inclusive of machine learning (ML), neural networks (NNs), and deep learning (DL), when amalgamated into the holistic management of HNTs, promise to augment the precision, safety, and efficacy of treatment regimens. The integration of AI within HNT management is intricately intertwined with domains such as medical imaging, bioinformatics, and medical robotics. This article intends to scrutinize the cutting-edge advancements and prospective applications of AI in the realm of HNTs, elucidating AI's indispensable role in prevention, diagnosis, treatment, prognostication, research, and inter-sectoral integration. The overarching objective is to stimulate scholarly discourse and invigorate insights among medical practitioners and researchers to propel further exploration, thereby facilitating superior therapeutic alternatives for patients.

A robust radiomic-based machine learning approach to detect cardiac amyloidosis using cardiac computed tomography

Introduction

Cardiac amyloidosis (CA) shares similar clinical and imaging characteristics (e.g., hypertrophic phenotype) with aortic stenosis (AS), but its prognosis is generally worse than severe AS alone. Recent studies suggest that the presence of CA is frequent (1 out of 8 patients) in patients with severe AS. The coexistence of the two diseases complicates the prognosis and therapeutic management of both conditions. Thus, there is an urgent need to standardize and optimize the diagnostic process of CA and AS. The aim of this study is to develop a robust and reliable radiomics-based pipeline to differentiate the two pathologies.

Methods

Thirty patients were included in the study, equally divided between CA and AS. For each patient, a cardiac computed tomography (CCT) was analyzed by extracting 107 radiomics features from the LV wall. Feature robustness was evaluated by means of geometrical transformations to the ROIs and intra-class correlation coefficient (ICC) computation. Various correlation thresholds (0.80, 0.85, 0.90, 0.95, 1), feature selection methods [p-value, least absolute shrinkage and selection operator (LASSO), semi-supervised LASSO, principal component analysis (PCA), semi-supervised PCA, sequential forwards selection] and machine learning classifiers (k-nearest neighbors, support vector machine, decision tree, logistic regression and gradient boosting) were assessed using a leave-one-out cross-validation. Data augmentation was performed using the synthetic minority oversampling technique. Finally, explainability analysis was performed by using the SHapley Additive exPlanations (SHAP) method.

Results

Ninety-two radiomic features were selected as robust and used in the further steps. Best performances of classification were obtained using a correlation threshold of 0.95, PCA (keeping 95% of the variance, corresponding to 9 PCs) and support vector machine classifier reaching an accuracy, sensitivity and specificity of 0.93. Four PCs were found to be mainly dependent on textural features, two on first-order statistics and three on shape and size features.

Conclusion

These preliminary results show that radiomics might be used as non-invasive tool able to differentiate CA from AS using clinical routine available images.

A radiomics approach to the diagnosis of femoroacetabular impingement

Introduction

Femoroacetabular Impingement (FAI) is a hip pathology characterized by impingement of the femoral head-neck junction against the acetabular rim, due to abnormalities in bone morphology. FAI is normally diagnosed by manual evaluation of morphologic features on magnetic resonance imaging (MRI). In this study, we assess, for the first time, the feasibility of using radiomics to detect FAI by automatically extracting quantitative features from images.

Material and methods

17 patients diagnosed with monolateral FAI underwent pre-surgical MR imaging, including a 3D Dixon sequence of the pelvis. An expert radiologist drew regions of interest on the water-only Dixon images outlining femur and acetabulum in both impingement (IJ) and healthy joints (HJ). 182 radiomic features were extracted for each hip. The dataset numerosity was increased by 60 times with an ad-hoc data augmentation tool. Features were subdivided by type and region in 24 subsets. For each, a univariate ANOVA F-value analysis was applied to find the 5 features most correlated with IJ based on p-value, for a total of 48 subsets. For each subset, a K-nearest neighbor model was trained to differentiate between IJ and HJ using the values of the radiomic features in the subset as input. The training was repeated 100 times, randomly subdividing the data with 75%/25% training/testing.

Results

The texture-based gray level features yielded the highest prediction max accuracy (0.972) with the smallest subset of features. This suggests that the gray image values are more homogeneously distributed in the HJ in comparison to IJ, which could be due to stress-related inflammation resulting from impingement.

Conclusions

We showed that radiomics can automatically distinguish IJ from HJ using water-only Dixon MRI. To our knowledge, this is the first application of radiomics for FAI diagnosis. We reported an accuracy greater than 97%, which is higher than the 90% accuracy for detecting FAI reported for standard diagnostic tests (90%). Our proposed radiomic analysis could be combined with methods for automated joint segmentation to rapidly identify patients with FAI, avoiding time-consuming radiological measurements of bone morphology.

Advanced Techniques in Head and Neck Cancer Imaging: Guide to Precision Cancer Management

Precision treatment requires precision imaging. With the advent of various advanced techniques in head and neck cancer treatment, imaging has become an integral part of the multidisciplinary approach to head and neck cancer care from diagnosis to staging and also plays a vital role in response evaluation in various tumors. Conventional anatomic imaging (CT scan, MRI, ultrasound) remains basic and focuses on defining the anatomical extent of the disease and its spread. Accurate assessment of the biological behavior of tumors, including tumor cellularity, growth, and response evaluation, is evolving with recent advances in molecular, functional, and hybrid/multiplex imaging. Integration of these various advanced diagnostic imaging and nonimaging methods aids understanding of cancer pathophysiology and provides a more comprehensive evaluation in this era of precision treatment. Here we discuss the current status of various advanced imaging techniques and their applications in head and neck cancer imaging.

Refining Tumor Treatment in Sinonasal Cancer Using Delta Radiomics of Multi-Parametric MRI after the First Cycle of Induction Chemotherapy

Background: Response to induction chemotherapy (IC) has been predicted in patients with sinonasal cancer using early delta radiomics obtained from T1- and T2-weighted images and apparent diffusion coefficient (ADC) maps, comparing results with early radiological evaluation by RECIST. Methods: Fifty patients were included in the study. For each image (at baseline and after the first IC cycle), 536 radiomic features were extracted as follows: semi-supervised principal component analysis components, explaining 97% of the variance, were used together with a support vector machine (SVM) to develop a radiomic signature. One signature was developed for each sequence (T1-, T2-weighted and ADC). A multiagent decision-making algorithm was used to merge multiple signatures into one score. Results: The area under the curve (AUC) for mono-modality signatures was 0.79 (CI: 0.65–0.88), 0.76 (CI: 0.62–0.87) and 0.93 (CI: 0.75–1) using T1-, T2-weighted and ADC images, respectively. The fuse signature improved the AUC when an ADC-based signature was added. Radiological prediction using RECIST criteria reached an accuracy of 0.78. Conclusions: These results suggest the importance of early delta radiomics and of ADC maps to predict the response to IC in sinonasal cancers.

Texture analysis imaging "what a clinical radiologist needs to know"

Texture analysis has arisen as a tool to explore the amount of data contained in images that cannot be explored by humans visually. Radiomics is a method that extracts a large number of features from radiographic medical images using data-characterisation algorithms. These features, termed radiomic features, have the potential to uncover disease characteristics. The goal of both radiomics and texture analysis is to go beyond size or human-eye based semantic descriptors, to enable the non-invasive extraction of quantitative radiological data to correlate them with clinical outcomes or pathological characteristics. In the latest years there has been a flourishing sub-field of radiology where texture analysis and radiomics have been used in many settings. It is difficult for the clinical radiologist to cope with such amount of data in all the different radiological sub-fields and to identify the most significant papers. The aim of this review is to provide a tool to better understand the basic principles underlining texture analysis and radiological data mining and a summary of the most significant papers of the latest years.

Radiomics in Oncology: A 10-Year Bibliometric Analysis

Objectives

To date, radiomics has been applied in oncology for over a decade and has shown great progress. We used a bibliometric analysis to analyze the publications of radiomics in oncology to clearly illustrate the current situation and future trends and encourage more researchers to participate in radiomics research in oncology.

Methods

Publications for radiomics in oncology were downloaded from the Web of Science Core Collection (WoSCC). WoSCC data were collected, and CiteSpace was used for a bibliometric analysis of countries, institutions, journals, authors, keywords, and references pertaining to this field. The state of research and areas of focus were analyzed through burst detection.

Results

A total of 7,199 pieces of literature concerning radiomics in oncology were analyzed on CiteSpace. The number of publications has undergone rapid growth and continues to increase. The USA and Chinese Academy of Sciences are found to be the most prolific country and institution, respectively. In terms of journals and co-cited journals, Scientific Reports is ranked highest with respect to the number of publications, and Radiology is ranked highest among co-cited journals. Moreover, Jie Tian has published the most publications, and Phillipe Lambin is the most cited author. A paper published by Gillies et al. presents the highest citation counts. Artificial intelligence (AI), segmentation methods, and the use of radiomics for classification and diagnosis in oncology are major areas of focus in this field. Test-retest statistics, including reproducibility and statistical methods of radiomics research, the relation between genomics and radiomics, and applications of radiomics to sarcoma and intensity-modulated radiotherapy, are frontier areas of this field.

Conclusion

To our knowledge, this is the first study to provide an overview of the literature related to radiomics in oncology and may inspire researchers from multiple disciplines to engage in radiomics-related research.

Application of radiomics and machine learning in head and neck cancers

With the continuous development of medical image informatics technology, more and more high-throughput quantitative data could be extracted from digital medical images, which has resulted in a new kind of omics-Radiomics. In recent years, in addition to genomics, proteomics and metabolomics, radiomic has attracted the interest of more and more researchers. Compared to other omics, radiomics can be perfectly integrated with clinical data, even with the pathology and molecular biomarker, so that the study can be closer to the clinical reality and more revealing of the tumor development. Mass data will also be generated in this process. Machine learning, due to its own characteristics, has a unique advantage in processing massive radiomic data. By analyzing mass amounts of data with strong clinical relevance, people can construct models that more accurately reflect tumor development and progression, thereby providing the possibility of personalized and sequential treatment of patients. As one of the cancer types whose treatment and diagnosis rely on imaging examination, radiomics has a very broad application prospect in head and neck cancers (HNC). Until now, there have been some notable results in HNC. In this review, we will introduce the concepts and workflow of radiomics and machine learning and their current applications in head and neck cancers, as well as the directions and applications of artificial intelligence in the treatment and diagnosis of HNC.