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Abbaspour E, Karimzadhagh S, Monsef A, Joukar F, Mansour-Ghanaei F, Hassanipour S. Application of radiomics for preoperative prediction of lymph node metastasis in colorectal cancer: a systematic review and meta-analysis. Int J Surg 2024; 110:3795-3813. [PMID: 38935817 PMCID: PMC11175807 DOI: 10.1097/js9.0000000000001239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/19/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) stands as the third most prevalent cancer globally, projecting 3.2 million new cases and 1.6 million deaths by 2040. Accurate lymph node metastasis (LNM) detection is critical for determining optimal surgical approaches, including preoperative neoadjuvant chemoradiotherapy and surgery, which significantly influence CRC prognosis. However, conventional imaging lacks adequate precision, prompting exploration into radiomics, which addresses this shortfall by converting medical images into reproducible, quantitative data. METHODS Following PRISMA, Supplemental Digital Content 1 (http://links.lww.com/JS9/C77) and Supplemental Digital Content 2 (http://links.lww.com/JS9/C78), and AMSTAR-2 guidelines, Supplemental Digital Content 3 (http://links.lww.com/JS9/C79), we systematically searched PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar databases until 11 January 2024, to evaluate radiomics models' diagnostic precision in predicting preoperative LNM in CRC patients. The quality and bias risk of the included studies were assessed using the Radiomics Quality Score (RQS) and the modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Subsequently, statistical analyses were conducted. RESULTS Thirty-six studies encompassing 8039 patients were included, with a significant concentration in 2022-2023 (20/36). Radiomics models predicting LNM demonstrated a pooled area under the curve (AUC) of 0.814 (95% CI: 0.78-0.85), featuring sensitivity and specificity of 0.77 (95% CI: 0.69, 0.84) and 0.73 (95% CI: 0.67, 0.78), respectively. Subgroup analyses revealed similar AUCs for CT and MRI-based models, and rectal cancer models outperformed colon and colorectal cancers. Additionally, studies utilizing cross-validation, 2D segmentation, internal validation, manual segmentation, prospective design, and single-center populations tended to have higher AUCs. However, these differences were not statistically significant. Radiologists collectively achieved a pooled AUC of 0.659 (95% CI: 0.627, 0.691), significantly differing from the performance of radiomics models (P<0.001). CONCLUSION Artificial intelligence-based radiomics shows promise in preoperative lymph node staging for CRC, exhibiting significant predictive performance. These findings support the integration of radiomics into clinical practice to enhance preoperative strategies in CRC management.
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Affiliation(s)
- Elahe Abbaspour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sahand Karimzadhagh
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Monsef
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Li J, Zhu J, Zou Y, Zhang G, Zhu P, Wang N, Xie P. Diagnostic CT of colorectal cancer with artificial intelligence iterative reconstruction: A clinical evaluation. Eur J Radiol 2024; 171:111301. [PMID: 38237522 DOI: 10.1016/j.ejrad.2024.111301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/26/2023] [Accepted: 01/07/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES To investigate the clinical value of a novel deep-learning based CT reconstruction algorithm, artificial intelligence iterative reconstruction (AIIR), in diagnostic imaging of colorectal cancer (CRC). METHODS This study retrospectively enrolled 217 patients with pathologically confirmed CRC. CT images were reconstructed with the AIIR algorithm and compared with those originally obtained with hybrid iterative reconstruction (HIR). Objective image quality was evaluated in terms of the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality was graded on the conspicuity of tumor margin and enhancement pattern as well as the certainty in diagnosing organ invasion and regional lymphadenopathy. In patients with surgical pathology (n = 116), the performance of diagnosing visceral peritoneum invasion was characterized using receiver operating characteristic (ROC) analysis. Changes of diagnostic thinking in diagnosing hepatic metastases were assessed through lesion classification confidence. RESULTS The SNRs and CNRs on AIIR images were significantly higher than those on HIR images (all p < 0.001). The AIIR was scored higher for all subjective metrics (all p < 0.001) except for the certainty of diagnosing regional lymphadenopathy (p = 0.467). In diagnosing visceral peritoneum invasion, higher area under curve (AUC) of the ROC was found for AIIR than HIR (0.87 vs 0.77, p = 0.001). In assessing hepatic metastases, AIIR was found capable of correcting the misdiagnosis and improving the diagnostic confidence provided by HIR (p = 0.01). CONCLUSIONS Compared to HIR, AIIR offers better image quality, improves the diagnostic performance regarding CRC, and thus has the potential for application in routine abdominal CT.
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Affiliation(s)
- Jiao Li
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
| | - Junying Zhu
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
| | - Yixuan Zou
- United Imaging Healthcare, Shanghai 201800, China.
| | - Guozhi Zhang
- United Imaging Healthcare, Shanghai 201800, China.
| | - Pan Zhu
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
| | - Ning Wang
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
| | - Peiyi Xie
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
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Zhao W, Xu H, Zhao R, Zhou S, Mei S, Wang Z, Zhao F, Xiao T, Huang F, Qiu W, Tang J, Liu Q. MRI-based Radiomics Model for Preoperative Prediction of Lateral Pelvic Lymph Node Metastasis in Locally Advanced Rectal Cancer. Acad Radiol 2023:S1076-6332(23)00385-9. [PMID: 37643928 DOI: 10.1016/j.acra.2023.07.016] [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: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/31/2023]
Abstract
RATIONALE AND OBJECTIVES To develop a magnetic resonance imaging (MRI)-based radiomics model for preoperative prediction of lateral pelvic lymph node (LPLN) metastasis (LPLNM) in patients with locally advanced rectal cancer MATERIALS AND METHODS: We retrospectively enrolled 263 patients with rectal cancer who underwent total mesorectal excision and LPLN dissection. Radiomics features from the primary lesion and LPLNs on baseline MRI images were utilized to construct a radiomics model, and their radiomics scores were combined to develop a radiomics scoring system. A clinical prediction model was developed using logistic regression. A hybrid predicting model was created through multivariable logistic regression analysis, integrating the radiomics score with significant clinical risk factors (baseline Carcinoembryonic Antigen (CEA), clinical circumferential resection margin status, and the short axis diameter of LPLN). This hybrid model was presented with a hybrid clinical-radiomics nomogram, and its calibration, discrimination, and clinical usefulness were assessed. RESULTS A total of 148 patients were included in the analysis and randomly divided into a training cohort (n = 104) and an independent internal testing cohort (n = 44). The hybrid clinical-radiomics model exhibited the highest discrimination, with an area under the receiver operating characteristic (AUC) of 0.843 [95% confidence interval (CI), 0.706-0.968] in the testing cohort compared to the clinical model [AUC (95% CI) = 0.772 (0.589-0.856)] and radiomics model [AUC (95% CI) = 0.731 (0.613-0.849)]. The hybrid prediction model also demonstrated good calibration, and decision curve analysis confirmed its clinical usefulness. CONCLUSION This study developed a hybrid MRI-based radiomics model that incorporates a combination of radiomics score and significant clinical risk factors. The proposed model holds promise for individualized preoperative prediction of LPLNM in patients with locally advanced rectal cancer. DATA AVAILABILITY STATEMENT The data presented in this study are available on request from the corresponding author.
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Affiliation(s)
- Wei Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China (W.Z., S.Z., S.M., Z.W., F.Z., T.X., F.H., W.Q., J.T., Q.L.)
| | - Hui Xu
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong, China (H.X.)
| | - Rui Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (R.Z.)
| | - Sicheng Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China (W.Z., S.Z., S.M., Z.W., F.Z., T.X., F.H., W.Q., J.T., Q.L.)
| | - Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China (W.Z., S.Z., S.M., Z.W., F.Z., T.X., F.H., W.Q., J.T., Q.L.)
| | - Zhijie Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China (W.Z., S.Z., S.M., Z.W., F.Z., T.X., F.H., W.Q., J.T., Q.L.)
| | - Fuqiang Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China (W.Z., S.Z., S.M., Z.W., F.Z., T.X., F.H., W.Q., J.T., Q.L.)
| | - Tixian Xiao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China (W.Z., S.Z., S.M., Z.W., F.Z., T.X., F.H., W.Q., J.T., Q.L.)
| | - Fei Huang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China (W.Z., S.Z., S.M., Z.W., F.Z., T.X., F.H., W.Q., J.T., Q.L.)
| | - Wenlong Qiu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China (W.Z., S.Z., S.M., Z.W., F.Z., T.X., F.H., W.Q., J.T., Q.L.)
| | - Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China (W.Z., S.Z., S.M., Z.W., F.Z., T.X., F.H., W.Q., J.T., Q.L.)
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China (W.Z., S.Z., S.M., Z.W., F.Z., T.X., F.H., W.Q., J.T., Q.L.).
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Peng W, Qiao H, Mo L, Guo Y. Progress in the diagnosis of lymph node metastasis in rectal cancer: a review. Front Oncol 2023; 13:1167289. [PMID: 37519802 PMCID: PMC10374255 DOI: 10.3389/fonc.2023.1167289] [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: 03/15/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Historically, the chief focus of lymph node metastasis research has been molecular and clinical studies of a few essential pathways and genes. Recent years have seen a rapid accumulation of massive omics and imaging data catalyzed by the rapid development of advanced technologies. This rapid increase in data has driven improvements in the accuracy of diagnosis of lymph node metastasis, and its analysis further demands new methods and the opportunity to provide novel insights for basic research. In fact, the combination of omics data, imaging data, clinical medicine, and diagnostic methods has led to notable advances in our basic understanding and transformation of lymph node metastases in rectal cancer. Higher levels of integration will require a concerted effort among data scientists and clinicians. Herein, we review the current state and future challenges to advance the diagnosis of lymph node metastases in rectal cancer.
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Affiliation(s)
- Wei Peng
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huimin Qiao
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Linfeng Mo
- School of Health and Medicine, Guangzhou Huashang Vocational College, Guangzhou, Guangdong, China
| | - You Guo
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
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Wang D, Zhuang Z, Wu S, Chen J, Fan X, Liu M, Zhu H, Wang M, Zou J, Zhou Q, Zhou P, Xue J, Meng X, Ju S, Zhang L. A Dual-Energy CT Radiomics of the Regional Largest Short-Axis Lymph Node Can Improve the Prediction of Lymph Node Metastasis in Patients With Rectal Cancer. Front Oncol 2022; 12:846840. [PMID: 35747803 PMCID: PMC9209707 DOI: 10.3389/fonc.2022.846840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/19/2022] [Indexed: 12/24/2022] Open
Abstract
ObjectiveTo explore the value of dual-energy computed tomography (DECT) radiomics of the regional largest short-axis lymph nodes for evaluating lymph node metastasis in patients with rectal cancer.Materials and MethodsOne hundred forty-one patients with rectal cancer (58 in LNM+ group, 83 in LNM- group) who underwent preoperative total abdominal DECT were divided into a training group and testing group (7:3 ratio). After post-processing DECT venous phase images, 120kVp-like images and iodine (water) images were obtained. The highest-risk lymph nodes were identified, and their long-axis and short-axis diameter and DECT quantitative parameters were measured manually by two experienced radiologists who were blind to the postoperative pathological results. Four DECT parameters were analyzed: arterial phase (AP) normalized iodine concentration, AP normalized effective atomic number, the venous phase (VP) normalized iodine concentration, and the venous phase normalized effective atomic number. The carcinoembryonic antigen (CEA) levels were recorded one week before surgery. Radiomics features of the largest lymph nodes were extracted, standardized, and reduced before modeling. Radomics signatures of 120kVp-like images (Rad-signature120kVp) and iodine map (Rad-signatureImap) were built based on Logistic Regression via Least Absolute Shrinkage and Selection Operator (LASSO).ResultsEight hundred thirty-three features were extracted from 120kVp-like and iodine images, respectively. In testing group, the radiomics features based on 120kVp-like images showed the best diagnostic performance (AUC=0.922) compared to other predictors [CT morphological indicators (short-axis diameter (AUC=0.779, IDI=0.262) and long-axis diameter alone (AUC=0.714, IDI=0.329)), CEA alone (AUC=0.540, IDI=0.414), and normalized DECT parameters alone (AUC=0.504-0.718, IDI=0.290-0.476)](P<0.05 in Delong test). Contrary, DECT iodine map-based radiomic signatures showed similar performance in predicting lymph node metastasis (AUC=0.866). The decision curve showed that the 120kVp-like-based radiomics signature has the highest net income.ConclusionPredictive model based on DECT and the largest short-axis diameter lymph nodes has the highest diagnostic value in predicting lymph node metastasis in patients with rectal cancer.
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Affiliation(s)
- Dongqing Wang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Zijian Zhuang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Shuting Wu
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jixiang Chen
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Xin Fan
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Mengsi Liu
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Haitao Zhu
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Ming Wang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jinmei Zou
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Qun Zhou
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Peng Zhou
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jing Xue
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Xiangpan Meng
- School of Medicine, Southeast University, Nanjing, China
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Shenghong Ju
- School of Medicine, Southeast University, Nanjing, China
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Lirong Zhang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
- School of Medicine, Southeast University, Nanjing, China
- *Correspondence: Lirong Zhang,
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Post mortem computed tomography meets radiomics: a case series on fractal analysis of post mortem changes in the brain. Int J Legal Med 2022; 136:719-727. [PMID: 35239030 PMCID: PMC9005394 DOI: 10.1007/s00414-022-02801-5] [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] [Received: 09/01/2021] [Accepted: 02/14/2022] [Indexed: 10/26/2022]
Abstract
Estimating the post-mortem interval is a fundamental, albeit challenging task in forensic sciences. To this aim, forensic practitioners need to assess post-mortem changes through a plethora of different methods, most of which are inherently qualitative, thus providing broad time intervals rather than precise determinations. This challenging problem is further complicated by the influence of environmental factors, which modify the temporal dynamics of post-mortem changes, sometimes in a rather unpredictable fashion. In this context, the search for quantitative and objective descriptors of post-mortem changes is highly demanded. In this study, we used computed tomography (CT) to assess the post-mortem anatomical modifications occurring in the time interval 0-4 days after death in the brain of four corpses. Our results show that fractal analysis of CT brain slices provides a set of quantitative descriptors able to map post-mortem changes over time throughout the whole brain. Although incapable of producing a direct estimation of the PMI, these descriptors could be used in combination with other more established methods to improve the accuracy and reliability of PMI determination.
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Onuma Y, Tsuruta C, Okita K, Hamabe A, Ogura K, Takemasa I, Hatakenaka M. CT reconstruction with thick slices not only underestimates lymph node size but also reduces data reproducibility in colorectal cancer. Acta Radiol 2021; 62:1275-1282. [PMID: 33121263 DOI: 10.1177/0284185120968569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reliable size measurement of lymph node (LN) metastases is important for the evaluation of cancer treatment. However, image analyses without proper settings may result in inappropriate diagnoses and staging. PURPOSE To investigate whether reconstruction slice thickness in computed tomography (CT) affects measurements of LN size and reproducibility. MATERIAL AND METHODS We analyzed 48 patients with histological diagnoses of sigmoid colon and rectal cancer who underwent contrast-enhanced CT colonography as part of a surgical treatment preparation. A board-certified radiologist selected 106 LNs whose short-axis diameter was ≥5 mm on 1-mm-thick images; the short-axis diameters were measured on 1- and 5-mm-thick images by the radiologist and residents and compared using Wilcoxon matched-pairs signed rank test. Data variation and reproducibility were evaluated using the F test and Bland-Altman analysis. P<0.05 was considered significant. RESULTS Short-axis diameters measured on 5-mm-thick images were significantly lower than those measured on 1-mm-thick images (P<0.01), even in the LNs whose short-axis diameters were over twice the slice thickness (P<0.05). Of the 106 LNs, 57 showed short-axis diameter <5 mm on 5-mm-thick images; the maximum short-axis diameter was 6.7 mm on a 1-mm thick image. Data variation was significantly larger on 5-mm thick images than 1-mm-thick images in small LNs (P<0.05) and reproducibility on 5-mm-thick images was inferior to that on 1-mm-thick images. CONCLUSION Thick reconstruction slices in CT can result in an underestimation of LN size and reduce data reproducibility. When measuring LN size, a thin reconstruction slice would be recommended based on targeted LN size.
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Affiliation(s)
- Yurina Onuma
- Department of Diagnostic Radiology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Chie Tsuruta
- Department of Diagnostic Radiology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kenji Okita
- Department of Surgery, Surgical Oncology and Science, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Atsushi Hamabe
- Department of Surgery, Surgical Oncology and Science, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Keishi Ogura
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Masamitsu Hatakenaka
- Department of Diagnostic Radiology, School of Medicine, Sapporo Medical University, Sapporo, Japan
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Bedrikovetski S, Dudi-Venkata NN, Kroon HM, Seow W, Vather R, Carneiro G, Moore JW, Sammour T. Artificial intelligence for pre-operative lymph node staging in colorectal cancer: a systematic review and meta-analysis. BMC Cancer 2021; 21:1058. [PMID: 34565338 PMCID: PMC8474828 DOI: 10.1186/s12885-021-08773-w] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/08/2021] [Indexed: 12/28/2022] Open
Abstract
Background Artificial intelligence (AI) is increasingly being used in medical imaging analysis. We aimed to evaluate the diagnostic accuracy of AI models used for detection of lymph node metastasis on pre-operative staging imaging for colorectal cancer. Methods A systematic review was conducted according to PRISMA guidelines using a literature search of PubMed (MEDLINE), EMBASE, IEEE Xplore and the Cochrane Library for studies published from January 2010 to October 2020. Studies reporting on the accuracy of radiomics models and/or deep learning for the detection of lymph node metastasis in colorectal cancer by CT/MRI were included. Conference abstracts and studies reporting accuracy of image segmentation rather than nodal classification were excluded. The quality of the studies was assessed using a modified questionnaire of the QUADAS-2 criteria. Characteristics and diagnostic measures from each study were extracted. Pooling of area under the receiver operating characteristic curve (AUROC) was calculated in a meta-analysis. Results Seventeen eligible studies were identified for inclusion in the systematic review, of which 12 used radiomics models and five used deep learning models. High risk of bias was found in two studies and there was significant heterogeneity among radiomics papers (73.0%). In rectal cancer, there was a per-patient AUROC of 0.808 (0.739–0.876) and 0.917 (0.882–0.952) for radiomics and deep learning models, respectively. Both models performed better than the radiologists who had an AUROC of 0.688 (0.603 to 0.772). Similarly in colorectal cancer, radiomics models with a per-patient AUROC of 0.727 (0.633–0.821) outperformed the radiologist who had an AUROC of 0.676 (0.627–0.725). Conclusion AI models have the potential to predict lymph node metastasis more accurately in rectal and colorectal cancer, however, radiomics studies are heterogeneous and deep learning studies are scarce. Trial registration PROSPERO CRD42020218004. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08773-w.
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Affiliation(s)
- Sergei Bedrikovetski
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia. .,Department of Surgery, Colorectal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Nagendra N Dudi-Venkata
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Department of Surgery, Colorectal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hidde M Kroon
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Department of Surgery, Colorectal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Warren Seow
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Ryash Vather
- Department of Surgery, Colorectal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Gustavo Carneiro
- Australian Institute for Machine Learning, School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - James W Moore
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Department of Surgery, Colorectal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tarik Sammour
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Department of Surgery, Colorectal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Watanabe H, Hayano K, Ohira G, Imanishi S, Hanaoka T, Hirata A, Kano M, Matsubara H. Quantification of Structural Heterogeneity Using Fractal Analysis of Contrast-Enhanced CT Image to Predict Survival in Gastric Cancer Patients. Dig Dis Sci 2021; 66:2069-2074. [PMID: 32691383 DOI: 10.1007/s10620-020-06479-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 07/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Malignant tumor essentially implies structural heterogeneity. Fractal analysis of medical imaging has a potential to quantify this structural heterogeneity in the tumor AIMS: The purpose of this study is to quantify this structural abnormality in the tumor applying fractal analysis to contrast-enhanced computed tomography (CE-CT) image and to evaluate its biomarker value for predicting survival of surgically treated gastric cancer patients. METHODS A total of 108 gastric cancer patients (77 men and 31 women; mean age: 69.1 years), who received curative surgery without any neoadjuvant therapy, were retrospectively investigated. Portal-phase CE-CT images were analyzed with use of a plug-in tool for ImageJ (NIH, Bethesda, USA), and the fractal dimension (FD) in the tumor was calculated using a differential box-counting method to quantify structural heterogeneity in the tumor. Tumor FD was compared with clinicopathologic features and disease-specific survival (DSS). RESULTS High FD value of the tumor significantly associated with high T stage and high pathological stage (P = 0.009, 0.007, respectively). In Kaplan-Meier analysis, patients with higher FD tumors (FD > 0.9746) showed a significantly worse DSS (P = 0.009, log rank). Multivariate analysis demonstrated that tumor FD, T stage, and N stage were independent prognostic factors for DSS. In subset analysis of lymph-node positive gastric cancers, only tumor FD was an independent prognostic factor for DSS. CONCLUSION CT fractal analysis can be a useful biomarker for gastric cancer patients, reflecting survival and clinicopathologic features.
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Affiliation(s)
- Hiroki Watanabe
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Gaku Ohira
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Shunsuke Imanishi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Toshiharu Hanaoka
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Atsushi Hirata
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Masayuki Kano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
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10
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Bedrikovetski S, Dudi-Venkata NN, Maicas G, Kroon HM, Seow W, Carneiro G, Moore JW, Sammour T. Artificial intelligence for the diagnosis of lymph node metastases in patients with abdominopelvic malignancy: A systematic review and meta-analysis. Artif Intell Med 2021; 113:102022. [PMID: 33685585 DOI: 10.1016/j.artmed.2021.102022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 12/28/2020] [Accepted: 01/10/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Accurate clinical diagnosis of lymph node metastases is of paramount importance in the treatment of patients with abdominopelvic malignancy. This review assesses the diagnostic performance of deep learning algorithms and radiomics models for lymph node metastases in abdominopelvic malignancies. METHODOLOGY Embase (PubMed, MEDLINE), Science Direct and IEEE Xplore databases were searched to identify eligible studies published between January 2009 and March 2019. Studies that reported on the accuracy of deep learning algorithms or radiomics models for abdominopelvic malignancy by CT or MRI were selected. Study characteristics and diagnostic measures were extracted. Estimates were pooled using random-effects meta-analysis. Evaluation of risk of bias was performed using the QUADAS-2 tool. RESULTS In total, 498 potentially eligible studies were identified, of which 21 were included and 17 offered enough information for a quantitative analysis. Studies were heterogeneous and substantial risk of bias was found in 18 studies. Almost all studies employed radiomics models (n = 20). The single published deep-learning model out-performed radiomics models with a higher AUROC (0.912 vs 0.895), but both radiomics and deep-learning models outperformed the radiologist's interpretation in isolation (0.774). Pooled results for radiomics nomograms amongst tumour subtypes demonstrated the highest AUC 0.895 (95 %CI, 0.810-0.980) for urological malignancy, and the lowest AUC 0.798 (95 %CI, 0.744-0.852) for colorectal malignancy. CONCLUSION Radiomics models improve the diagnostic accuracy of lymph node staging for abdominopelvic malignancies in comparison with radiologist's assessment. Deep learning models may further improve on this, but data remain limited.
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Affiliation(s)
- Sergei Bedrikovetski
- Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Nagendra N Dudi-Venkata
- Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Gabriel Maicas
- Australian Institute for Machine Learning, School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Hidde M Kroon
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Warren Seow
- Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Gustavo Carneiro
- Australian Institute for Machine Learning, School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - James W Moore
- Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tarik Sammour
- Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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11
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Zhang Y, Li X, Lv Y, Gu X. Review of Value of CT Texture Analysis and Machine Learning in Differentiating Fat-Poor Renal Angiomyolipoma from Renal Cell Carcinoma. Tomography 2020; 6:325-332. [PMID: 33364422 PMCID: PMC7744193 DOI: 10.18383/j.tom.2020.00039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The diagnosis of patients with suspected angiomyolipoma relies on the detection of abundant macroscopic intralesional fat, which is always of no use to differentiate fat-poor angiomyolipoma (fp-AML) from renal cell carcinoma and diagnosis of fp-AML excessively depends on individual experience. Texture analysis was proven to be a potentially useful biomarker for distinguishing between benign and malignant tumors because of its capability of providing objective and quantitative assessment of lesions by analyzing features that are not visible to the human eye. This review aimed to summarize the literature on the use of texture analysis to diagnose patients with fat-poor angiomyolipoma vs those with renal cell carcinoma and to evaluate its current application, limitations, and future challenges in order to avoid unnecessary surgical resection.
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Affiliation(s)
- Yuhan Zhang
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, China; and
| | - Xu Li
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, China; and
| | - Yang Lv
- Department of Anesthesia, The Second Hospital of Jilin University, Changchun, China
| | - Xinquan Gu
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, China; and
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12
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Kim SH, Cho SH. Assessment of pelvic lymph node metastasis in FIGO IB and IIA cervical cancer using quantitative dynamic contrast-enhanced MRI parameters. Diagn Interv Radiol 2020; 26:382-389. [PMID: 32673204 DOI: 10.5152/dir.2020.19365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We prospectively determined whether the quantitative parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) are useful for predicting pelvic lymph node (LN) status in cervical cancer through node-by-node pathologic validation of images. METHODS Overall, 182 LNs harvested from 200 consecutive patients with 2018 FIGO stage IB-IIA cervical cancer (82 metastatic and 100 nonmetastatic) were used for node-by-node assessment. Each LN was quantitatively assessed using Ktrans, Ve, and Kep values. The short-axis diameter, ratio of the long-axis to short-axis diameter, and long-axis diameter were also assessed. Data on metastatic LNs were divided into four groups according to the FIGO staging system. Receiver operating characteristic (ROC) curve analysis was performed to evaluate statistically significant parameters derived from DCE-MRI for the differentiation of metastatic LNs from nonmetastatic LNs. RESULTS The mean short-axis diameter of metastatic LNs was significantly larger than that of nonmetastatic LNs (all P < 0.05) despite several overlaps. In comparison with nonmetastatic LNs, metastatic LNs showed a significantly lower Ktrans (all P < 0.05); however, Kep and Ve were not significantly different (all P > 0.05). For IB3 and IIA2 cervical cancer, Ktrans had moderate diagnostic ability for differentiating metastatic LNs from nonmetastatic LNs (for IB3: area under the curve [AUC] 0.740, 95% CI 0.657-0.838, 61.7% sensitivity, 80.2% specificity, P = 0.007; for IIA2: AUC 0.786, 95% CI 0.650-0.846, 60.2% sensitivity, 81.8% specificity, P = 0.008). CONCLUSION Ktrans appears to be a useful parameter for detecting metastatic LNs, especially for IB3 and IIA2 cervical cancer.
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Affiliation(s)
- See Hyung Kim
- Departmet of Radiology, Kyungpook National University School of Medicine,, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Seung Hyun Cho
- Departmet of Radiology, Kyungpook National University School of Medicine,, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Liu Y, Dou Y, Lu F, Liu L. A study of radiomics parameters from dual-energy computed tomography images for lymph node metastasis evaluation in colorectal mucinous adenocarcinoma. Medicine (Baltimore) 2020; 99:e19251. [PMID: 32176049 PMCID: PMC7220403 DOI: 10.1097/md.0000000000019251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Lymph nodes (LN) metastasis differentiation from computed tomography (CT) images is a challenging problem. This study aims to investigate the association between radiomics image parameters and LN metastasis in colorectal mucinous adenocarcinoma (MAC).Clinical records and CT images of 15 patients were included in this study. Among them, 1 patient was confirmed with all metastatic LNs, the other 14 were confirmed with all non-metastatic LNs. The regions of the LNs were manually labeled on each slice by experienced radiologists. A total of 1054 LN regions were obtained. Among them, 164 were from metastatic LNs. One hundred nine image parameters were computed and analyzed using 2-sample t test method and logistic regression classifier.Based on 2 sample t test, image parameters between the metastatic group and the non-metastatic group were compared. A total of 73 parameters were found to be significant (P < .01). The selected shape parameters demonstrate that non-metastatic LNs tend to have smaller sizes and more circle-like shapes than metastatic LNs, which validates the common agreement of LN diagnosis using computational method. Besides, several high order parameters were selected as well, which indicates that the textures vary between non-metastatic LNs and metastatic LNs. The selected parameters of significance were further used to train logistic regression classifier with L1 penalty. Based on receiver operating characteristic (ROC) analysis, large area under curve (AUC) values were achieved over 5-fold cross validation (0.88 ± 0.06). Moreover, high accuracy, specificity, and sensitivity values were observed as well.The results of the study demonstrate that some quantitative image parameters are of significance in differentiating LN metastasis. Logistic regression classifiers showed that the parameters are with predictive values in LN metastasis, which may be used to assist preoperative diagnosis.
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Affiliation(s)
- Yingying Liu
- Institutes of Biomedical Sciences, Fudan University School of Basic Medical Sciences
| | - Yafang Dou
- Department of Radiology, Shanghai Shuguang Hospital Affiliated to TCM University, Shanghai, China
| | - Fang Lu
- Department of Radiology, Shanghai Shuguang Hospital Affiliated to TCM University, Shanghai, China
| | - Lei Liu
- Institutes of Biomedical Sciences, Fudan University School of Basic Medical Sciences
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Yue Y, Hu F, Hu T, Sun Y, Tong T, Gu Y. Three-Dimensional CT Texture Analysis to Differentiate Colorectal Signet-Ring Cell Carcinoma and Adenocarcinoma. Cancer Manag Res 2019; 11:10445-10453. [PMID: 31997883 PMCID: PMC6918095 DOI: 10.2147/cmar.s233595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/19/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose The objective of this research was to validate the diagnostic value of three-dimensional texture parameters and clinical characteristics in the differentiation of colorectal signet-ring cell carcinoma (SRCC) and adenocarcinoma (AC). Methods We retrospectively analyzed data from 102 patients with SRCC or AC confirmed by pathology, including 51 SRCC (from January 2015 to July 2019) and 51 AC patients (from January 2019 to July 2019). CT findings and clinical data, including age, gender, clinical symptoms, serological biomarkers, tumor size, and tumor location, were compared between SRCC and AC. CT texture features were quantified on portal phase images using three-dimensional analysis. A list of texture parameters was generated with MaZda software for the classification of tumors. The texture features, clinical data and CT findings were statistically analyzed for the discrimination ability of SRCC and AC, and the potential predictive parameters that may be used to differentiate the two groups were subsequently tested using the least absolute shrinkage and selection operator (LASSO) and logistic regression analyses. The receiver operating characteristic curve (ROC) provided a range of values for establishing the cutoff value, as well as the sensitivity and specificity of prediction for each significant variable. Results SRCC occurred more often in men than AC did (80.39% vs 49.02%, P < 0.01). The patients were younger in the SRCC group than in the AC group, without a statistically significant difference (55.84 vs 59.20 years, P = 0.216). There were no significant differences in the clinical symptoms, tumor size, or tumor location between the two groups (P=0.505, P=0.19, P=0.843, respectively). The elevation of serological biomarker CA724 was more common in SRCC than in AC (P< 0.001). Perc.01%3D, Perc.10%3D and s(1,0,0) SumAverg were lower in the SRCC group than in the AC group during the portal phase, with the areas under curve (AUCs) of 0.892–0.929, sensitivity of 76.5–84.3% and specificity of 88.2–96.1%. In the differentiation between SRCC and AC, the 1-NN minimal classification error (MCR) was 29.41%. Conclusion Three-dimensional texture parameters, including Perc.01%3D, Perc.10%3D and s(1,0,0) SumAverg, exhibited a favorable discriminatory ability to distinguish SRCC from AC.
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Affiliation(s)
- Yali Yue
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
| | - Feixiang Hu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
| | - Tingdan Hu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
| | - Yiqun Sun
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
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15
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Challenges and Promises of Radiomics for Rectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2019. [DOI: 10.1007/s11888-019-00446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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16
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Yang X, Chen Y, Wen Z, Liu Y, Xiao X, Liang W, Yu S. Non-invasive MR assessment of the microstructure and microcirculation in regional lymph nodes for rectal cancer: a study of intravoxel incoherent motion imaging. Cancer Imaging 2019; 19:70. [PMID: 31685035 PMCID: PMC6829929 DOI: 10.1186/s40644-019-0255-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/20/2019] [Indexed: 01/02/2023] Open
Abstract
Background The aim of this study is to evaluate the microstructure and microcirculation of regional lymph nodes (LNs) in rectal cancer by using non-invasive intravoxel incoherent motion MRI (IVIM-MRI), and to distinguish metastatic from non-metastatic LNs by quantitative parameters. Methods All recruited patients underwent IVIM-MRI (b = 0, 5, 10, 20, 30, 40, 60, 80, 100, 150, 200, 400, 600, 1000, 1500 and 2000 s/mm2) on a 3.0 T MRI system. One hundred sixty-eight regional LNs with a short-axis diameter equal to or greater than 5 mm from 116 patients were evaluated by two radiologists independently, including 78 malignant LNs and 90 benign LNs. The following parameters were assessed: the short-axis diameter (S), long-axis diameter (L), short- to long-axis diameter ratio (S/L), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion factor (f). Intraclass correlation coefficients (ICCs) were calculated to assess the interobserver agreement between two readers. Receiver operating characteristic curves were applied for analyzing statistically significant parameters. Results Interobserver agreement of IVIM-MRI parameters between two readers was excellent (ICCs> 0.75). The metastatic group exhibited higher S, L and D (P < 0.001), but lower f (P < 0.001) than the non-metastatic group. The area under the curve (95% CI, sensitivity, specificity) of the multi-parameter combined equation for D, f and S was 0.811 (0.744~0.868, 62.82%, 87.78%). The diagnostic performance of the multi-parameter model was better than that of an individual parameter (P < 0.05). Conclusion IVIM-MRI parameters provided information about the microstructure and microcirculation of regional LNs in rectal cancer, also improved diagnostic performance in identifying metastatic LNs.
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Affiliation(s)
- Xinyue Yang
- Department of Radiology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China, 510280
| | - Yan Chen
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China, 510080
| | - Ziqiang Wen
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China, 510080
| | - Yiyan Liu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China, 510080
| | - Xiaojuan Xiao
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China, 518033
| | - Wen Liang
- Department of Radiology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China, 510280.
| | - Shenping Yu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China, 510080.
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Mainenti PP, Stanzione A, Guarino S, Romeo V, Ugga L, Romano F, Storto G, Maurea S, Brunetti A. Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging. World J Gastroenterol 2019; 25:5233-5256. [PMID: 31558870 PMCID: PMC6761241 DOI: 10.3748/wjg.v25.i35.5233] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the leading causes of tumor-related deaths worldwide. Among the various tools at physicians’ disposal for the diagnostic management of the disease, tomographic imaging (e.g., CT, MRI, and hybrid PET imaging) is considered essential. The qualitative and subjective evaluation of tomographic images is the main approach used to obtain valuable clinical information, although this strategy suffers from both intrinsic and operator-dependent limitations. More recently, advanced imaging techniques have been developed with the aim of overcoming these issues. Such techniques, such as diffusion-weighted MRI and perfusion imaging, were designed for the “in vivo” evaluation of specific biological tissue features in order to describe them in terms of quantitative parameters, which could answer questions difficult to address with conventional imaging alone (e.g., questions related to tissue characterization and prognosis). Furthermore, it has been observed that a large amount of numerical and statistical information is buried inside tomographic images, resulting in their invisibility during conventional assessment. This information can be extracted and represented in terms of quantitative parameters through different processes (e.g., texture analysis). Numerous researchers have focused their work on the significance of these quantitative imaging parameters for the management of CRC patients. In this review, we aimed to focus on evidence reported in the academic literature regarding the application of parametric imaging to the diagnosis, staging and prognosis of CRC while discussing future perspectives and present limitations. While the transition from purely anatomical to quantitative tomographic imaging appears achievable for CRC diagnostics, some essential milestones, such as scanning and analysis standardization and the definition of robust cut-off values, must be achieved before quantitative tomographic imaging can be incorporated into daily clinical practice.
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Affiliation(s)
- Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples 80145, Italy
| | - Arnaldo Stanzione
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Salvatore Guarino
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Valeria Romeo
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Lorenzo Ugga
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Federica Romano
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Giovanni Storto
- IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture 85028, Italy
| | - Simone Maurea
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Arturo Brunetti
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
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Valentini V, Marijnen C, Beets G, Bujko K, De Bari B, Cervantes A, Chiloiro G, Coco C, Gambacorta MA, Glynne-Jones R, Haustermans K, Meldolesi E, Peters F, Rödel C, Rutten H, van de Velde C, Aristei C. The 2017 Assisi Think Tank Meeting on rectal cancer: A positioning paper. Radiother Oncol 2019; 142:6-16. [PMID: 31431374 DOI: 10.1016/j.radonc.2019.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/06/2019] [Accepted: 07/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSES To describe current practice in the management of rectal cancer, to identify uncertainties that usually arise in the multidisciplinary team (MDT)'s discussions ('grey zones') and propose next generation studies which may provide answers to them. MATERIALS AND METHODS A questionnaire on the areas of controversy in managing T2, T3 and T4 rectal cancer was drawn up and distributed to the Rectal-Assisi Think Tank Meeting (ATTM) Expert European Board. Less than 70% agreement on a treatment option was indicated as uncertainty and selected as a 'grey zone'. Topics with large disagreement were selected by the task force group for discussion at the Rectal-ATTM. RESULTS The controversial clinical issues that had been identified within cT2-cT3-cT4 needed further investigation. The discussions focused on the role of (1) neoadjuvant therapy and organ preservation on cT2-3a low-middle rectal cancer; (2) neoadjuvant therapy in cT3 low rectal cancer without high risk features; (3) total neoadjuvant therapy, radiotherapy boost and the best chemo-radiotherapy schedule in T4 tumors. A description of each area of investigation and trial proposals are reported. CONCLUSION The meeting successfully identified 'grey zones' and, in the light of new evidence, proposed clinical trials for treatment of early, intermediate and advanced stage rectal cancer.
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Affiliation(s)
- Vincenzo Valentini
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Corrie Marijnen
- Department of Radiotherapy, Leiden University Medical Centre, the Netherlands
| | - Geerard Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School of Oncology and Developmental Biology, University of Maastricht, the Netherlands
| | - Krzysztof Bujko
- Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Berardino De Bari
- Service de Radio-oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Andres Cervantes
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | - Giuditta Chiloiro
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Coco
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Italy
| | | | | | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals, Leuven, Belgium
| | - Elisa Meldolesi
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Femke Peters
- Department of Radiotherapy, Leiden University Medical Centre, the Netherlands
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Germany
| | - Harm Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; GROW School of Oncology and Developmental Biology, University of Maastricht, the Netherlands
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Italy
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Badic B, Desseroit MC, Hatt M, Visvikis D. Potential Complementary Value of Noncontrast and Contrast Enhanced CT Radiomics in Colorectal Cancers. Acad Radiol 2019; 26:469-479. [PMID: 30072293 DOI: 10.1016/j.acra.2018.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 01/08/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of our study was to assess the relationships between textural features extracted from contrast enhanced (CE) and noncontrast enhanced (NCE) computed tomography (CT) images of primary colorectal cancer, in order to identify radiomics features more likely to provide potential complementary information regarding outcome. MATERIALS AND METHODS Sixty-one patients with primary colorectal cancer underwent both CE-CT and NCE-CT scans within the same acquisition. First-order and textural features (with three different methods for grey-level discretization) were extracted from the tumor volume in both modalities and their correlation was assessed with Spearman's rank correlation (rs). Significance was assessed at p < 0.05 with correction for multiple comparisons. Kaplan-Meier estimation and log-rank tests were used to identify features associated with long term patient survival. RESULTS Moderate positive correlations were observed between CE-CT and NCE-CT histogram-derived entropy (EntropyHist) and area under the curve (CHAUC) (rs = 0.49, p < 0.001 and rs= 0.45, p < 0.001, respectively). Some second and third order textural features were found highly correlated between CE-CT and NCE-CT, such as small zone-size emphasis SZSE (rs = 0.729, p < 0.001) and zone-size percentage (rs = 0.770, p < 0.001). Grey-levels discretization methods influenced these correlations. A few of the third order NCE-CT and CE-CT features were significantly associated with survival. CONCLUSION Some radiomics features with moderate correlations between nonenhanced and enhanced CT images were found to be associated with survival, thus suggesting that complementary prognostic value may be extracted from both modalities when available.
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Quantitative image analysis using chest computed tomography in the evaluation of lymph node involvement in pulmonary sarcoidosis and tuberculosis. PLoS One 2018; 13:e0207959. [PMID: 30475907 PMCID: PMC6258228 DOI: 10.1371/journal.pone.0207959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/08/2018] [Indexed: 01/19/2023] Open
Abstract
Purpose To evaluate the feasibility of quantitative analysis of chest computed tomography (CT) scans for the assessment of lymph node (LN) involvement in patients with pulmonary tuberculosis and sarcoidosis. Methods In 47 patients with tuberculosis (n = 26) or sarcoidosis (n = 21), 115 lymph nodes (tuberculous, 55; sarcoid, 60) were visually analyzed on chest CT scans according to their size, location, attenuation and shape. Each node was manually segmented using image analysis tool, which was quantitatively analyzed using the following variables: Feret’s diameter, perimeter, area, circularity, mean grey value (Mean), standard deviation (SD) of grey value, minimum grey value (Min), maximum grey value (Max), median grey value (Median), skewness, kurtosis, and net enhancement. We statistically analyzed the visual and quantitative CT features of tuberculous and sarcoid LNs. Results In visual CT analysis, the mean node size in sarcoidosis was significantly greater than that in tuberculosis. There were no statistical differences between tuberculous and sarcoid LNs in terms of location and shape. Central low attenuation and peripheral rim enhancement were more frequently observed in tuberculous LNs than in the sarcoid ones. In quantitative CT analysis, there were significant differences in the values of the Feret’s diameter, perimeter, area, circularity, mean grey value, SD, median, skewness, and kurtosis between tuberculous and sarcoid LNs. Conclusions Quantitative CT analysis using CT parameters with pixel-by-pixel measurements can help to differentiate of tuberculous and sarcoid LNs.
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Role of Quantitative Dynamic Contrast-Enhanced MRI in Evaluating Regional Lymph Nodes With a Short-Axis Diameter of Less Than 5 mm in Rectal Cancer. AJR Am J Roentgenol 2018; 212:77-83. [PMID: 30354269 DOI: 10.2214/ajr.18.19866] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to discriminate metastatic from nonmetastatic regional lymph nodes (LNs) with short-axis diameters of less than 5 mm in rectal cancer using quantitative parameters derived from dynamic contrast-enhanced (DCE) MRI. SUBJECTS AND METHODS Sixty-five LNs from 122 patients were evaluated, including malignant LNs (n = 27) and benign LNs (n = 38). The following parameters were assessed: the forward volume transfer constant (Ktrans), reverse volume transfer constant (kep), fractional extravascular extracellular space volume (Ve), short-axis diameter, long-axis diameter, and short- to long-axis diameter ratio. ROC curves were used to analyze statistically significant parameters. RESULTS Metastatic LNs exhibited a lower Ktrans than did nonmetastatic LNs (p < 0.001), but the other parameters were not significantly different between the two groups. The AUC of the Ktrans was 0.732, with a 95% CI of 0.610-0.854, and the diagnostic cutoff value was 0.088 min-1 (sensitivity, 60.5%; specificity, 81.5%). CONCLUSION Ktrans had moderate diagnostic performance in assessing small regional LNs in rectal cancer and appears to be a useful predictor when distinguishing malignant LNs from benign LNs only by morphology is difficult.
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Yun G, Kim YH, Lee YJ, Kim B, Hwang JH, Choi DJ. Tumor heterogeneity of pancreas head cancer assessed by CT texture analysis: association with survival outcomes after curative resection. Sci Rep 2018; 8:7226. [PMID: 29740111 PMCID: PMC5940761 DOI: 10.1038/s41598-018-25627-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 04/25/2018] [Indexed: 12/12/2022] Open
Abstract
The value of image based texture features as a powerful method to predict prognosis and assist clinical management in cancer patients has been established recently. However, texture analysis using histograms and grey-level co-occurrence matrix in pancreas cancer patients has rarely been reported. We aimed to analyze the association of survival outcomes with texture features in pancreas head cancer patients. Eighty-eight pancreas head cancer patients who underwent preoperative CT images followed by curative resection were included. Texture features using different filter values were obtained. The texture features of average, contrast, correlation, and standard deviation with no filter, and fine to medium filter values as well as the presence of nodal metastasis were significantly different between the recurred (n = 70, 79.5%) and non-recurred group (n = 18, 20.5%). In the multivariate Cox regression analysis, lower standard deviation and contrast and higher correlation with lower average value representing homogenous texture were significantly associated with poorer DFS (disease free survival), along with the presence of lymph node metastasis. Texture parameters from routinely performed pre-operative CT images could be used as an independent imaging tool for predicting the prognosis in pancreas head cancer patients who underwent curative resection.
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Affiliation(s)
- Gabin Yun
- Seoul National University Bundang Hospital, Department of Radiology, Seongnam, 13620, Korea
| | - Young Hoon Kim
- Seoul National University Bundang Hospital, Department of Radiology, Seongnam, 13620, Korea.
| | - Yoon Jin Lee
- Seoul National University Bundang Hospital, Department of Radiology, Seongnam, 13620, Korea
| | - Bohyoung Kim
- Seoul National University Bundang Hospital, Department of Radiology, Seongnam, 13620, Korea.,Hankuk University of Foreign Studies, Division of Biomedical Engineering, Yongin, 17035, Korea
| | - Jin-Hyeok Hwang
- Seoul National University Bundang Hospital, Department of Internal Medicine, Seongnam, 13620, Korea
| | - Dong Joon Choi
- Seoul National University Bundang Hospital, Department of Radiology, Seongnam, 13620, Korea
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García-Figueiras R, Baleato-González S, Padhani AR, Luna-Alcalá A, Marhuenda A, Vilanova JC, Osorio-Vázquez I, Martínez-de-Alegría A, Gómez-Caamaño A. Advanced Imaging Techniques in Evaluation of Colorectal Cancer. Radiographics 2018; 38:740-765. [PMID: 29676964 DOI: 10.1148/rg.2018170044] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Imaging techniques are clinical decision-making tools in the evaluation of patients with colorectal cancer (CRC). The aim of this article is to discuss the potential of recent advances in imaging for diagnosis, prognosis, therapy planning, and assessment of response to treatment of CRC. Recent developments and new clinical applications of conventional imaging techniques such as virtual colonoscopy, dual-energy spectral computed tomography, elastography, advanced computing techniques (including volumetric rendering techniques and machine learning), magnetic resonance (MR) imaging-based magnetization transfer, and new liver imaging techniques, which may offer additional clinical information in patients with CRC, are summarized. In addition, the clinical value of functional and molecular imaging techniques such as diffusion-weighted MR imaging, dynamic contrast material-enhanced imaging, blood oxygen level-dependent imaging, lymphography with contrast agents, positron emission tomography with different radiotracers, and MR spectroscopy is reviewed, and the advantages and disadvantages of these modalities are evaluated. Finally, the future role of imaging-based analysis of tumor heterogeneity and multiparametric imaging, the development of radiomics and radiogenomics, and future challenges for imaging of patients with CRC are discussed. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Roberto García-Figueiras
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Sandra Baleato-González
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Anwar R Padhani
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Antonio Luna-Alcalá
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Ana Marhuenda
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Joan C Vilanova
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Iria Osorio-Vázquez
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Anxo Martínez-de-Alegría
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Antonio Gómez-Caamaño
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
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Chaddad A, Daniel P, Niazi T. Radiomics Evaluation of Histological Heterogeneity Using Multiscale Textures Derived From 3D Wavelet Transformation of Multispectral Images. Front Oncol 2018; 8:96. [PMID: 29670857 PMCID: PMC5893871 DOI: 10.3389/fonc.2018.00096] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/19/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose Colorectal cancer (CRC) is markedly heterogeneous and develops progressively toward malignancy through several stages which include stroma (ST), benign hyperplasia (BH), intraepithelial neoplasia (IN) or precursor cancerous lesion, and carcinoma (CA). Identification of the malignancy stage of CRC pathology tissues (PT) allows the most appropriate therapeutic intervention. Methods This study investigates multiscale texture features extracted from CRC pathology sections using 3D wavelet transform (3D-WT) filter. Multiscale features were extracted from digital whole slide images of 39 patients that were segmented in a pre-processing step using an active contour model. The capacity for multiscale texture to compare and classify between PTs was investigated using ANOVA significance test and random forest classifier models, respectively. Results 12 significant features derived from the multiscale texture (i.e., variance, entropy, and energy) were found to discriminate between CRC grades at a significance value of p < 0.01 after correction. Combining multiscale texture features lead to a better predictive capacity compared to prediction models based on individual scale features with an average (±SD) classification accuracy of 93.33 (±3.52)%, sensitivity of 88.33 (± 4.12)%, and specificity of 96.89 (± 3.88)%. Entropy was found to be the best classifier feature across all the PT grades with an average of the area under the curve (AUC) value of 91.17, 94.21, 97.70, 100% for ST, BH, IN, and CA, respectively. Conclusion Our results suggest that multiscale texture features based on 3D-WT are sensitive enough to discriminate between CRC grades with the entropy feature, the best predictor of pathology grade.
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Affiliation(s)
- Ahmad Chaddad
- Division of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - Paul Daniel
- Division of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - Tamim Niazi
- Division of Radiation Oncology, McGill University, Montreal, QC, Canada
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Pre-treatment magnetic resonance-based texture features as potential imaging biomarkers for predicting event free survival in anal cancer treated by chemoradiotherapy. Eur Radiol 2018; 28:2801-2811. [DOI: 10.1007/s00330-017-5284-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/08/2017] [Accepted: 12/22/2017] [Indexed: 01/11/2023]
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Gourtsoyianni S, Doumou G, Prezzi D, Taylor B, Stirling JJ, Taylor NJ, Siddique M, Cook GJR, Glynne-Jones R, Goh V. Primary Rectal Cancer: Repeatability of Global and Local-Regional MR Imaging Texture Features. Radiology 2017; 284:552-561. [PMID: 28481194 PMCID: PMC6150741 DOI: 10.1148/radiol.2017161375] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Purpose To assess the day-to-day repeatability of global and local-regional magnetic resonance (MR) imaging texture features derived from primary rectal cancer. Materials and Methods After ethical approval and patient informed consent were obtained, two pretreatment T2-weighted axial MR imaging studies performed prospectively with the same imaging unit on 2 consecutive days in 14 patients with rectal cancer (11 men [mean age, 61.7 years], three women [mean age, 70.0 years]) were analyzed to extract (a) global first-order statistical histogram and model-based fractal features reflecting the whole-tumor voxel intensity histogram distribution and repeating patterns, respectively, without spatial information and (b) local-regional second-order and high-order statistical texture features reflecting the intensity and spatial interrelationships between adjacent in-plane or multiplanar voxels or regions, respectively. Repeatability was assessed for 46 texture features, and mean difference, 95% limits of agreement, within-subject coefficient of variation (wCV), and repeatability coefficient (r) were recorded. Results Repeatability was better for global parameters than for most local-regional parameters. In particular, histogram mean, median, and entropy, fractal dimension mean and standard deviation, and second-order entropy, homogeneity, difference entropy, and inverse difference moment demonstrated good repeatability, with narrow limits of agreement and wCVs of 10% or lower. Repeatability was poorest for the following high-order gray-level run-length (GLRL) gray-level zone size matrix (GLZSM) and neighborhood gray-tone difference matrix (NGTDM) parameters: GLRL intensity variability, GLZSM short-zone emphasis, GLZSM intensity nonuniformity, GLZSM intensity variability, GLZSM size zone variability, and NGTDM complexity, demonstrating wider agreement limits and wCVs of 50% or greater. Conclusion MR imaging repeatability is better for global texture parameters than for local-regional texture parameters, indicating that global texture parameters should be sufficiently robust for clinical practice. Online supplemental material is available for this article.
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Affiliation(s)
- Sofia Gourtsoyianni
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Georgia Doumou
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Davide Prezzi
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Benjamin Taylor
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - J. James Stirling
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - N. Jane Taylor
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Musib Siddique
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Gary J. R. Cook
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Robert Glynne-Jones
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Vicky Goh
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
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Nardone V, Tini P, Carbone SF, Grassi A, Biondi M, Sebaste L, Carfagno T, Vanzi E, De Otto G, Battaglia G, Rubino G, Pastina P, Belmonte G, Mazzoni LN, Banci Buonamici F, Mazzei MA, Pirtoli L. Bone texture analysis using CT-simulation scans to individuate risk parameters for radiation-induced insufficiency fractures. Osteoporos Int 2017; 28:1915-1923. [PMID: 28243706 DOI: 10.1007/s00198-017-3968-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/13/2017] [Indexed: 12/29/2022]
Abstract
UNLABELLED This study deals with the role of texture analysis as a predictive factor of radiation-induced insufficiency fractures in patients undergoing pelvic radiation. INTRODUCTION This study aims to assess the texture analysis (TA) of computed tomography (CT) simulation scans as a predictive factor of insufficiency fractures (IFs) in patients with pelvic malignancies undergoing radiation therapy (RT). METHODS We performed an analysis of patients undergoing pelvic RT from January 2010 to December 2014, 24 of whom had developed pelvic bone IFs. We analyzed CT-simulation images using ImageJ macro software and selected two regions of interest (ROIs), which are L5 body and the femoral head. TA parameters included mean (m), standard deviation (SD), skewness (sk), kurtosis (k), entropy (e), and uniformity (u). The IFs patients were compared (1:2 ratio) with controlled patients who had not developed IFs and matched for sex, age, menopausal status, type of tumor, use of chemotherapy, and RT dose. A reliability test of intra- and inter-reader ROI TA reproducibility with the intra-class correlation coefficient (ICC) was performed. Univariate and multivariate analyses (logistic regression) were applied for TA parameters observed both in the IFs and the controlled groups. RESULTS Inter- and intra-reader ROI TA was highly reproducible (ICC > 0.90). Significant TA parameters on paired t test included L5 m (p = 0.001), SD (p = 0.002), k (p = 0.006), e (p = 0.004), and u (p = 0.015) and femoral head m (p < 0.001) and SD (p = 0.001), whereas on logistic regression analysis, L5 e (p = 0.003) and u (p = 0.010) and femoral head m (p = 0.027), SD (p = 0.015), and sex (p = 0.044). CONCLUSIONS In our experience, bone CT TA could be correlated to the risk of radiation-induced IFs. Studies on a large patient series and methodological refinements are warranted.
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Affiliation(s)
- V Nardone
- Unit of Radiation Oncology, University Hospital of Siena, Viale Bracci, 53100, Siena, Italy.
| | - P Tini
- Unit of Radiation Oncology, University Hospital of Siena, Viale Bracci, 53100, Siena, Italy
| | - S F Carbone
- Unit of Diagnostic Imaging, University Hospital of Siena, Siena, Italy
| | - A Grassi
- Unit of Diagnostic Imaging, University Hospital of Siena, Siena, Italy
| | - M Biondi
- Unit of Medical Physics, University Hospital of Siena, Siena, Italy
| | - L Sebaste
- Unit of Radiation Oncology, University Hospital of Siena, Viale Bracci, 53100, Siena, Italy
| | - T Carfagno
- Unit of Radiation Oncology, University Hospital of Siena, Viale Bracci, 53100, Siena, Italy
| | - E Vanzi
- Unit of Medical Physics, University Hospital of Siena, Siena, Italy
| | - G De Otto
- Unit of Medical Physics, University Hospital of Siena, Siena, Italy
| | - G Battaglia
- Unit of Radiation Oncology, University Hospital of Siena, Viale Bracci, 53100, Siena, Italy
| | - G Rubino
- Unit of Radiation Oncology, University Hospital of Siena, Viale Bracci, 53100, Siena, Italy
| | - P Pastina
- Unit of Radiation Oncology, University Hospital of Siena, Viale Bracci, 53100, Siena, Italy
| | - G Belmonte
- Unit of Medical Physics, University Hospital of Siena, Siena, Italy
| | - L N Mazzoni
- Unit of Medical Physics, University Hospital of Siena, Siena, Italy
| | | | - M A Mazzei
- Unit of Diagnostic Imaging, University Hospital of Siena, Siena, Italy
| | - L Pirtoli
- Unit of Radiation Oncology, University Hospital of Siena, Viale Bracci, 53100, Siena, Italy
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Texture Analysis of Abnormal Cell Images for Predicting the Continuum of Colorectal Cancer. Anal Cell Pathol (Amst) 2017; 2017:8428102. [PMID: 28331793 PMCID: PMC5282460 DOI: 10.1155/2017/8428102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/20/2015] [Indexed: 11/17/2022] Open
Abstract
Abnormal cell (ABC) is a markedly heterogeneous tissue area and can be categorized into three main types: benign hyperplasia (BH), carcinoma (Ca), and intraepithelial neoplasia (IN) or precursor cancerous lesion. In this study, the goal is to determine and characterize the continuum of colorectal cancer by using a 3D-texture approach. ABC was segmented in preprocessing step using an active contour segmentation technique. Cell types were analyzed based on textural features extracted from the gray level cooccurrence matrices (GLCMs). Significant texture features were selected using an analysis of variance (ANOVA) of ABC with a p value cutoff of p < 0.01. Features selected were reduced with a principal component analysis (PCA), which accounted for 97% of the cumulative variance from significant features. The simulation results identified 158 significant features based on ANOVA from a total of 624 texture features extracted from GLCMs. Performance metrics of ABC discrimination based on significant texture features showed 92.59% classification accuracy, 100% sensitivity, and 94.44% specificity. These findings suggest that texture features extracted from GLCMs are sensitive enough to discriminate between the ABC types and offer the opportunity to predict cell characteristics of colorectal cancer.
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Hiroshima Y, Shuto K, Yamazaki K, Kawaguchi D, Yamada M, Kikuchi Y, Kasahara K, Murakami T, Hirano A, Mori M, Kosugi C, Matsuo K, Ishida Y, Koda K, Tanaka K. Fractal Dimension of Tc-99m DTPA GSA Estimates Pathologic Liver Injury due to Chemotherapy in Liver Cancer Patients. Ann Surg Oncol 2016; 23:4384-4391. [PMID: 27439417 DOI: 10.1245/s10434-016-5441-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chemotherapy-induced liver injury after potent chemotherapy is a considerable problem in patients undergoing liver resection. The aim of this study was to assess the relationship between the fractal dimension (FD) of Tc-99m diethylenetriaminepentaacetic acid (DTPA) galactosyl human serum albumin (GSA) and pathologic change of liver parenchyma in liver cancer patients who have undergone chemotherapy. METHODS We examined 34 patients (10 female and 24 male; mean age, 68.5 years) who underwent hepatectomy. Hepatic injury was defined as steatosis more than 30 %, grade 2-3 sinusoidal dilation, and/or steatohepatitis Kleiner score ≥4. Fractal analysis was applied to all images of Tc-99m DTPA GSA using a plug-in tool on ImageJ software (NIH, Bethesda, MD). A differential box-counting method was applied, and FD was calculated as a heterogeneity parameter. Correlations between FD and clinicopathological variables were examined. RESULTS FD values of patients with steatosis and steatohepatitis were significantly higher than those without (P > .001 and P > .001, respectively). There was no difference between the FD values of patients with and without sinusoidal dilatation (P = .357). Multivariate logistic regression showed FD as the only significant predictor for steatosis (P = .005; OR 36.5; 95 % CI 3.0-446.3) and steatohepatitis (P = .012; OR, 29.1; 95 % CI 2.1-400.1). CONCLUSIONS FD of Tc-99m DTPA GSA was the significant predictor for fatty liver disease in patients who underwent chemotherapy. This new modality is able to differentiate steatohepatitis from steatosis; therefore, it may be useful for predicting chemotherapy-induced pathologic liver injury.
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Affiliation(s)
- Yukihiko Hiroshima
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kazuto Yamazaki
- Department of Pathology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Daisuke Kawaguchi
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Masatoshi Yamada
- Department of Pathology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Yutaro Kikuchi
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kohei Kasahara
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Takashi Murakami
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Atsushi Hirano
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Mikito Mori
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Chihiro Kosugi
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kenichi Matsuo
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Yasuo Ishida
- Department of Pathology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kuniya Tanaka
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
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García-Figueiras R, Baleato-González S, Padhani AR, Marhuenda A, Luna A, Alcalá L, Carballo-Castro A, Álvarez-Castro A. Advanced imaging of colorectal cancer: From anatomy to molecular imaging. Insights Imaging 2016; 7:285-309. [PMID: 27136925 PMCID: PMC4877344 DOI: 10.1007/s13244-016-0465-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/30/2015] [Accepted: 01/19/2016] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED Imaging techniques play a key role in the management of patients with colorectal cancer. The introduction of new advanced anatomical, functional, and molecular imaging techniques may improve the assessment of diagnosis, prognosis, planning therapy, and assessment of response to treatment of these patients. Functional and molecular imaging techniques in clinical practice may allow the assessment of tumour-specific characteristics and tumour heterogeneity. This paper will review recent developments in imaging technologies and the evolving roles for these techniques in colorectal cancer. TEACHING POINTS • Imaging techniques play a key role in the management of patients with colorectal cancer. • Advanced imaging techniques improve the evaluation of these patients. • Functional and molecular imaging allows assessment of tumour hallmarks and tumour heterogeneity.
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Affiliation(s)
- Roberto García-Figueiras
- />Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Sandra Baleato-González
- />Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Anwar R. Padhani
- />Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England, HA6 2RN UK
| | - Ana Marhuenda
- />Department of Radiology, IVO (Instituto Valenciano de Oncología), C/ Beltrán Báguena, 8, 46009 Valencia, Spain
| | - Antonio Luna
- />Department of Radiology, Advanced Medical Imaging, Clinica Las Nieves, SERCOSA, Grupo Health Time, C/ Carmelo Torres 2, 23007 Jaén, Spain
- />Case Western Reserve University, Cleveland, OH USA
| | - Lidia Alcalá
- />Department of Radiology, Advanced Medical Imaging, Clinica Las Nieves, SERCOSA, Grupo Health Time, C/ Carmelo Torres 2, 23007 Jaén, Spain
| | - Ana Carballo-Castro
- />Department of Radiotherapy, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Ana Álvarez-Castro
- />Department of Gastroenterology, Colorectal Cancer Group, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, Santiago de Compostela, 15706 Spain
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Nam SJ, Yoo J, Lee HS, Kim EK, Moon HJ, Yoon JH, Kwak JY. Quantitative Evaluation for Differentiating Malignant and Benign Thyroid Nodules Using Histogram Analysis of Grayscale Sonograms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:775-782. [PMID: 26969596 DOI: 10.7863/ultra.15.05055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/27/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the diagnostic value of histogram analysis using grayscale sonograms for differentiation of malignant and benign thyroid nodules. METHODS From July 2013 through October 2013, 579 nodules in 563 patients who had undergone ultrasound-guided fine-needle aspiration were included. For the grayscale histogram analysis, pixel echogenicity values in regions of interest were measured as 0 to 255 (0, black; 255, white) with in-house software. Five parameters (mean, skewness, kurtosis, standard deviation, and entropy) were obtained for each thyroid nodule. With principal component analysis, an index was derived. Diagnostic performance rates for the 5 histogram parameters and the principal component analysis index were calculated. RESULTS A total of 563 patients were included in the study (mean age ± SD, 50.3 ± 12.3 years;range, 15-79 years). Of the 579 nodules, 431 were benign, and 148 were malignant. Among the 5 parameters and the principal component analysis index, the standard deviation (75.546 ± 14.153 versus 62.761 ± 16.01; P < .001), kurtosis (3.898 ± 2.652 versus 6.251 ± 9.102; P < .001), entropy (0.16 ± 0.135 versus 0.239 ± 0.185; P < .001), and principal component analysis index (-0.386±0.774 versus 0.134 ± 0.889; P < .001) were significantly different between the malignant and benign nodules. With the calculated cutoff values, the areas under the curve were 0.681 (95% confidence interval, 0.643-0.721) for standard deviation, 0.661 (0.620-0.703) for principal component analysis index, 0.651 (0.607-0.691) for kurtosis, 0.638 (0.596-0.681) for entropy, and 0.606 (0.563-0.647) for skewness. The subjective analysis of grayscale sonograms by radiologists alone showed an area under the curve of 0.861 (0.833-0.888). CONCLUSIONS Grayscale histogram analysis was feasible for differentiating malignant and benign thyroid nodules but did not show better diagnostic performance than subjective analysis performed by radiologists. Further technical advances will be needed to objectify interpretations of thyroid grayscale sonograms.
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Affiliation(s)
- Se Jin Nam
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeheung Yoo
- Yonsei University, College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Parekh V, Jacobs MA. Radiomics: a new application from established techniques. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016; 1:207-226. [PMID: 28042608 PMCID: PMC5193485 DOI: 10.1080/23808993.2016.1164013] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The increasing use of biomarkers in cancer have led to the concept of personalized medicine for patients. Personalized medicine provides better diagnosis and treatment options available to clinicians. Radiological imaging techniques provide an opportunity to deliver unique data on different types of tissue. However, obtaining useful information from all radiological data is challenging in the era of "big data". Recent advances in computational power and the use of genomics have generated a new area of research termed Radiomics. Radiomics is defined as the high throughput extraction of quantitative imaging features or texture (radiomics) from imaging to decode tissue pathology and creating a high dimensional data set for feature extraction. Radiomic features provide information about the gray-scale patterns, inter-pixel relationships. In addition, shape and spectral properties can be extracted within the same regions of interest on radiological images. Moreover, these features can be further used to develop computational models using advanced machine learning algorithms that may serve as a tool for personalized diagnosis and treatment guidance.
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Affiliation(s)
- Vishwa Parekh
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of Cancer Imaging, The Johns Hopkins University School of Medicine, Baltimore, MD 21205
- Department of Computer Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Michael A. Jacobs
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of Cancer Imaging, The Johns Hopkins University School of Medicine, Baltimore, MD 21205
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21205
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Ştefănescu D, Streba C, Cârţână ET, Săftoiu A, Gruionu G, Gruionu LG. Computer Aided Diagnosis for Confocal Laser Endomicroscopy in Advanced Colorectal Adenocarcinoma. PLoS One 2016; 11:e0154863. [PMID: 27144985 PMCID: PMC4856267 DOI: 10.1371/journal.pone.0154863] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 04/20/2016] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Confocal laser endomicroscopy (CLE) is becoming a popular method for optical biopsy of digestive mucosa for both diagnostic and therapeutic procedures. Computer aided diagnosis of CLE images, using image processing and fractal analysis can be used to quantify the histological structures in the CLE generated images. The aim of this study is to develop an automatic diagnosis algorithm of colorectal cancer (CRC), based on fractal analysis and neural network modeling of the CLE-generated colon mucosa images. MATERIALS AND METHODS We retrospectively analyzed a series of 1035 artifact-free endomicroscopy images, obtained during CLE examinations from normal mucosa (356 images) and tumor regions (679 images). The images were processed using a computer aided diagnosis (CAD) medical imaging system in order to obtain an automatic diagnosis. The CAD application includes image reading and processing functions, a module for fractal analysis, grey-level co-occurrence matrix (GLCM) computation module, and a feature identification module based on the Marching Squares and linear interpolation methods. A two-layer neural network was trained to automatically interpret the imaging data and diagnose the pathological samples based on the fractal dimension and the characteristic features of the biological tissues. RESULTS Normal colon mucosa is characterized by regular polyhedral crypt structures whereas malignant colon mucosa is characterized by irregular and interrupted crypts, which can be diagnosed by CAD. For this purpose, seven geometric parameters were defined for each image: fractal dimension, lacunarity, contrast correlation, energy, homogeneity, and feature number. Of the seven parameters only contrast, homogeneity and feature number were significantly different between normal and cancer samples. Next, a two-layer feed forward neural network was used to train and automatically diagnose the malignant samples, based on the seven parameters tested. The neural network operations were cross-entropy with the results: training: 0.53, validation: 1.17, testing: 1.17, and percent error, resulting: training: 16.14, validation: 17.42, testing: 15.48. The diagnosis accuracy error was 15.5%. CONCLUSIONS Computed aided diagnosis via fractal analysis of glandular structures can complement the traditional histological and minimally invasive imaging methods. A larger dataset from colorectal and other pathologies should be used to further validate the diagnostic power of the method.
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Affiliation(s)
- Daniela Ştefănescu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania
| | - Costin Streba
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania
| | - Elena Tatiana Cârţână
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania
- Endoscopy Department, Copenhagen University Hospital, Herlev, Denmark
| | - Gabriel Gruionu
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, United States of America
- Department of Engineering and Management of Technological Systems, Faculty of Mechanics, University of Craiova, Craiova, Romania
| | - Lucian Gheorghe Gruionu
- Department of Engineering and Management of Technological Systems, Faculty of Mechanics, University of Craiova, Craiova, Romania
- * E-mail:
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Sadot E, Simpson AL, Do RKG, Gonen M, Shia J, Allen PJ, D’Angelica MI, DeMatteo RP, Kingham TP, Jarnagin WR. Cholangiocarcinoma: Correlation between Molecular Profiling and Imaging Phenotypes. PLoS One 2015. [PMID: 26207380 PMCID: PMC4514866 DOI: 10.1371/journal.pone.0132953] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To investigate associations between imaging features of cholangiocarcinoma by visual assessment and texture analysis, which quantifies heterogeneity in tumor enhancement patterns, with molecular profiles based on hypoxia markers. METHODS The institutional review board approved this HIPAA-compliant retrospective study of CT images of intrahepatic cholangiocarcinoma, obtained before surgery. Immunostaining for hypoxia markers (EGFR, VEGF, CD24, P53, MDM2, MRP-1, HIF-1α, CA-IX, and GLUT1) was performed on pre-treatment liver biopsies. Quantitative imaging phenotypes were determined by texture analysis with gray level co-occurrence matrixes. The correlations between quantitative imaging phenotypes, qualitative imaging features (measured by radiographic inspection alone), and expression levels of the hypoxia markers from the 25 tumors were assessed. RESULTS Twenty-five patients were included with a median age of 62 years (range: 54-84). The median tumor size was 10.2 cm (range: 4-14), 10 (40%) were single tumors, and 90% were moderately differentiated. Positive immunostaining was recorded for VEGF in 67% of the cases, EGFR in 75%, and CD24 in 55%. On multiple linear regression analysis, quantitative imaging phenotypes correlated significantly with EGFR and VEGF expression levels (R2 = 0.4, p<0.05 and R2 = 0.2, p<0.05, respectively), while a trend was demonstrated with CD24 expression (R2 = 0.33, p = 0.1). Three qualitative imaging features correlated with VEGF and CD24 expression (P<0.05), however, none of the qualitative features correlated with the quantitative imaging phenotypes. CONCLUSION Quantitative imaging phenotypes, as defined by texture analysis, correlated with expression of specific markers of hypoxia, regardless of conventional imaging features.
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Affiliation(s)
- Eran Sadot
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Amber L. Simpson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Richard K. G. Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Peter J. Allen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Michael I. D’Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Ronald P. DeMatteo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - William R. Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * E-mail:
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Frenkel JL, Marks JH. Predicting the risk of lymph node metastasis in early rectal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2014.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kijima S, Sasaki T, Nagata K, Utano K, Lefor AT, Sugimoto H. Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT. World J Gastroenterol 2014; 20:16964-16975. [PMID: 25493009 PMCID: PMC4258565 DOI: 10.3748/wjg.v20.i45.16964] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 07/13/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
Imaging studies are a major component in the evaluation of patients for the screening, staging and surveillance of colorectal cancer. This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography (CT) colonography, magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT colonography. CT colonography provides important information for the preoperative assessment of T staging. Wall deformities are associated with muscular or subserosal invasion. Lymph node metastases from colorectal cancer often present with calcifications. CT is superior to detect calcified metastases. Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery. T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure. N staging in patients with colorectal cancer is still challenging using any imaging modality. MRI is more accurate than CT for the evaluation of liver metastases. PET/CT colonography is valuable in the evaluation of extra-colonic and hepatic disease. PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically. PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely. However, there is no definite evidence to support the routine clinical use of PET/CT colonography.
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Alic L, Niessen WJ, Veenland JF. Quantification of heterogeneity as a biomarker in tumor imaging: a systematic review. PLoS One 2014; 9:e110300. [PMID: 25330171 PMCID: PMC4203782 DOI: 10.1371/journal.pone.0110300] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/15/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many techniques are proposed for the quantification of tumor heterogeneity as an imaging biomarker for differentiation between tumor types, tumor grading, response monitoring and outcome prediction. However, in clinical practice these methods are barely used. This study evaluates the reported performance of the described methods and identifies barriers to their implementation in clinical practice. METHODOLOGY The Ovid, Embase, and Cochrane Central databases were searched up to 20 September 2013. Heterogeneity analysis methods were classified into four categories, i.e., non-spatial methods (NSM), spatial grey level methods (SGLM), fractal analysis (FA) methods, and filters and transforms (F&T). The performance of the different methods was compared. PRINCIPAL FINDINGS Of the 7351 potentially relevant publications, 209 were included. Of these studies, 58% reported the use of NSM, 49% SGLM, 10% FA, and 28% F&T. Differentiation between tumor types, tumor grading and/or outcome prediction was the goal in 87% of the studies. Overall, the reported area under the curve (AUC) ranged from 0.5 to 1 (median 0.87). No relation was found between the performance and the quantification methods used, or between the performance and the imaging modality. A negative correlation was found between the tumor-feature ratio and the AUC, which is presumably caused by overfitting in small datasets. Cross-validation was reported in 63% of the classification studies. Retrospective analyses were conducted in 57% of the studies without a clear description. CONCLUSIONS In a research setting, heterogeneity quantification methods can differentiate between tumor types, grade tumors, and predict outcome and monitor treatment effects. To translate these methods to clinical practice, more prospective studies are required that use external datasets for validation: these datasets should be made available to the community to facilitate the development of new and improved methods.
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Affiliation(s)
- Lejla Alic
- Biomedical Imaging Group Rotterdam, Department of Radiology and Medical Informatics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Intelligent Imaging, Netherlands Organization for Applied Scientific Research (TNO), The Hague, The Netherlands
| | - Wiro J. Niessen
- Biomedical Imaging Group Rotterdam, Department of Radiology and Medical Informatics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - Jifke F. Veenland
- Biomedical Imaging Group Rotterdam, Department of Radiology and Medical Informatics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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Fractal analysis of contrast-enhanced CT images to predict survival of patients with hepatocellular carcinoma treated with sunitinib. Dig Dis Sci 2014; 59:1996-2003. [PMID: 24563237 DOI: 10.1007/s10620-014-3064-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/05/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intratumoral heterogeneity is a well-recognized feature of malignancy. AIMS To assess the heterogeneity of tumor using fractal analysis of contrast-enhanced computed tomography (CE-CT) images for predicting survival of hepatocellular carcinoma (HCC) patients treated with sunitinib. METHODS The patient cohort comprised 23 patients (19 men, 4 women; mean age 61.5 years) with HCC who underwent CE-CT at baseline and after one cycle of sunitinib. Arterial-phase (AP) and portal-phase (PP) CE-CT images were analyzed using a plugin software for ImageJ (NIH, Bethesda, MD). A differential box-counting method was employed to calculate the fractal dimension (FD) of the tumor. Tumor FD, density, and size were compared with survival. RESULTS Median progression-free survival (PFS) was 4.43 months. Patients were grouped into a favorable PFS (PFS >4.43 months; 9 patients) and an unfavorable PFS group (PFS ≤ 4.43; 13 patients). The baseline FD on both the AP and PP images was lower in the favorable PFS group than in the unfavorable PFS group (both P = 0.03). There was a significant difference in the change of the FD on the AP image between the favorable and unfavorable PFS groups (P = 0.02). Tumor density and size showed no significant correlations with PFS. In the Kaplan-Meier analysis, patients with tumors showing lower FD on the AP image at baseline showed longer PFS (P = 0.002). Patients with tumors showing a greater reduction in the FD on the PP image after one cycle of the therapy showed longer overall survival (P = 0.002). CONCLUSION The FD of the tumor on CE-CT images may be a useful biomarker for HCC patients treated with sunitinib.
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Hayano K, Lee SH, Yoshida H, Zhu AX, Sahani DV. Fractal analysis of CT perfusion images for evaluation of antiangiogenic treatment and survival in hepatocellular carcinoma. Acad Radiol 2014; 21:654-60. [PMID: 24703479 DOI: 10.1016/j.acra.2014.01.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/28/2014] [Accepted: 01/29/2014] [Indexed: 12/18/2022]
Abstract
RATIONALE AND OBJECTIVES Tumor vascular heterogeneity is a recognized biomarker for cancer progression. Our purpose was to assess the tumor perfusion heterogeneity during antiangiogenic therapy in hepatocellular carcinoma (HCC) by means of fractal analysis on computed tomography perfusion (CTP) images. MATERIALS AND METHODS Twenty-two patients (15 men and 7 women; mean age: 61.5 years) with advanced HCC underwent CTP at baseline and 2 weeks after administration of bevacizumab. Perfusion maps of blood flow (BF) were generated by the adiabatic approximation to the tissue homogeneity model with a motion registration, and fractal analyses were applied to gray-scale perfusion maps using a plugin tool on ImageJ software (NIH, Bethesda, MD). A differential box-counting method was applied, and the fractal dimension (FD) was calculated as a heterogeneity parameter. RESULTS Patients were grouped into favorable progression-free survival (PFS) group (PFS>6 months, 11 patients) and unfavorable PFS group (PFS≤6, 11 patients). After 2 weeks of antiangiogenic therapy, the BF decreased significantly (P < .0001), whereas the FD showed no significant change (P = .69). The percent change of the FD in tumor BF was significantly different between patients with favorable PFS and those without (-2.52% vs. 3.72%, P = .01), whereas the change of tumor BF showed no significant difference between them (-28.93% vs. -25.47%, P = .64). In Kaplan-Meier analysis, patients with greater reduction in the percent change of FD and lower baseline FD in tumor BF showed significantly longer overall survival (P = .009, P = .005). CONCLUSIONS Fractal analysis of tumor BF can be a biomarker for antiangiogenic therapy.
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Zhou J, Zhan S, Zhu Q, Gong H, Wang Y, Fan D, Gong Z, Huang Y. Prediction of nodal involvement in primary rectal carcinoma without invasion to pelvic structures: accuracy of preoperative CT, MR, and DWIBS assessments relative to histopathologic findings. PLoS One 2014; 9:e92779. [PMID: 24695111 PMCID: PMC3973633 DOI: 10.1371/journal.pone.0092779] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/26/2014] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the accuracy of preoperative computed tomography (CT), magnetic resonance (MR) imaging and diffusion-weighted imaging with background body signal suppression (DWIBS) in the prediction of nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. METHODS AND MATERIALS Fifty-two subjects with primary rectal cancer were preoperatively assessed by CT and MRI at 1.5 T with a phased-array coil. Preoperative lymph node staging with imaging modalities (CT, MRI, and DWIBS) were compared with the final histological findings. RESULTS The accuracy of CT, MRI, and DWIBS were 57.7%, 63.5%, and 40.4%. The accuracy of DWIBS with higher sensitivity and negative predictive value for evaluating primary rectal cancer patients was lower than that of CT and MRI. Nodal staging agreement between imaging and pathology was fairly strong for CT and MRI (Kappa value = 0.331 and 0.348, P<0.01) but was relatively weaker for DWIBS (Kappa value = 0.174, P<0.05). The accuracy was 57.7% and 59.6%, respectively, for CT and MRI when the lymph node border information was used as the criteria, and was 57.7% and 61.5%, respectively, for enhanced CT and MRI when the lymph node enhancement pattern was used as the criteria. CONCLUSION MRI is more accurate than CT in predicting nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. DWIBS has a great diagnostic value in differentiating small malignant from benign lymph nodes.
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Affiliation(s)
- Jun Zhou
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Songhua Zhan
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- * E-mail:
| | - Qiong Zhu
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hangjun Gong
- Department of General Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yidong Wang
- Department of General Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Desheng Fan
- Department of Pathology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhigang Gong
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanwen Huang
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Yip C, Landau D, Kozarski R, Ganeshan B, Thomas R, Michaelidou A, Goh V. Primary esophageal cancer: heterogeneity as potential prognostic biomarker in patients treated with definitive chemotherapy and radiation therapy. Radiology 2014; 270:141-8. [PMID: 23985274 DOI: 10.1148/radiol.13122869] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine the association between tumor heterogeneity, morphologic tumor response, and overall survival in primary esophageal cancer treated with chemotherapy and radiation therapy (CRT). MATERIALS AND METHODS After an institutional review board waiver was obtained, contrast material-enhanced computed tomographic (CT) studies in 36 patients with stage T2 or greater esophageal tumors who underwent contrast-enhanced CT before and after CRT between 2005 and 2008 were analyzed in terms of whole-tumor texture, with quantification of entropy, uniformity, mean gray-level intensity, kurtosis, standard deviation of the histogram, and skewness for fine to coarse textures (filters 1.0-2.5, respectively). The association between texture parameters and survival time was assessed by using Kaplan-Meier analysis and a Cox proportional hazards model. Survival models involving texture parameters and combinations of texture and morphologic response assessment were compared with morphologic assessment alone by means of receiver operating characteristic (ROC) analysis. RESULTS Posttreatment medium entropy of less than 7.356 (median overall survival, 33.2 vs 11.7 months; P = .0002), coarse entropy of less than 7.116 (median overall survival, 33.2 vs 11.7 months; P = .0002), and medium uniformity of 0.007 or greater (median overall survival, 33.2 vs 11.7 months; P = .0002) were associated with improved survival time. These remained significant prognostic factors after adjustment for stage and age: entropy (filter 2.0: hazard ratio [HR] = 5.038, P = .0004; filter 2.5: HR = 5.038, P = .0004) and uniformity (HR = 0.199, P = .0004). Survival models that included a combination of pretreatment entropy and uniformity with maximal wall thickness assessment, respectively, performed better than morphologic assessment alone (area under the ROC curve, 0.767 vs 0.487 [P = .00005] and 0.802 vs 0.487 [P = .0003]). CONCLUSION Posttreatment texture parameters are associated with survival time, and the combination of pretreatment texture parameters and maximal wall thickness performed better in survival models than morphologic tumor response alone.
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Affiliation(s)
- Connie Yip
- From the Departments of Oncology (C.Y., D.L., A.M.) and Radiology (R.T., V.G.), Guy's and St Thomas' National Health Service Foundation Trust, Lower Ground Floor, Lambeth Wing, Westminster Bridge Road, London SE1 7EH, England; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield, England (R.K.); Institute of Nuclear Medicine, University College London, London, England (B.G.); and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (V.G.)
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Abstract
Heterogeneity is a key feature of malignancy associated with adverse tumour biology. Quantifying heterogeneity could provide a useful non-invasive imaging biomarker. Heterogeneity on computed tomography (CT) can be quantified using texture analysis which extracts spatial information from CT images (unenhanced, contrast-enhanced and derived images such as CT perfusion) that may not be perceptible to the naked eye. The main components of texture analysis can be categorized into image transformation and quantification. Image transformation filters the conventional image into its basic components (spatial, frequency, etc.) to produce derived subimages. Texture quantification techniques include structural-, model- (fractal dimensions), statistical- and frequency-based methods. The underlying tumour biology that CT texture analysis may reflect includes (but is not limited to) tumour hypoxia and angiogenesis. Emerging studies show that CT texture analysis has the potential to be a useful adjunct in clinical oncologic imaging, providing important information about tumour characterization, prognosis and treatment prediction and response.
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Affiliation(s)
- Balaji Ganeshan
- Institute of Nuclear Medicine, University College London, Eustace Road, London, UK.
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Quantitative ultrasound image analysis of axillary lymph node status in breast cancer patients. Int J Comput Assist Radiol Surg 2013; 8:895-903. [DOI: 10.1007/s11548-013-0829-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/06/2013] [Indexed: 11/27/2022]
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Ng F, Kozarski R, Ganeshan B, Goh V. Assessment of tumor heterogeneity by CT texture analysis: can the largest cross-sectional area be used as an alternative to whole tumor analysis? Eur J Radiol 2012. [PMID: 23194641 DOI: 10.1016/j.ejrad.2012.10.023] [Citation(s) in RCA: 286] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine if there is a difference between contrast enhanced CT texture features from the largest cross-sectional area versus the whole tumor, and its effect on clinical outcome prediction. METHODS Entropy (E) and uniformity (U) were derived for different filter values (1.0-2.5: fine to coarse textures) for the largest primary tumor cross-sectional area and the whole tumor of the staging contrast enhanced CT in 55 patients with primary colorectal cancer. Parameters were compared using non-parametric Wilcoxon test. Kaplan-Meier analysis was performed to determine the relationship between CT texture and 5-year overall survival. RESULTS E was higher and U lower for the whole tumor indicating greater heterogeneity at all filter levels (1.0-2.5): median (range) for E and U for whole tumor versus largest cross-sectional area of 7.89 (7.43-8.31) versus 7.62 (6.94-8.08) and 0.005 (0.004-0.01) versus 0.006 (0.005-0.01) for filter 1.0; 7.88 (7.22-8.48) versus 7.54 (6.86-8.1) and 0.005 (0.003-0.01) versus 0.007 (0.004-0.01) for filter 1.5; 7.88 (7.17-8.54) versus 7.48 (5.84-8.25) and 0.005 (0.003-0.01) versus 0.007 (0.004-0.02) for filter 2.0; and 7.83 (7.03-8.57) versus 7.42 (5.19-8.26) and 0.005 (0.003-0.01) versus 0.006 (0.004-0.03) for filter 2.5 respectively (p ≤ 0.001). Kaplan-Meier analysis demonstrated better separation of E and U for whole tumor analysis for 5-year overall survival. CONCLUSION Whole tumor analysis appears more representative of tumor heterogeneity.
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Affiliation(s)
- Francesca Ng
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, UK.
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Ng F, Ganeshan B, Kozarski R, Miles KA, Goh V. Assessment of primary colorectal cancer heterogeneity by using whole-tumor texture analysis: contrast-enhanced CT texture as a biomarker of 5-year survival. Radiology 2012; 266:177-84. [PMID: 23151829 DOI: 10.1148/radiol.12120254] [Citation(s) in RCA: 333] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine if computed tomographic (CT) texture features of primary colorectal cancer are related to 5-year overall survival rate. MATERIALS AND METHODS Institutional review board waiver was obtained for this retrospective analysis. Texture features of the entire primary tumor were assessed with contrast material-enhanced staging CT studies obtained in 57 patients as part of an ethically approved study and by using proprietary software. Entropy, uniformity, kurtosis, skewness, and standard deviation of the pixel distribution histogram were derived from CT images without filtration and with filter values corresponding to fine (1.0), medium (1.5, 2.0), and coarse (2.5) textures. Patients were followed up until death and were censored at 5 years if they were still alive. Kaplan-Meier analysis was performed to determine the relationship, if any, between CT texture and 5-year overall survival rate. The Cox proportional hazards model was used to assess independence of texture parameters from stage. RESULTS Follow-up data were available for 55 of 57 patients. There were eight stage I, 19 stage II, 17 stage III, and 11 stage IV cancers. Fine-texture feature Kaplan-Meier survival plots for entropy, uniformity, kurtosis, skewness, and standard deviation of the pixel distribution histogram were significantly different for tumors above and below each respective threshold receiver operating characteristic (ROC) curve optimal cutoff value (P = .001, P = .018, P = .032, P = .008, and P = .001, respectively), with poorer prognosis for ROC optimal values (a) less than 7.89 for entropy, (b) at least 0.01 for uniformity, (c) less than 2.48 for kurtosis, (d) at least -0.38 for skewness, and (e) less than 61.83 for standard deviation. Multivariate Cox proportional hazards regression analysis showed that each parameter was independent from the stage predictor of overall survival rate (P = .001, P = .009, P = .006, P = .02, and P = .001, respectively). CONCLUSION Fine-texture features are associated with poorer 5-year overall survival rate in patients with primary colorectal cancer. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120254/-/DC1.
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Affiliation(s)
- Francesca Ng
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England
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Assessment of tumor heterogeneity: an emerging imaging tool for clinical practice? Insights Imaging 2012; 3:573-89. [PMID: 23093486 PMCID: PMC3505569 DOI: 10.1007/s13244-012-0196-6] [Citation(s) in RCA: 644] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 08/30/2012] [Accepted: 09/24/2012] [Indexed: 12/17/2022] Open
Abstract
Background Tumor spatial heterogeneity is an important prognostic factor, which may be reflected in medical images Methods Image texture analysis is an approach of quantifying heterogeneity that may not be appreciated by the naked eye. Different methods can be applied including statistical-, model-, and transform-based methods. Results Early evidence suggests that texture analysis has the potential to augment diagnosis and characterization as well as improve tumor staging and therapy response assessment in oncological practice. Conclusion This review provides an overview of the application of texture analysis with different imaging modalities, CT, MRI, and PET, to date and describes the technical challenges that have limited its widespread clinical implementation so far. With further efforts to refine its application, image texture analysis has the potential to develop into a valuable clinical tool for oncologic imaging. Teaching Points • Tumor spatial heterogeneity is an important prognostic factor. • Image texture analysis is an approach of quantifying heterogeneity. • Different methods can be applied, including statistical-, model-, and transform-based methods. • Texture analysis could improve the diagnosis, tumor staging, and therapy response assessment.
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