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Bai Y, An ZC, Li F, Du LF, Xie TW, Zhang XP, Cai YY. Deep learning using contrast-enhanced ultrasound images to predict the nuclear grade of clear cell renal cell carcinoma. World J Urol 2024; 42:184. [PMID: 38512539 DOI: 10.1007/s00345-024-04889-3] [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: 11/28/2023] [Accepted: 02/12/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE To assess the effectiveness of a deep learning model using contrastenhanced ultrasound (CEUS) images in distinguishing between low-grade (grade I and II) and high-grade (grade III and IV) clear cell renal cell carcinoma (ccRCC). METHODS A retrospective study was conducted using CEUS images of 177 Fuhrmangraded ccRCCs (93 low-grade and 84 high-grade) from May 2017 to December 2020. A total of 6412 CEUS images were captured from the videos and normalized for subsequent analysis. A deep learning model using the RepVGG architecture was proposed to differentiate between low-grade and high-grade ccRCC. The model's performance was evaluated based on sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic curve (AUC). Class activation mapping (CAM) was used to visualize the specific areas that contribute to the model's predictions. RESULTS For discriminating high-grade ccRCC from low-grade, the deep learning model achieved a sensitivity of 74.8%, specificity of 79.1%, accuracy of 77.0%, and an AUC of 0.852 in the test set. CONCLUSION The deep learning model based on CEUS images can accurately differentiate between low-grade and high-grade ccRCC in a non-invasive manner.
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Affiliation(s)
- Yun Bai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85/86 Wujin Road, Shanghai, 200080, China
| | - Zi-Chen An
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85/86 Wujin Road, Shanghai, 200080, China
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85/86 Wujin Road, Shanghai, 200080, China
| | - Lian-Fang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85/86 Wujin Road, Shanghai, 200080, China
| | - Tian-Wu Xie
- Institute of Radiation Medicine, Fudan University, No. 2094 Xietu Road, Shanghai, 200032, China.
| | - Xi-Peng Zhang
- School of Computer Science and Technology, Taiyuan Normal University, No. 319 Daxue Street, Taiyuan, 030619, China.
| | - Ying-Yu Cai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85/86 Wujin Road, Shanghai, 200080, China.
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Pan L, Chen M, Sun J, Jin P, Ding J, Cai P, Chen J, Xing W. Prediction of Fuhrman grade of renal clear cell carcinoma by multimodal MRI radiomics: a retrospective study. Clin Radiol 2024; 79:e273-e281. [PMID: 38065776 DOI: 10.1016/j.crad.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/16/2023] [Accepted: 11/05/2023] [Indexed: 01/02/2024]
Abstract
AIM To explore the value of multimodal magnetic resonance imaging (MRI) radiomics combined with traditional radiologist-defined semantic characteristics and conventional (cMRI) and functional MRI (fMRI) texture features in predicting Fuhrman grade of clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS The data of 89 patients with histopathologically proven ccRCC (low-grade, 54; high-grade, 35) were collected. Texture features were extracted from cMRI (T1- and T2-weighted imaging) and fMRI (Dixon-MRI; blood-oxygen-level dependent [BOLD]-MRI; and susceptibility-weighted imaging [SWI]) images, and the traditional characteristics (TC) were evaluated. Logistic regression analysis was performed to develop models based on TC, cMRI, and fMRI texture features for grading. Receiver operating characteristic (ROC) curve analysis and leave-group-out cross-validation (LGOCV) were performed to test the reliability of combined models. RESULTS Two T2-weighted imaging-based, two Dixon_W-based, one Dixon_F-based, one BOLD-based, and three SWI-based texture features, and three TC were extracted for feature selection. TC, cMRI, fMRI, cMRI+fMRI, cMRI+TC, fMRI+TC, and cMRI+fMRI+TC models were constructed. The AUC of the cMRI+fMRI+TC model for differentiating high- from low-grade ccRCC was 0.74, with 81.42% accuracy, 75.93% sensitivity, and 91.43% specificity. The fMRI+TC model exhibited a performance similar to that of the cMRI+fMRI+TC model (p>0.05). The areas under the curve (AUCs) of the fMRI+TC and cMRI+fMRI+TC models were significantly higher than those of the other five models (all p<0.05). For the cMRI+fMRI+TC model, the mean accuracy was 85.40% after 100 LGOCV for the test sets. CONCLUSION Multimodal MRI radiomics combined with TC, cMRI, and fMRI texture features may be a reliable quantitative approach for differentiating high-grade ccRCC from low-grade ccRCC.
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Affiliation(s)
- L Pan
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China
| | - M Chen
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China
| | - J Sun
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China
| | - P Jin
- Department of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - J Ding
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China
| | - P Cai
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China
| | - J Chen
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China.
| | - W Xing
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China.
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Hu C, Qiao X, Xu Z, Zhang Z, Zhang X. Machine learning-based CT texture analysis in the differentiation of testicular masses. Front Oncol 2024; 13:1284040. [PMID: 38293700 PMCID: PMC10826395 DOI: 10.3389/fonc.2023.1284040] [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: 08/27/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024] Open
Abstract
Purpose To evaluate the ability of texture features for distinguishing between benign and malignant testicular masses, and furthermore, for identifying primary testicular lymphoma in malignant tumors and identifying seminoma in testicular germ cell tumors, respectively. Methods We retrospectively collected 77 patients with an abdominal and pelvic enhanced computed tomography (CT) examination and a histopathologically confirmed testicular mass from a single center. The ROI of each mass was split into two parts by the largest cross-sectional slice and deemed to be two samples. After all processing steps, three-dimensional texture features were extracted from unenhanced and contrast-enhanced CT images. Excellent reproducibility of texture features was defined as intra-class correlation coefficient ≥0.8 (ICC ≥0.8). All the groups were balanced via the synthetic minority over-sampling technique (SMOTE) method. Dimension reduction was based on pearson correlation coefficient (PCC). Before model building, minimum-redundancy maximum-relevance (mRMR) selection and recursive feature elimination (RFE) were used for further feature selection. At last, three ML classifiers with the highest cross validation with 5-fold were selected: autoencoder (AE), support vector machine(SVM), linear discriminant analysis (LAD). Logistics regression (LR) and LR-LASSO were also constructed to compare with the ML classifiers. Results 985 texture features with ICC ≥0.8 were extracted for further feature selection process. With the highest AUC of 0.946 (P <0.01), logistics regression was proved to be the best model for the identification of benign or malignant testicular masses. Besides, LR also had the best performance in identifying primary testicular lymphoma in malignant testicular tumors and in identifying seminoma in testicular germ cell tumors, with the AUC of 0.982 (P <0.01) and 0.928 (P <0.01), respectively. Conclusion Until now, this is the first study that applied CT texture analysis (CTTA) to assess the heterogeneity of testicular tumors. LR model based on CTTA might be a promising non-invasive tool for the diagnosis and differentiation of testicular masses. The accurate diagnosis of testicular masses would assist urologists in correct preoperative and perioperative decision making.
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Affiliation(s)
- Can Hu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Urology, Suzhou Xiangcheng People’s Hospital, Suzhou, China
| | - Xiaomeng Qiao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhenyu Xu
- Department of Urology, The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine: Traditional Chinese Medicine Hospital of Kunshan, Kunshan, China
| | - Zhiyu Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xuefeng Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Deng Y, Wang H, He L. CT radiomics to differentiate between Wilms tumor and clear cell sarcoma of the kidney in children. BMC Med Imaging 2024; 24:13. [PMID: 38182986 PMCID: PMC10768092 DOI: 10.1186/s12880-023-01184-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND To investigate the role of CT radiomics in distinguishing Wilms tumor (WT) from clear cell sarcoma of the kidney (CCSK) in pediatric patients. METHODS We retrospectively enrolled 83 cases of WT and 33 cases of CCSK. These cases were randomly stratified into a training set (n = 81) and a test set (n = 35). Several imaging features from the nephrographic phase were analyzed, including the maximum tumor diameter, the ratio of the maximum CT value of the tumor solid portion to the mean CT value of the contralateral renal vein (CTmax/CT renal vein), and the presence of dilated peritumoral cysts. Radiomics features from corticomedullary phase were extracted, selected, and subsequently integrated into a logistic regression model. We evaluated the model's performance using the area under the curve (AUC), 95% confidence interval (CI), and accuracy. RESULTS In the training set, there were statistically significant differences in the maximum tumor diameter (P = 0.021) and the presence of dilated peritumoral cysts (P = 0.005) between WT and CCSK, whereas in the test set, no statistically significant differences were observed (P > 0.05). The radiomics model, constructed using four radiomics features, demonstrated strong performance in the training set with an AUC of 0.889 (95% CI: 0.811-0.967) and an accuracy of 0.864. Upon evaluation using fivefold cross-validation in the training set, the AUC remained high at 0.863 (95% CI: 0.774-0.952), with an accuracy of 0.852. In the test set, the radiomics model achieved an AUC of 0.792 (95% CI: 0.616-0.968) and an accuracy of 0.857. CONCLUSION CT radiomics proves to be diagnostically valuable for distinguishing between WT and CCSK in pediatric cases.
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Affiliation(s)
- Yaxin Deng
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Haoru Wang
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Ling He
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
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Yang H, Liu H, Lin J, Xiao H, Guo Y, Mei H, Ding Q, Yuan Y, Lai X, Wu K, Wu S. An automatic texture feature analysis framework of renal tumor: surgical, pathological, and molecular evaluation based on multi-phase abdominal CT. Eur Radiol 2024; 34:355-366. [PMID: 37528301 DOI: 10.1007/s00330-023-10016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES To determine whether the texture feature analysis of multi-phase abdominal CT can provide a robust prediction of benign and malignant, histological subtype, pathological stage, nephrectomy risk, pathological grade, and Ki67 index in renal tumor. METHODS A total of 1051 participants with renal tumor were split into the internal cohort (850 patients from four different hospitals) and the external testing cohort (201 patients from another local hospital). The proposed framework comprised a 3D-kidney and tumor segmentation model by 3D-UNet, a feature extractor for the regions of interest based on radiomics and image dimension reduction, and the six classifiers by XGBoost. A quantitative model interpretation method called SHAP was used to explore the contribution of each feature. RESULTS The proposed multi-phase abdominal CT model provides robust prediction for benign and malignant, histological subtype, pathological stage, nephrectomy risk, pathological grade, and Ki67 index in the internal validation set, with the AUROC values of 0.88 ± 0.1, 0.90 ± 0.1, 0.91 ± 0.1, 0.89 ± 0.1, 0.84 ± 0.1, and 0.88 ± 0.1, respectively. The external testing set also showed impressive results, with AUROC values of 0.83 ± 0.1, 0.83 ± 0.1, 0.85 ± 0.1, 0.81 ± 0.1, 0.79 ± 0.1, and 0.81 ± 0.1, respectively. The radiomics feature including the first-order statistics, the tumor size-related morphology, and the shape-related tumor features contributed most to the model predictions. CONCLUSIONS Automatic texture feature analysis of abdominal multi-phase CT provides reliable predictions for multi-tasks, suggesting the potential usage of clinical application. CLINICAL RELEVANCE STATEMENT The automatic texture feature analysis framework, based on multi-phase abdominal CT, provides robust and reliable predictions for multi-tasks. These valuable insights can serve as a guiding tool for clinical diagnosis and treatment, making medical imaging an essential component in the process. KEY POINTS • The automatic texture feature analysis framework based on multi-phase abdominal CT can provide more accurate prediction of benign and malignant, histological subtype, pathological stage, nephrectomy risk, pathological grade, and Ki67 index in renal tumor. • The quantitative decomposition of the prediction model was conducted to explore the contribution of the extracted feature. • The study involving 1051 patients from 5 medical centers, along with a heterogeneous external data testing strategy, can be seamlessly transferred to various tasks involving new datasets.
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Affiliation(s)
- Huancheng Yang
- Luohu Clinical Institute, Shantou University Medical College, Shantou, 515000, China
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
- Shenzhen Following Precision Medical Research Institute, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
- Shantou University Medical College, Shantou University, Shantou, 515000, China
| | - Hanlin Liu
- Department of Radiology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
| | - Jiashan Lin
- Luohu Clinical Institute, Shantou University Medical College, Shantou, 515000, China
- Shantou University Medical College, Shantou University, Shantou, 515000, China
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Hongwei Xiao
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
- Shenzhen Following Precision Medical Research Institute, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
| | - Yiqi Guo
- Luohu Clinical Institute, Shantou University Medical College, Shantou, 515000, China
- Shantou University Medical College, Shantou University, Shantou, 515000, China
| | - Hangru Mei
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
- Shenzhen Following Precision Medical Research Institute, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
| | - Qiuxia Ding
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
- Shenzhen Following Precision Medical Research Institute, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
| | - Yangguang Yuan
- Department of Radiology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
| | - Xiaohui Lai
- Department of Radiology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
| | - Kai Wu
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China.
- Shenzhen Following Precision Medical Research Institute, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China.
| | - Song Wu
- Luohu Clinical Institute, Shantou University Medical College, Shantou, 515000, China.
- Shenzhen Following Precision Medical Research Institute, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China.
- Shantou University Medical College, Shantou University, Shantou, 515000, China.
- Department of Urology, Health Science Center, South China Hospital, Shenzhen University, Shenzhen, 518116, China.
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Zhou Z, Qian X, Hu J, Geng C, Zhang Y, Dou X, Che T, Zhu J, Dai Y. Multi-phase-combined CECT radiomics models for Fuhrman grade prediction of clear cell renal cell carcinoma. Front Oncol 2023; 13:1167328. [PMID: 37692840 PMCID: PMC10485140 DOI: 10.3389/fonc.2023.1167328] [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: 02/16/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023] Open
Abstract
Objective This study aimed to evaluate the effectiveness of multi-phase-combined contrast-enhanced CT (CECT) radiomics methods for noninvasive Fuhrman grade prediction of clear cell renal cell carcinoma (ccRCC). Methods A total of 187 patients with four-phase CECT images were retrospectively enrolled and then were categorized into training cohort (n=126) and testing cohort (n=61). All patients were confirmed as ccRCC by histopathological reports. A total of 110 3D classical radiomics features were extracted from each phase of CECT for individual ccRCC lesion, and contrast-enhanced variation features were also calculated as derived radiomics features. These features were concatenated together, and redundant features were removed by Pearson correlation analysis. The discriminative features were selected by minimum redundancy maximum relevance method (mRMR) and then input into a C-support vector classifier to build multi-phase-combined CECT radiomics models. The prediction performance was evaluated by the area under the curve (AUC) of receiver operating characteristic (ROC). Results The multi-phase-combined CECT radiomics model showed the best prediction performance (AUC=0.777) than the single-phase CECT radiomics model (AUC=0.711) in the testing cohort (p value=0.039). Conclusion The multi-phase-combined CECT radiomics model is a potential effective way to noninvasively predict Fuhrman grade of ccRCC. The concatenation of first-order features and texture features extracted from corticomedullary phase and nephrographic phase are discriminative feature representations.
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Affiliation(s)
- Zhiyong Zhou
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Xusheng Qian
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Suzhou, Jiangsu, China
| | - Jisu Hu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Suzhou, Jiangsu, China
| | - Chen Geng
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Yongsheng Zhang
- Department of Pathology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xin Dou
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tuanjie Che
- Key Laboratory of Functional Genomic and Molecular Diagnosis of Gansu Province, Lanzhou, Gansu, China
- Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jianbing Zhu
- Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yakang Dai
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
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Shehata M, Abouelkheir RT, Gayhart M, Van Bogaert E, Abou El-Ghar M, Dwyer AC, Ouseph R, Yousaf J, Ghazal M, Contractor S, El-Baz A. Role of AI and Radiomic Markers in Early Diagnosis of Renal Cancer and Clinical Outcome Prediction: A Brief Review. Cancers (Basel) 2023; 15:2835. [PMID: 37345172 DOI: 10.3390/cancers15102835] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
Globally, renal cancer (RC) is the 10th most common cancer among men and women. The new era of artificial intelligence (AI) and radiomics have allowed the development of AI-based computer-aided diagnostic/prediction (AI-based CAD/CAP) systems, which have shown promise for the diagnosis of RC (i.e., subtyping, grading, and staging) and prediction of clinical outcomes at an early stage. This will absolutely help reduce diagnosis time, enhance diagnostic abilities, reduce invasiveness, and provide guidance for appropriate management procedures to avoid the burden of unresponsive treatment plans. This survey mainly has three primary aims. The first aim is to highlight the most recent technical diagnostic studies developed in the last decade, with their findings and limitations, that have taken the advantages of AI and radiomic markers derived from either computed tomography (CT) or magnetic resonance (MR) images to develop AI-based CAD systems for accurate diagnosis of renal tumors at an early stage. The second aim is to highlight the few studies that have utilized AI and radiomic markers, with their findings and limitations, to predict patients' clinical outcome/treatment response, including possible recurrence after treatment, overall survival, and progression-free survival in patients with renal tumors. The promising findings of the aforementioned studies motivated us to highlight the optimal AI-based radiomic makers that are correlated with the diagnosis of renal tumors and prediction/assessment of patients' clinical outcomes. Finally, we conclude with a discussion and possible future avenues for improving diagnostic and treatment prediction performance.
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Affiliation(s)
- Mohamed Shehata
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA
| | - Rasha T Abouelkheir
- Department of Radiology, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | | | - Eric Van Bogaert
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Mohamed Abou El-Ghar
- Department of Radiology, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | - Amy C Dwyer
- Kidney Disease Program, University of Louisville, Louisville, KY 40202, USA
| | - Rosemary Ouseph
- Kidney Disease Program, University of Louisville, Louisville, KY 40202, USA
| | - Jawad Yousaf
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates
| | - Mohammed Ghazal
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates
| | - Sohail Contractor
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Ayman El-Baz
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA
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8
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Abstract
Computed tomography (CT) of the abdomen is usually appropriate for the initial imaging of many urinary tract diseases, due to its wide availability, fast scanning and acquisition of thin slices and isotropic data, that allow the creation of multiplanar reformatted and three-dimensional reconstructed images of excellent anatomic details. Non-enhanced CT remains the standard imaging modality for assessing renal colic. The technique allows the detection of nearly all types of urinary calculi and the estimation of stone burden. CT is the primary diagnostic tool for the characterization of an indeterminate renal mass, including both cystic and solid tumors. It is also the modality of choice for staging a primary renal tumor. Urolithiasis and urinary tract malignancies represent the main urogenic causes of hematuria. CT urography (CTU) improves the visualization of both the upper and lower urinary tract and is recommended for the investigation of gross hematuria and microscopic hematuria, in patients with predisposing factors for urologic malignancies. CTU is highly accurate in the detection and staging of upper tract urothelial malignancies. CT represents the most commonly used technique for the detection and staging of bladder carcinoma and the diagnostic efficacy of CT staging improves with more advanced disease. Nevertheless, it has limited accuracy in differentiating non-muscle invasive bladder carcinoma from muscle-invasive bladder carcinoma. In this review, clinical indications and the optimal imaging technique for CT of the urinary tract is reviewed. The CT features of common urologic diseases, including ureterolithiasis, renal tumors and urothelial carcinomas are discussed.
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Ferro M, Crocetto F, Barone B, del Giudice F, Maggi M, Lucarelli G, Busetto GM, Autorino R, Marchioni M, Cantiello F, Crocerossa F, Luzzago S, Piccinelli M, Mistretta FA, Tozzi M, Schips L, Falagario UG, Veccia A, Vartolomei MD, Musi G, de Cobelli O, Montanari E, Tătaru OS. Artificial intelligence and radiomics in evaluation of kidney lesions: a comprehensive literature review. Ther Adv Urol 2023; 15:17562872231164803. [PMID: 37113657 PMCID: PMC10126666 DOI: 10.1177/17562872231164803] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/04/2023] [Indexed: 04/29/2023] Open
Abstract
Radiomics and artificial intelligence (AI) may increase the differentiation of benign from malignant kidney lesions, differentiation of angiomyolipoma (AML) from renal cell carcinoma (RCC), differentiation of oncocytoma from RCC, differentiation of different subtypes of RCC, to predict Fuhrman grade, to predict gene mutation through molecular biomarkers and to predict treatment response in metastatic RCC undergoing immunotherapy. Neural networks analyze imaging data. Statistical, geometrical, textural features derived are giving quantitative data of contour, internal heterogeneity and gray zone features of lesions. A comprehensive literature review was performed, until July 2022. Studies investigating the diagnostic value of radiomics in differentiation of renal lesions, grade prediction, gene alterations, molecular biomarkers and ongoing clinical trials have been analyzed. The application of AI and radiomics could lead to improved sensitivity, specificity, accuracy in detecting and differentiating between renal lesions. Standardization of scanner protocols will improve preoperative differentiation between benign, low-risk cancers and clinically significant renal cancers and holds the premises to enhance the diagnostic ability of imaging tools to characterize renal lesions.
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Affiliation(s)
| | - Felice Crocetto
- Department of Neurosciences and Reproductive
Sciences and Odontostomatology, University of Naples Federico II, Naples,
Italy
| | - Biagio Barone
- Department of Neurosciences and Reproductive
Sciences and Odontostomatology, University of Naples Federico II, Naples,
Italy
| | - Francesco del Giudice
- Department of Maternal Infant and Urologic
Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome,
Italy
| | - Martina Maggi
- Department of Maternal Infant and Urologic
Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome,
Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation
Unit, Department of Emergency and Organ Transplantation, University of Bari,
Bari, Italy
| | - Gian Maria Busetto
- Department of Urology and Organ
Transplantation, University of Foggia, Foggia, Italy
| | | | - Michele Marchioni
- Department of Medical, Oral and
Biotechnological Sciences, Urology Unit, SS Annunziata Hospital, G.
d’Annunzio University of Chieti, Chieti, Italy
- Department of Urology, ASL Abruzzo 2, Chieti,
Italy
| | - Francesco Cantiello
- Department of Urology, Magna Graecia
University of Catanzaro, Catanzaro, Italy
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia
University of Catanzaro, Catanzaro, Italy
| | - Stefano Luzzago
- Department of Urology, IEO – European
Institute of Oncology, IRCCS – Istituto di Ricovero e Cura a Carattere
Scientifico, Milan, Italy
- Università degli Studi di Milano, Milan,
Italy
| | - Mattia Piccinelli
- Cancer Prognostics and Health Outcomes Unit,
Division of Urology, University of Montréal Health Center, Montréal, QC,
Canada
- Department of Urology, IEO – European
Institute of Oncology, IRCCS – Istituto di Ricovero e Cura a Carattere
Scientifico, Milan, Italy
| | - Francesco Alessandro Mistretta
- Department of Urology, IEO – European
Institute of Oncology, IRCCS – Istituto di Ricovero e Cura a Carattere
Scientifico, Milan, Italy
- Department of Oncology and
Hematology-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Marco Tozzi
- Department of Urology, IEO – European
Institute of Oncology, IRCCS – Istituto di Ricovero e Cura a Carattere
Scientifico, Milan, Italy
- Università degli Studi di Milano, Milan,
Italy
| | - Luigi Schips
- Department of Medical, Oral and
Biotechnological Sciences, Urology Unit, SS Annunziata Hospital, G.
d’Annunzio University of Chieti, Chieti, Italy
| | | | - Alessandro Veccia
- Urology Unit, Azienda Ospedaliera
Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Mihai Dorin Vartolomei
- Department of Cell and Molecular Biology,
George Emil Palade University of Medicine, Pharmacy, Science and Technology
of Târgu Mures, Târgu Mures, Romania
- Department of Urology, Medical University of
Vienna, Vienna, Austria
| | - Gennaro Musi
- Department of Urology, IEO – European
Institute of Oncology, IRCCS – Istituto di Ricovero e Cura a Carattere
Scientifico, Milan, Italy
- Department of Oncology and
Hematology-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO – European
Institute of Oncology, IRCCS – Istituto di Ricovero e Cura a Carattere
Scientifico, Milan, Italy
- Department of Oncology and
Hematology-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca’
Granda – Ospedale Maggiore Policlinico, Department of Clinical Sciences and
Community Health, University of Milan, Milan, Italy
| | - Octavian Sabin Tătaru
- Institution Organizing University Doctoral
Studies (IOSUD), George Emil Palade University of Medicine, Pharmacy,
Science and Technology of Târgu Mures, Târgu Mures, Romania
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10
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Whole-Lesion CT Texture Analysis as a Quantitative Biomarker for the Identification of Homogeneous Renal Tumors. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122148. [PMID: 36556513 PMCID: PMC9781849 DOI: 10.3390/life12122148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Renal tumors are very common in the urinary system, and the preoperative differential diagnosis of homogeneous renal tumors remains a challenge. This study aimed to evaluate the feasibility of the whole-lesion CT texture analysis for the identification of homogeneous renal tumors including clear cell renal cell carcinoma (ccRCC), chromophobe RCC (chRCC), and renal oncocytoma (RO). This retrospective study was approved by our local IRB. Contrast-enhanced CT examination was performed in 128 patients and histopathologically confirmed ccRCC, chRCC, and RO. The one-way ANOVA test with Bonferroni corrections was used to compare the differences, and the receiver operating characteristic (ROC) curve analysis was applied to determine the diagnostic efficiency. The whole-lesion CT histogram analysis was used to demonstrate significant differences between ccRCC and chRCC in both arterial and venous phases, and the entropy demonstrated excellent performance in discriminating these two types of tumors (AUCs = 0.95, 0.91). The inhomogeneity of ccRCC was significantly higher than that of RO both in arterial and venous phases. The entropy of chRCC was significantly lower than that of RO, and the kurtosis and entropy yielded high sensitivity (91%) and moderate specificity (74%) in the arterial phase. The whole-lesion CT histogram analysis could be useful for the differential diagnosis of homogeneous ccRCC, chRCC, and RO.
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11
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Muacevic A, Adler JR, Mohd OB, Elayan R, Albakri K, Huneiti N, Daraghmeh F, Al-khatatbeh E, Al-thnaibat M. Etiologies, Gross Appearance, Histopathological Patterns, Prognosis, and Best Treatments for Subtypes of Renal Carcinoma: An Educational Review. Cureus 2022; 14:e32338. [PMID: 36627997 PMCID: PMC9825816 DOI: 10.7759/cureus.32338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Of all primary renal neoplasms, 80-85% are renal cell carcinomas (RCCs), which develop in the renal cortex. There are more than 10 histological and molecular subtypes of the disease, the most frequent of which is clear cell RCC, which also causes most cancer-related deaths. Other renal neoplasms, including urothelial carcinoma, Wilms' tumor, and renal sarcoma, each affect a particular age group and have specific gross and histological features. Due to the genetic susceptibility of each of these malignancies, early mutation discovery is necessary for the early detection of a tumor. Furthermore, it is crucial to avoid environmental factors leading to each type. This study provides relatively detailed and essential information regarding each subtype of renal carcinoma.
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12
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Su GY, Liu J, Xu XQ, Lu MP, Yin M, Wu FY. Texture analysis of conventional magnetic resonance imaging and diffusion-weighted imaging for distinguishing sinonasal non-Hodgkin's lymphoma from squamous cell carcinoma. Eur Arch Otorhinolaryngol 2022; 279:5715-5720. [PMID: 35731296 DOI: 10.1007/s00405-022-07493-6] [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: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the value of texture analysis (TA) of conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in the differential diagnosis between sinonasal non-Hodgkin's lymphoma (NHL) and squamous cell carcinoma (SCC). METHODS Forty-two patients with sinonasal SCC and 30 patients with NHL were retrospectively enrolled. TAs were performed on T2-weighted image (T2WI), apparent diffusion coefficient (ADC) and contrast-enhanced T1-weighted image (T1WI). Texture parameters, including mean value, skewness, kurtosis, entropy and uniformity were obtained and compared between sinonasal SCC and NHL groups. Receiver-operating characteristic (ROC) curves and logistic regression analyses were used to evaluate the diagnostic value and identify the independent TA parameters. RESULTS The mean value and entropy of ADC, and mean value of contrast-enhanced T1WI were significantly lower in the sinonasal NHL group than those in the SCC group (all P < 0.05). ROC analysis indicated that the entropy of ADC had the best diagnostic performance (AUC 0.832; Sensitivity 0.95; Specificity 0.67; Cutoff value 6.522). Logistic regression analysis showed that the entropy of ADC (P = 0.002, OR = 26.990) was the independent parameter for differentiating sinonasal NHL from SCC. CONCLUSION TA parameters of conventional MRI and DWI, particularly the entropy value of ADC, might be useful in the differentiating diagnosis between sinonasal NHL and SCC.
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Affiliation(s)
- Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China
| | - Jun Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China
| | - Mei-Ping Lu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Yin
- Department of Otorhinolaryngology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China.
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13
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A Clinical Radiomics Nomogram Was Developed by Integrating Radiomics Signatures and Clinical Variables to Distinguish High-Grade ccRCC from Type 2 pRCC. JOURNAL OF ONCOLOGY 2022; 2022:6844349. [PMID: 36059810 PMCID: PMC9439906 DOI: 10.1155/2022/6844349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Abstract
Purpose A nomogram was constructed by combining clinical factors and a CT-based radiomics signature to discriminate between high-grade clear cell renal cell carcinoma (ccRCC) and type 2 papillary renal cell carcinoma (pRCC). Methods A total of 142 patients with 71 in high-grade ccRCC and seventy-one in type 2 pRCC were enrolled and split into a training cohort (n = 98) and a testing cohort (n = 44). A clinical factor model containing patient demographics and CT imaging characteristics was designed. By extracting the radiomics features from the precontrast phase, corticomedullary phase (CMP), and nephrographic phase (NP) CT images, a radiomics signature was established, and a Rad-score was computed. By combining the Rad-score and significant clinical factors using multivariate logistic regression analysis, a clinical radiomics nomogram was subsequently developed. The diagnostic performance of these three models was evaluated by using data from both the training and testing groups using a receiver operating characteristic (ROC) curve analysis. Results The radiomics signature contained eight validated features from the CT images. The relative enhancement value of CMP (REV1) was an independent risk factor in the clinical factor model. The area under the curve (AUC) value of the clinical radiomics nomogram was 0.974 and 0.952 in the training and testing cohorts, respectively. In the training cohort, the decision curves of the nomogram demonstrated an added overall net advantage compared to the clinical factor model. Conclusion A noninvasive prediction tool termed radiomics nomogram, combining clinical criteria and the radiomics signature, may accurately predict high-grade ccRCC and type 2 pRCC before surgery. It also has some importance in assisting clinicians in determining future treatment strategies.
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14
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Gao Y, Wang X, Wang S, Miao Y, Zhu C, Li C, Huang G, Jiang Y, Li J, Zhao X, Wu X. Differential Diagnosis of Type 1 and Type 2 Papillary Renal Cell Carcinoma Based on Enhanced CT Radiomics Nomogram. Front Oncol 2022; 12:854979. [PMID: 35719928 PMCID: PMC9204229 DOI: 10.3389/fonc.2022.854979] [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: 01/14/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To construct a contrast-enhanced CT-based radiomics nomogram that combines clinical factors and a radiomics signature to distinguish papillary renal cell carcinoma (pRCC) type 1 from pRCC type 2 tumours. Methods A total of 131 patients with 60 in pRCC type 1 and 71 in pRCC type 2 were enrolled and divided into training set (n=91) and testing set (n=40). Patient demographics and enhanced CT imaging characteristics were evaluated to set up a clinical factors model. A radiomics signature was constructed and radiomics score (Rad-score) was calculated by extracting radiomics features from contrast-enhanced CT images in corticomedullary phase (CMP) and nephrographic phase (NP). A radiomics nomogram was then built by incorporating the Rad-score and significant clinical factors according to multivariate logistic regression analysis. The diagnostic performance of the clinical factors model, radiomics signature and radiomics nomogram was evaluated on both the training and testing sets. Results Three validated features were extracted from the CT images and used to construct the radiomics signature. Boundary blurring as an independent risk factor for tumours was used to build clinical factors model. The AUC value of the radiomics nomogram, which was based on the selected clinical factors and Rad-score, were 0.855 and 0.831 in the training and testing sets, respectively. The decision curves of the radiomics nomogram and radiomics signature in the training set indicated an overall net benefit over the clinical factors model. Conclusion Radiomics nomogram combining clinical factors and radiomics signature is a non-invasive prediction method with a good prediction for pRCC type 1 tumours and type 2 tumours preoperatively and has some significance in guiding clinicians selecting subsequent treatment plans.
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Affiliation(s)
- Yankun Gao
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xingwei Wang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shihui Wang
- Department of Radiology, The First Affiliated Hospital of Wannan Medical college, Wuhu, China
| | - Yingying Miao
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chao Zhu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cuiping Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guoquan Huang
- Department of Imaging, Wuhu Second People's Hospital, Wuhu, China
| | - Yan Jiang
- Department of Pathology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jianying Li
- CT Research Center, GE Healthcare China, Shanghai, China
| | - Xiaoying Zhao
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xingwang Wu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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15
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Goo HW. Contrast-Enhanced CT Protocol for the Fontan Pathway: Comparison Between 1- and 3-Minute Scan Delays. Pediatr Cardiol 2022; 43:1104-1113. [PMID: 35107628 DOI: 10.1007/s00246-022-02830-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
Optimal enhancement of the Fontan pathway is crucial for the accurate CT evaluation. Current guidelines for contrast-enhanced CT protocols are rather inconsistent in scan delays and injection methods. This single-center, retrospective study was performed to compare objective measures of contrast enhancement between 1- and 3-min scan delays (41 and 36 patients, respectively) to determine a better contrast-enhanced CT protocols for evaluating the Fontan pathway. In both groups, a biphasic injection protocol, in which 50% diluted contrast agent (the amount of iodinated contrast agent: 2.0 mL/kg; the amount of saline: 2.0 mL/kg) was injected at the injection rate of 0.5‒2.5 mL/s for 50 s followed by a saline flush at the same injection rate (0.5‒2.5 mL/s), was used. The degree and heterogeneity of cardiovascular enhancement, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were quantitatively evaluated. The mean densities of all cardiovascular structures were significantly higher in the 1-min delay protocol than in the 3-min delay protocols (p < 0.001). Heterogeneous enhancement (normalized standard deviation > 0.70) in the Fontan pathway was significantly more frequent in the 1-min delay protocol (p < 0.001). No significant differences were found in image noise (p > 0.141) and the frequency showing suboptimal noise (p = 1.000) between the two protocols. SNR and CNR were significantly lower in the 3-min delay protocol (p < 0.001). Compared with the 1-min delay protocol, the 3-min delay protocol achieved more homogeneous enhancement in the Fontan pathway on CT but showed lower contrast enhancement, SNR, and, CNR, indicating the need for further improvement.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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16
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Roussel E, Capitanio U, Kutikov A, Oosterwijk E, Pedrosa I, Rowe SP, Gorin MA. Novel Imaging Methods for Renal Mass Characterization: A Collaborative Review. Eur Urol 2022; 81:476-488. [PMID: 35216855 PMCID: PMC9844544 DOI: 10.1016/j.eururo.2022.01.040] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/08/2022] [Accepted: 01/21/2022] [Indexed: 01/19/2023]
Abstract
CONTEXT The incidental detection of localized renal masses has been rising steadily, but a significant proportion of these tumors are benign or indolent and, in most cases, do not require treatment. At the present time, a majority of patients with an incidentally detected renal tumor undergo treatment for the presumption of cancer, leading to a significant number of unnecessary surgical interventions that can result in complications including loss of renal function. Thus, there exists a clinical need for improved tools to aid in the pretreatment characterization of renal tumors to inform patient management. OBJECTIVE To systematically review the evidence on noninvasive, imaging-based tools for solid renal mass characterization. EVIDENCE ACQUISITION The MEDLINE database was systematically searched for relevant studies on novel imaging techniques and interpretative tools for the characterization of solid renal masses, published in the past 10 yr. EVIDENCE SYNTHESIS Over the past decade, several novel imaging tools have offered promise for the improved characterization of indeterminate renal masses. Technologies of particular note include multiparametric magnetic resonance imaging of the kidney, molecular imaging with targeted radiopharmaceutical agents, and use of radiomics as well as artificial intelligence to enhance the interpretation of imaging studies. Among these, 99mTc-sestamibi single photon emission computed tomography/computed tomography (CT) for the identification of benign renal oncocytomas and hybrid oncocytic chromophobe tumors, and positron emission tomography/CT imaging with radiolabeled girentuximab for the identification of clear cell renal cell carcinoma, are likely to be closest to implementation in clinical practice. CONCLUSIONS A number of novel imaging tools stand poised to aid in the noninvasive characterization of indeterminate renal masses. In the future, these tools may aid in patient management by providing a comprehensive virtual biopsy, complete with information on tumor histology, underlying molecular abnormalities, and ultimately disease prognosis. PATIENT SUMMARY Not all renal tumors require treatment, as a significant proportion are either benign or have limited metastatic potential. Several innovative imaging tools have shown promise for their ability to improve the characterization of renal tumors and provide guidance in terms of patient management.
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Affiliation(s)
- Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Umberto Capitanio
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alexander Kutikov
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, The Netherlands
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Advanced Imaging Research Center. University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, MD, USA; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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17
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Wu K, Wu P, Yang K, Li Z, Kong S, Yu L, Zhang E, Liu H, Guo Q, Wu S. A comprehensive texture feature analysis framework of renal cell carcinoma: pathological, prognostic, and genomic evaluation based on CT images. Eur Radiol 2022; 32:2255-2265. [PMID: 34800150 DOI: 10.1007/s00330-021-08353-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We tried to realize accurate pathological classification, assessment of prognosis, and genomic molecular typing of renal cell carcinoma by CT texture feature analysis. To determine whether CT texture features can perform accurate pathological classification and evaluation of prognosis and genomic characteristics in renal cell carcinoma. METHODS Patients with renal cell carcinoma from five open-source cohorts were analyzed retrospectively in this study. These data were randomly split to train and test machine learning algorithms to segment the lesion, predict the histological subtype, tumor stage, and pathological grade. Dice coefficient and performance metrics such as accuracy and AUC were calculated to evaluate the segmentation and classification model. Quantitative decomposition of the predictive model was conducted to explore the contribution of each feature. Besides, survival analysis and the statistical correlation between CT texture features, pathological, and genomic signatures were investigated. RESULTS A total of 569 enhanced CT images of 443 patients (mean age 59.4, 278 males) were included in the analysis. In the segmentation task, the mean dice coefficient was 0.96 for the kidney and 0.88 for the cancer region. For classification of histologic subtype, tumor stage, and pathological grade, the model was on a par with radiologists and the AUC was 0.83 [Formula: see text] 0.1, 0.80 [Formula: see text] 0.1, and 0.77 [Formula: see text] 0.1 at 95% confidence intervals, respectively. Moreover, specific quantitative CT features related to clinical prognosis were identified. A strong statistical correlation (R2 = 0.83) between the feature crosses and genomic characteristics was shown. The structural equation modeling confirmed significant associations between CT features, pathological (β = - 0.75), and molecular subtype (β = - 0.30). CONCLUSIONS The framework illustrates high performance in the pathological classification of renal cell carcinoma. Prognosis and genomic characteristics can be inferred by quantitative image analysis. KEY POINTS • The analytical framework exhibits high-performance pathological classification of renal cell carcinoma and is on a par with human radiologists. • Quantitative decomposition of the predictive model shows that specific texture features contribute to histologic subtype and tumor stage classification. • Structural equation modeling shows the associations of genomic characteristics to CT texture features. Overall survival and molecular characteristics can be inferred by quantitative CT texture analysis in renal cell carcinoma.
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Affiliation(s)
- Kai Wu
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518001, China
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 518001, China
| | - Peng Wu
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518001, China
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 518001, China
| | - Kai Yang
- Department of Urology, South China Hospital, Health Science Center, Shenzhen University, Shenzhen, 518116, China
| | - Zhe Li
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518001, China
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 518001, China
| | - Sijia Kong
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518001, China
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 518001, China
| | - Lu Yu
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518001, China
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 518001, China
| | - Enpu Zhang
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518001, China
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 518001, China
| | - Hanlin Liu
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518001, China
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 518001, China
| | - Qing Guo
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518001, China
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 518001, China
| | - Song Wu
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518001, China
- Department of Urology, South China Hospital, Health Science Center, Shenzhen University, Shenzhen, 518116, China
- Teaching Center of Shenzhen Luohu Hospital, Shantou University Medical College, Shantou, 515041, China
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18
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Radiofrequency ablation of hepatocellular carcinoma: CT texture analysis of the ablated area to predict local recurrence. Eur J Radiol 2022; 150:110250. [DOI: 10.1016/j.ejrad.2022.110250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 11/22/2022]
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Imaging Tool for Predicting Renal Clear Cell Carcinoma Fuhrman Grade: Comparing R.E.N.A.L. Nephrometry Score and CT Texture Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2021:1821876. [PMID: 34977234 PMCID: PMC8718284 DOI: 10.1155/2021/1821876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
Background Clear cell renal cell carcinoma (ccRCC) is the most common renal malignant tumor. Preoperative imaging boasts advantages in diagnosing and choosing treatment methods for ccRCC. Purpose This study is aimed at building models based on R.E.N.A.L. nephrometry score (RNS) and CT texture analysis (CTTA) to estimate the Fuhrman grade of ccRCC and comparing the advantages and disadvantages of the two models. Materials and Methods 143 patients with pathologically confirmed ccRCC were enrolled. All patients were stratified into Fuhrman low-grade and high-grade groups with complete CT data and R.E.N.A.L. nephrometry scores. CTTA features were extracted from the ROI delineated at the largest tumor level, and RNS and CTTA features were included in the logistic regression model, respectively. Results RNS model constructed based on multivariate logistic regression analysis showed that 3 pts for R-scores, 2 pts for E-scores, and 3 pts for L-scores were significant indicators to predict high-grade ccRCC, the AUC of RNS model was 0.911, and the sensitivity and specificity were 71.11% and 83.67%, respectively. The CTTA-model confirmed energy, kurtosis, and entropy as independent predictive factors, and the AUC of CTTA model was 0.941, with an optimal sensitivity and specificity of 84.44% and 93.88%. Conclusions R.E.N.A.L. nephrometry score has a certain provocative effect on the Fuhrman pathological grading of ccRCC. As a potential emerging technology, CTTA is expected to replace R.E.N.A.L. nephrometry score in evaluating patients' Fuhrman classification, and this approach might become an available method for assisting clinicians in choosing appropriate operation.
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Yu W, Liang G, Zeng L, Yang Y, Wu Y. Accuracy of CT texture analysis for differentiating low-grade and high-grade renal cell carcinoma: systematic review and meta-analysis. BMJ Open 2021; 11:e051470. [PMID: 34937716 PMCID: PMC8704996 DOI: 10.1136/bmjopen-2021-051470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to assess the accuracy of CT texture analysis (CTTA) for differentiating low-grade and high-grade renal cell carcinoma (RCC). DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Cochrane Library, Embase, Web of Science, OVID Medline, Science Direct and Springer were searched to identify the included studies. ELIGIBILITY CRITERIA FOR INCLUDING STUDIES Clinical studies that report about the accuracy of CTTA in differentiating low-grade and high-grade RCC. METHODS Multiple databases were searched to identify studies from their inception to 20 October 2021. Two radiologists independently extracted data from the primary studies. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic OR (DOR) were calculated to assess CTTA performance. The summary receiver operating characteristic (SROC) curve was plotted, and the area under the curve (AUC) was calculated to evaluate the accuracy of CTTA in grading RCC. RESULTS This meta-analysis included 11 studies, with 1603 lesions observed in 1601 patients. Values of the pooled sensitivity, specificity, PLR, NLR, DOR were 0.79 (95% CI 0.73 to 0.84), 0.84 (95% CI 0.81 to 0.87), 5.1 (95% CI 4.0 to 6.4), 0.24 (95% CI 0.19 to 0.32) and 21 (95% CI 13 to 33), respectively. The SROC curve showed that the AUC was 0.88 (95% CI 0.84 to 0.90). Deeks' test found no significant publication bias among the studies (p=0.42). CONCLUSIONS The findings of this meta-analysis suggest that CTTA has a high accuracy in differentiating low-grade and high-grade RCC. A standardised methodology and large sample-based study are necessary to certain the diagnostic accuracy of CTTA in RCC grading for clinical decision making.
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Affiliation(s)
- Wei Yu
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Gao Liang
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Lichuan Zeng
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yang Yang
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yinghua Wu
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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18F-FDG texture analysis predicts the pathological Fuhrman nuclear grade of clear cell renal cell carcinoma. Abdom Radiol (NY) 2021; 46:5618-5628. [PMID: 34455450 PMCID: PMC8590655 DOI: 10.1007/s00261-021-03246-x] [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: 03/17/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
Purpose This article analyzes the image heterogeneity of clear cell renal cell carcinoma (ccRCC) based on positron emission tomography (PET) and positron emission tomography-computed tomography (PET/CT) texture parameters, and provides a new objective quantitative parameter for predicting pathological Fuhrman nuclear grading before surgery. Methods A retrospective analysis was performed on preoperative PET/CT images of 49 patients whose surgical pathology was ccRCC, 27 of whom were low grade (Fuhrman I/II) and 22 of whom were high grade (Fuhrman III/IV). Radiological parameters and standard uptake value (SUV) indicators on PET and computed tomography (CT) images were extracted by using the LIFEx software package. The discriminative ability of each texture parameter was evaluated through receiver operating curve (ROC). Binary logistic regression analysis was used to screen the texture parameters with distinguishing and diagnostic capabilities and whose area under curve (AUC) > 0.5. DeLong's test was used to compare the AUCs of PET texture parameter model and PET/CT texture parameter model with traditional maximum standardized uptake value (SUVmax) model and the ratio of tumor SUVmax to liver SUVmean (SUL)model. In addition, the models with the larger AUCs among the SUV models and texture models were prospectively internally verified. Results In the ROC curve analysis, the AUCs of SUVmax model, SUL model, PET texture parameter model, and PET/CT texture parameter model were 0.803, 0.819, 0.873, and 0.926, respectively. The prediction ability of PET texture parameter model or PET/CT texture parameter model was significantly better than SUVmax model (P = 0.017, P = 0.02), but it was not better than SUL model (P = 0.269, P = 0.053). In the prospective validation cohort, both the SUL model and the PET/CT texture parameter model had good predictive ability, and the AUCs of them were 0.727 and 0.792, respectively. Conclusion PET and PET/CT texture parameter models can improve the prediction ability of ccRCC Fuhrman nuclear grade; SUL model may be the more accurate and easiest way to predict ccRCC Fuhrman nuclear grade. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00261-021-03246-x.
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Stanzione A, Ricciardi C, Cuocolo R, Romeo V, Petrone J, Sarnataro M, Mainenti PP, Improta G, De Rosa F, Insabato L, Brunetti A, Maurea S. MRI Radiomics for the Prediction of Fuhrman Grade in Clear Cell Renal Cell Carcinoma: a Machine Learning Exploratory Study. J Digit Imaging 2021; 33:879-887. [PMID: 32314070 DOI: 10.1007/s10278-020-00336-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The Fuhrman nuclear grade is a recognized prognostic factor for patients with clear cell renal cell carcinoma (CCRCC) and its pre-treatment evaluation significantly affects decision-making in terms of management. In this study, we aimed to assess the feasibility of a combined approach of radiomics and machine learning based on MR images for a non-invasive prediction of Fuhrman grade, specifically differentiation of high- from low-grade tumor and grade assessment. Images acquired on a 3-Tesla scanner (T2-weighted and post-contrast) from 32 patients (20 with low-grade and 12 with high-grade tumor) were annotated to generate volumes of interest enclosing CCRCC lesions. After image resampling, normalization, and filtering, 2438 features were extracted. A two-step feature reduction process was used to between 1 and 7 features depending on the algorithm employed. A J48 decision tree alone and in combination with ensemble learning methods were used. In the differentiation between high- and low-grade tumors, all the ensemble methods achieved an accuracy greater than 90%. On the other end, the best results in terms of accuracy (84.4%) in the assessment of tumor grade were achieved by the random forest. These evidences support the hypothesis that a combined radiomic and machine learning approach based on MR images could represent a feasible tool for the prediction of Fuhrman grade in patients affected by CCRCC.
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Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80123, Naples, Italy
| | - Carlo Ricciardi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80123, Naples, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80123, Naples, Italy.
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80123, Naples, Italy
| | - Jessica Petrone
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80123, Naples, Italy
| | - Michela Sarnataro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80123, Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging of the National Research Council (CNR), Naples, Italy
| | - Giovanni Improta
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Filippo De Rosa
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80123, Naples, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80123, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80123, Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80123, Naples, Italy
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Kim TY, Lee JY, Lee YJ, Park DW, Tae K, Choi YY. CT texture analysis of tonsil cancer: Discrimination from normal palatine tonsils. PLoS One 2021; 16:e0255835. [PMID: 34379652 PMCID: PMC8357133 DOI: 10.1371/journal.pone.0255835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/23/2021] [Indexed: 11/18/2022] Open
Abstract
The purposes of the study were to determine whether there are differences in texture analysis parameters between tonsil cancers and normal tonsils, and to correlate texture analysis with 18F-FDG PET/CT to investigate the relationship between texture analysis and metabolic parameters. Sixty-four patients with squamous cell carcinoma of the palatine tonsil were included. A ROI was drawn, including all slices, to involve the entire tumor. The contralateral normal tonsil was used for comparison with the tumors. Texture analysis parameters, mean, standard deviation (SD), entropy, mean positive pixels, skewness, and kurtosis were obtained using commercially available software. Parameters were compared between the tumor and the normal palatine tonsils. Comparisons were also performed among early tonsil cancer, advanced tonsil cancer, and normal tonsils. An ROC curve analysis was performed to assess discrimination of tumor from normal tonsils. Correlation between texture analysis and 18F-FDG PET/CT was performed. Compared to normal tonsils, the tumors showed a significantly lower mean, higher SD, higher entropy, lower skewness, and higher kurtosis on most filters (p<0.001). On comparisons among normal tonsils, early cancers, and advanced tonsil cancers, SD and entropy showed significantly higher values on all filters (p<0.001) between early cancers and normal tonsils. The AUC from the ROC analysis was 0.91, obtained from the entropy. A mild correlation was shown between texture parameters and metabolic parameters. The texture analysis parameters, especially entropy, showed significant differences in contrast-enhanced CT results between tumor and normal tonsils, and between early tonsil cancers and normal tonsils. Texture analysis can be useful as an adjunctive tool for the diagnosis of tonsil cancers.
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Affiliation(s)
- Tae-Yoon Kim
- Department of Radiology, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Ji Young Lee
- Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea
- * E-mail: (JYL); (YJL)
| | - Young-Jun Lee
- Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea
- * E-mail: (JYL); (YJL)
| | - Dong Woo Park
- Department of Radiology, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University Hospital, Seoul, Republic of Korea
| | - Yun Young Choi
- Department of Nuclear Medicine, Hanyang University Hospital, Seoul, Republic of Korea
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Sun J, Pan L, Zha T, Xing W, Chen J, Duan S. The role of MRI texture analysis based on susceptibility-weighted imaging in predicting Fuhrman grade of clear cell renal cell carcinoma. Acta Radiol 2021; 62:1104-1111. [PMID: 32867506 DOI: 10.1177/0284185120951964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Fuhrman nuclear grade system is one of the most important independent indicators in patients with clear cell renal cell carcinoma (ccRCC) for aggressiveness and prognosis. Preoperative assessment of tumor aggressiveness is important for surgical decision-making. PURPOSE To explore the role of magnetic resonance imaging (MRI) texture analysis based on susceptibility-weighted imaging (SWI) in predicting Fuhrman grade of ccRCC. MATERIAL AND METHODS A total of 45 patients with SWI and surgically proven ccRCC were divided into two groups: the low-grade group (Fuhrman I/II, n = 29) and the high-grade group (Fuhrman III/IV, n = 16). Texture features were extracted from SWI images. Feature selection was performed, and multivariable logistic regression analysis was performed to develop the SWI-based texture model for grading ccRCCs. Receiver operating characteristic (ROC) curve analysis and leave-group-out cross-validation (LGOCV) were performed to test the reliability of the model. RESULTS A total of 396 SWI-based texture features were extracted from each SWI image. The SWI-based texture model developed by multivariable logistic regression analysis was: SWIscore = -0.59 + 1.60 * ZonePercentage. The area under the ROC curve of the SWI-based texture model for differentiating high-grade ccRCC from low-grade ccRCC was 0.81 (95% confidence interval 0.67-0.94), with 80% accuracy, 56.25% sensitivity, and 93.10% specificity. After 100 LGOCVs, the mean accuracy, sensitivity, and specificity were 90.91%, 91.83%, and 89.89% for the training sets, and 77.29%, 80.52%, and 71.44% for the test sets, respectively. CONCLUSION SWI-based texture analysis might be a reliable quantitative approach for differentiating high-grade ccRCC from low-grade ccRCC.
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Affiliation(s)
- Jun Sun
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, PR China
| | - Liang Pan
- GE Healthcare China, Shanghai, Shanghai, PR China
| | - Tingting Zha
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, PR China
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, PR China
| | - Jie Chen
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, PR China
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Su GY, Xu XQ, Zhou Y, Zhang H, Si Y, Shen MP, Wu FY. Texture analysis of dual-phase contrast-enhanced CT in the diagnosis of cervical lymph node metastasis in patients with papillary thyroid cancer. Acta Radiol 2021; 62:890-896. [PMID: 32757639 DOI: 10.1177/0284185120946711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Computed tomography texture analysis (CTTA) provides objective and quantitative information regarding tumor heterogeneity beyond visual inspection. However, no study has yet used CTTA to differentiate metastatic from non-metastatic cervical lymph node in patients with papillary thyroid cancer (PTC). PURPOSE To evaluate the value of texture analysis of dual-phase contrast-enhanced CT images in diagnosing cervical lymph node metastasis in patients with PTC. MATERIAL AND METHODS Metastatic (n = 27) and non-metastatic (n = 32) cervical lymph nodes were analyzed retrospectively. Texture analyses were performed on both arterial (A) and venous (V) phase CT images. Texture parameters, including mean gray-level intensity, skewness, kurtosis, entropy, and uniformity, were obtained and compared between groups. Receiver operating characteristic (ROC) curves analyses and multivariate logistic regression analysis were used in our study. RESULTS Metastatic lymph nodes showed significantly higher A-mean gray-level intensity, A-entropy, and lower A-kurtosis and V-kurtosis (all P < 0.001) than non-metastatic mimics. The ROC curve analyses indicated that A-kurtosis demonstrated an optimal diagnostic area under the curve (AUC; 0.884) and specificity (92.59%), while the A-mean gray-level intensity showed optimal diagnostic sensitivity (90.62%). Multivariate logistic regression analysis showed that A-mean gray-level intensity (P = 0.006, odds ratio [OR] = 24.297) and V-kurtosis (P = 0.014, OR = 19.651) were the independent predictor for metastatic cervical lymph node. CONCLUSION Dual-phase contrast-enhanced CCTA-especially A-mean gray-level intensity and V-kurtosis-may have the potential to diagnose metastatic cervical lymph node in patients with PTC.
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Affiliation(s)
- Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yan Si
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Mei-Ping Shen
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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26
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Wang YY, Wu Q, Chen L, Chen W, Yang T, Xu XQ, Wu FY, Hu H, Chen HH. Texture analysis of orbital magnetic resonance imaging for monitoring and predicting treatment response to glucocorticoids in patients with thyroid-associated ophthalmopathy. Endocr Connect 2021; 10:676-684. [PMID: 34077388 PMCID: PMC8240707 DOI: 10.1530/ec-21-0162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the value of MRI-based texture analysis of extraocular muscle (EOM) and orbital fat (OF) in monitoring and predicting the response to glucocorticoid (GC) therapy in patients with thyroid-associated ophthalmopathy (TAO). METHODS Thirty-seven active and moderate-to-severe TAO patients (responders, n = 23; unresponders, n = 14) were retrospectively enrolled. MRI-based texture parameters (entropy, uniformity, skewness and kurtosis) of EOM and OF were measured before and after GC therapy, and compared between groups. Correlations between the changes of clinical activity score (CAS) and imaging parameters before and after treatment were assessed. Receiver operating characteristic curves were used to evaluate the predictive value of identified variables. RESULTS Responsive TAOs showed significantly decreased entropy and increased uniformity at EOM and OF after GC therapy (P < 0.01), while unresponders showed no significance. Changes of entropy and uniformity at EOM and OF were significantly correlated with changes of CAS before and after treatment (P < 0.05). Responders showed significantly lower entropy and higher uniformity at EOM than unresponders before treatment (P < 0.01). Entropy and uniformity of EOM and disease duration were identified as independent predictors for responsive TAOs. Combination of all three variables demonstrated optimal efficiency (area under curve, 0.802) and sensitivity (82.6%), and disease duration alone demonstrated optimal specificity (100%) for predicting responsive TAOs. CONCLUSION MRI-based texture analysis can reflect histopathological heterogeneity of orbital tissues. It could be useful for monitoring and predicting the response to GC in TAO patients.
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Affiliation(s)
- Yue-Yue Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Correspondence should be addressed to H Hu or H-H Chen: or
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Correspondence should be addressed to H Hu or H-H Chen: or
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Correspondence should be addressed to H Hu or H-H Chen: or
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Frank V, Shariati S, Budai BK, Fejér B, Tóth A, Orbán V, Bérczi V, Kaposi PN. CT texture analysis of abdominal lesions – Part II: Tumors of the Kidney and Pancreas. IMAGING 2021. [DOI: 10.1556/1647.2021.00020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
AbstractIt has been proven in a few early studies that radiomic analysis offers a promising opportunity to detect or differentiate between organ lesions based on their unique texture parameters. Recently, the utilization of CT texture analysis (CTTA) has been receiving significant attention, especially for response evaluation and prognostication of different oncological diagnoses. In this review article, we discuss the unique ability of radiomics and its subfield CTTA to diagnose lesions in the pancreas and kidney. We review studies in which CTTA was used for the classification of histology grades in pancreas and kidney tumors. We also review the role of radiogenomics in the prediction of the molecular and genetic subtypes of pancreatic tumors. Furthermore, we provide a short report on recent advancements of radiomic analysis in predicting prognosis and survival of patients with pancreatic and renal cancers.
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Affiliation(s)
- Veronica Frank
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Sonaz Shariati
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Bettina Katalin Budai
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Bence Fejér
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Ambrus Tóth
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Vince Orbán
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Viktor Bérczi
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Pál Novák Kaposi
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Faculty of Medicine, Budapest, Hungary
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Tsili AC, Andriotis E, Gkeli MG, Krokidis M, Stasinopoulou M, Varkarakis IM, Moulopoulos LA. The role of imaging in the management of renal masses. Eur J Radiol 2021; 141:109777. [PMID: 34020173 DOI: 10.1016/j.ejrad.2021.109777] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 12/26/2022]
Abstract
The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50 % of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI) is pivotal in diagnosing and characterizing a renal mass, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, imaging data for renal masses that urologists need for accurate treatment planning will be discussed. The role of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of surgically treated or untreated localized RCC will be presented. The role of percutaneous image-guided ablation in the management of RCC will be also reviewed.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece.
| | - Efthimios Andriotis
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Myrsini G Gkeli
- 1st Department of Radiology, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Miltiadis Krokidis
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Myrsini Stasinopoulou
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Ioannis M Varkarakis
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, 15126, Athens, Greece.
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece.
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Bhandari A, Ibrahim M, Sharma C, Liong R, Gustafson S, Prior M. CT-based radiomics for differentiating renal tumours: a systematic review. Abdom Radiol (NY) 2021; 46:2052-2063. [PMID: 33136182 DOI: 10.1007/s00261-020-02832-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Differentiating renal tumours into grades and tumour subtype from medical imaging is important for patient management; however, there is an element of subjectivity when performed qualitatively. Quantitative analysis such as radiomics may provide a more objective approach. The purpose of this article is to systematically review the literature on computed tomography (CT) radiomics for grading and differentiating renal tumour subtypes. An educational perspective will also be provided. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed. PubMed, Scopus and Web of Science were searched for relevant articles. The quality of each study was assessed using the Radiomic Quality Score (RQS). RESULTS 13 studies were found. The main outcomes were prediction of pathological grade and differentiating between renal tumour types, measured as area under the curve (AUC) for either the receiver operator curve or precision recall curve. Features extracted to predict pathological grade or tumour subtype included shape, intensity, texture and wavelet (a type of higher order feature). Four studies differentiated between low-grade and high-grade clear cell renal cell cancer (RCC) with good performance (AUC = 0.82-0.978). One other study differentiated low- and high-grade chromophobe with AUC = 0.84. Finally, eight studies used radiomics to differentiate between tumour types such as clear cell RCC, fat-poor angiomyolipoma, papillary RCC, chromophobe RCC and renal oncocytoma with high levels of performance (AUC 0.82-0.96). CONCLUSION Renal tumours can be pathologically classified using CT-based radiomics with good performance. The main radiomic feature used for tumour differentiation was texture. Fuhrman was the most common pathologic grading system used in the reviewed studies. Renal tumour grading studies should be extended beyond clear cell RCC and chromophobe RCC. Further research with larger prospective studies, performed in the clinical setting, across multiple institutions would help with clinical translation to the radiologist's workstation.
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Hussain MA, Hamarneh G, Garbi R. Learnable image histograms-based deep radiomics for renal cell carcinoma grading and staging. Comput Med Imaging Graph 2021; 90:101924. [PMID: 33895621 DOI: 10.1016/j.compmedimag.2021.101924] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/07/2021] [Accepted: 04/05/2021] [Indexed: 12/11/2022]
Abstract
Fuhrman cancer grading and tumor-node-metastasis (TNM) cancer staging systems are typically used by clinicians in the treatment planning of renal cell carcinoma (RCC), a common cancer in men and women worldwide. Pathologists typically use percutaneous renal biopsy for RCC grading, while staging is performed by volumetric medical image analysis before renal surgery. Recent studies suggest that clinicians can effectively perform these classification tasks non-invasively by analyzing image texture features of RCC from computed tomography (CT) data. However, image feature identification for RCC grading and staging often relies on laborious manual processes, which is error prone and time-intensive. To address this challenge, this paper proposes a learnable image histogram in the deep neural network framework that can learn task-specific image histograms with variable bin centers and widths. The proposed approach enables learning statistical context features from raw medical data, which cannot be performed by a conventional convolutional neural network (CNN). The linear basis function of our learnable image histogram is piece-wise differentiable, enabling back-propagating errors to update the variable bin centers and widths during training. This novel approach can segregate the CT textures of an RCC in different intensity spectra, which enables efficient Fuhrman low (I/II) and high (III/IV) grading as well as RCC low (I/II) and high (III/IV) staging. The proposed method is validated on a clinical CT dataset of 159 patients from The Cancer Imaging Archive (TCIA) database, and it demonstrates 80% and 83% accuracy in RCC grading and staging, respectively.
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Affiliation(s)
| | - Ghassan Hamarneh
- Medical Image Analysis Lab, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
| | - Rafeef Garbi
- BiSICL, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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Assessment of Renal Cell Carcinoma by Texture Analysis in Clinical Practice: A Six-Site, Six-Platform Analysis of Reliability. AJR Am J Roentgenol 2021; 217:1132-1140. [PMID: 33852355 DOI: 10.2214/ajr.21.25456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Multiple commercial and open-source software applications are available for texture analysis. Nonstandard techniques can cause undesirable variability that impedes result reproducibility and limits clinical utility. Objective: The purpose of this study is to measure agreement of texture metrics extracted by 6 software packages. Methods: This retrospective study included 40 renal cell carcinomas with contrast-enhanced CT from The Cancer Genome Atlas and Imaging Archive. Images were analyzed by 7 readers at 6 sites. Each reader used 1 of 6 software packages to extract commonly studied texture features. Inter and intra-reader agreement for segmentation was assessed with intra-class correlation coefficients. First-order (available in 6 packages) and second-order (available in 3 packages) texture features were compared between software pairs using Pearson correlation. Results: Inter- and intra-reader agreement was excellent (ICC 0.93-1). First-order feature correlations were strong (r>0.8, p<0.001) between 75% (21/28) of software pairs for mean and standard deviation, 48% (10/21) for entropy, 29% (8/28) for skewness, and 25% (7/28) for kurtosis. Of 15 second-order features, only co-occurrence matrix correlation, grey-level non-uniformity, and run-length non-uniformity showed strong correlation between software packages (0.90-1, p<0.001). Conclusion: Variability in first and second order texture features was common across software configurations and produced inconsistent results. Standardized algorithms and reporting methods are needed before texture data can be reliably used for clinical applications. Clinical Impact: It is important to be aware of variability related to texture software processing and configuration when reporting and comparing outputs.
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Lai S, Sun L, Wu J, Wei R, Luo S, Ding W, Liu X, Yang R, Zhen X. Multiphase Contrast-Enhanced CT-Based Machine Learning Models to Predict the Fuhrman Nuclear Grade of Clear Cell Renal Cell Carcinoma. Cancer Manag Res 2021; 13:999-1008. [PMID: 33568946 PMCID: PMC7869703 DOI: 10.2147/cmar.s290327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/08/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the predictive performance of different machine learning models for the discrimination of low and high nuclear grade clear cell renal cell carcinoma (ccRCC) by using multiphase computed tomography (CT)-based radiomic features. Materials and Methods A total of 137 consecutive patients with pathologically proven ccRCC (including 96 low-grade [grade 1 or 2] and 41 high-grade [grade 3 or 4] ccRCC) from January 2011 to January 2019 were enrolled in this retrospective study. Target region of interest (ROI) delineation followed by texture extraction was performed on a representative slice with the largest section of the tumor on the four-phase (unenhanced phase [UP], corticomedullary phase [CMP], nephrographic phase [NP] and excretory phase [EP]) CT images. Fifteen concatenations of the four-phase features were fed into 176 classification models (built with 8 classifiers and 22 feature selection methods), the classification performances of the 2640 resultant discriminative models were compared, and the top-ranked features were analyzed. Results Image features extracted from the unenhanced phase (UP) CT images demonstrated a dominant classification performance over features from the other three phases. The discriminative model "Bagging + CMIM" achieved the highest classification AUC of 0.75. The top-ranked features from the UP included one shape-based feature and five first-order statistical features. Conclusion Image features extracted from the UP are more effective than other CT phases in differentiating low and high nuclear grade ccRCC based on machine learning-based classification modeling.
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Affiliation(s)
- Shengsheng Lai
- School of Medical Equipment, Guangdong Food and Drug Vocational College, Guangzhou, Guangdong, 510520, People's Republic of China
| | - Lei Sun
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Jialiang Wu
- Department of Radiology, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, 518000, People's Republic of China
| | - Ruili Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, People's Republic of China
| | - Shiwei Luo
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, People's Republic of China
| | - Wenshuang Ding
- Department of Pathology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, People's Republic of China
| | - Xilong Liu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Ruimeng Yang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, People's Republic of China
| | - Xin Zhen
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
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Campi R, Stewart GD, Staehler M, Dabestani S, Kuczyk MA, Shuch BM, Finelli A, Bex A, Ljungberg B, Capitanio U. Novel Liquid Biomarkers and Innovative Imaging for Kidney Cancer Diagnosis: What Can Be Implemented in Our Practice Today? A Systematic Review of the Literature. Eur Urol Oncol 2021; 4:22-41. [DOI: 10.1016/j.euo.2020.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/26/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022]
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Nicolau C, Antunes N, Paño B, Sebastia C. Imaging Characterization of Renal Masses. ACTA ACUST UNITED AC 2021; 57:medicina57010051. [PMID: 33435540 PMCID: PMC7827903 DOI: 10.3390/medicina57010051] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 01/10/2023]
Abstract
The detection of a renal mass is a relatively frequent occurrence in the daily practice of any Radiology Department. The diagnostic approaches depend on whether the lesion is cystic or solid. Cystic lesions can be managed using the Bosniak classification, while management of solid lesions depends on whether the lesion is well-defined or infiltrative. The approach to well-defined lesions focuses mainly on the differentiation between renal cancer and benign tumors such as angiomyolipoma (AML) and oncocytoma. Differential diagnosis of infiltrative lesions is wider, including primary and secondary malignancies and inflammatory disease, and knowledge of the patient history is essential. Radiologists may establish a possible differential diagnosis based on the imaging features of the renal masses and the clinical history. The aim of this review is to present the contribution of the different imaging techniques and image guided biopsies in the diagnostic management of cystic and solid renal lesions.
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Affiliation(s)
- Carlos Nicolau
- Radiology Department, Hospital Clinic, University of Barcelona (UB), 08036 Barcelona, Spain; (B.P.); (C.S.)
- Correspondence:
| | - Natalie Antunes
- Radiology Department, Hospital de Santa Marta, 1169-024 Lisboa, Portugal;
| | - Blanca Paño
- Radiology Department, Hospital Clinic, University of Barcelona (UB), 08036 Barcelona, Spain; (B.P.); (C.S.)
| | - Carmen Sebastia
- Radiology Department, Hospital Clinic, University of Barcelona (UB), 08036 Barcelona, Spain; (B.P.); (C.S.)
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Ni XQ, Yin HK, Fan GH, Shi D, Xu L, Jin D. Differentiation of pulmonary sclerosing pneumocytoma from solid malignant pulmonary nodules by radiomic analysis on multiphasic CT. J Appl Clin Med Phys 2020; 22:158-164. [PMID: 33369106 PMCID: PMC7882110 DOI: 10.1002/acm2.13154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose To investigate the diagnostic value and feasibility of radiomics‐based texture analysis in differentiating pulmonary sclerosing pneumocytoma (PSP) from solid malignant pulmonary nodules (SMPN) on single‐ and three‐phase computed tomography (CT) images. Materials and Methods A total of 25 PSP patients and 35 SMPN patients with pathologically confirmed results were retrospectively included in this study. For each patient, the tumor regions were manually labeled in images acquired at the noncontrast phase (NCP), arterial phase (AP), and venous phase (VP). The least absolute shrinkage and selection operator (LASSO) method was used to select the most useful predictive features extracted from the CT images. The predictive models that discriminate PSP from SMPN based on single‐phase CT images (NCP, AP, and VP) or three‐phase CT images (Combined model) were developed and validated through fivefold cross‐validation using a logistic regression classifier. Model performance was evaluated using receiver operating characteristic (ROC) analysis. The predictive performance was also compared between the Combined model and human readers. Results Four, five, and five features were selected from NCP, AP, and VP CT images for the development of radiomic models, respectively. The NCP, AP, and VP models exhibited areas under the curve (AUCs) of 0.748 (95% confidence interval [CI], 0.620–0.852), 0.749 (95% CI, 0.620–0.852), and 0.790 (95% CI, 0.665–0.884) in the validation dataset, respectively. The Combined model based on three‐phase CT images outperformed the NCP, AP, and VP models (all p < 0.05), yielding an AUC of 0.882 (95% CI, 0.773–0.951) in the validation dataset. The Combined model displayed noninferior performance compared to two senior radiologists; however, it outperformed two junior radiologists (p = 0.004 and 0.001, respectively). Conclusion The Combined model based on radiomic features extracted from three‐phase CT images achieved radiologist‐level performance and could be used as promising noninvasive tool to differentiate PSP from SMPN.
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Affiliation(s)
- Xiao-Qiong Ni
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong-Kun Yin
- Beijing Infervision Technology Co.,Ltd, Beijing, China
| | - Guo-Hua Fan
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Dai Shi
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Liang Xu
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Dan Jin
- The Second Affiliated Hospital of Soochow University, Suzhou, China
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Liang P, Xu C, Tan F, Li S, Chen M, Hu D, Kamel I, Duan Y, Li Z. Prediction of the World Health Organization Grade of rectal neuroendocrine tumors based on CT histogram analysis. Cancer Med 2020; 10:595-604. [PMID: 33263225 PMCID: PMC7877354 DOI: 10.1002/cam4.3628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/19/2020] [Accepted: 11/10/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To investigate the diagnostic value of contrast-enhanced computed tomography (CECT) histogram analysis in predicting the World Health Organization (WHO) grade of rectal neuroendocrine tumors (R-NETs). MATERIALS AND METHODS A total of 61 (35 G1, 12 G2, 10 G3, and 4 NECs) patients who underwent preoperative CECT and treated with surgery to be confirmed as R-NETs were included in this study from January 2014 to May 2019. We depicted ROIs and measured the CECT texture parameters (mean, median, 10th, 25th, 75th, 90th percentiles, skewness, kurtosis, and entropy) from arterial phase (AP) and venous phase (VP) images by two radiologists. We calculated intraclass correlation coefficient (ICC) and compared the histogram parameters between low-grade (G1) and higher grade (HG) (G2/G3/NECs) by applying appropriate statistical method. We obtained the optimal parameters to identify G1 from HG using receiver operating characteristic (ROC) curves. RESULTS The capability of AP and VP histogram parameters for differentiating G1 from HG was similar in several histogram parameters (mean, median, 10th, 25th, 75th, and 90th percentiles) (all p < 0.001). Skewness, kurtosis, and entropy on AP images showed no significant differences between G1 and HG (p = 0.853, 0.512, 0.557, respectively). Entropy on VP images was significantly different (p = 0.017) between G1 and HG, however, skewness and kurtosis showed no significant differences (p = 0.654, 0.172, respectively). ROC analysis showed a good predictive performance between G1 and HG, and the 75th (AP) generated the highest area under the curve (AUC = 0.871), followed by the 25th (AP), mean (VP), and median (VP) (AUC = 0.864). Combined the size of tumor and the 75th (AP) generated the highest AUC. CONCLUSIONS CECT histogram parameters, including arterial and venous phases, can be used as excellent indicators for predicting G1 and HG of rectal neuroendocrine tumors, and the size of the tumor is also an important independent predictor.
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Affiliation(s)
- Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chuou Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fangqin Tan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingzhen Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ihab Kamel
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Yaqi Duan
- Department of Pathology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Kang B, Sun C, Gu H, Yang S, Yuan X, Ji C, Huang Z, Yu X, Duan S, Wang X. T1 Stage Clear Cell Renal Cell Carcinoma: A CT-Based Radiomics Nomogram to Estimate the Risk of Recurrence and Metastasis. Front Oncol 2020; 10:579619. [PMID: 33251142 PMCID: PMC7672185 DOI: 10.3389/fonc.2020.579619] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives To develop and validate a radiomics nomogram to improve prediction of recurrence and metastasis risk in T1 stage clear cell renal cell carcinoma (ccRCC). Methods This retrospective study recruited 168 consecutive patients (mean age, 53.9 years; range, 28–76 years; 43 women) with T1 ccRCC between January 2012 and June 2019, including 50 aggressive ccRCC based on synchronous metastasis or recurrence after surgery. The patients were divided into two cohorts (training and validation) at a 7:3 ratio. Radiomics features were extracted from contrast enhanced CT images. A radiomics signature was developed based on reproducible features by means of the least absolute shrinkage and selection operator method. Demographics, laboratory variables (including sex, age, Fuhrman grade, hemoglobin, platelet, neutrophils, albumin, and calcium) and CT findings were combined to develop clinical factors model. Integrating radiomics signature and independent clinical factors, a radiomics nomogram was developed. Nomogram performance was determined by calibration, discrimination, and clinical usefulness. Results Ten features were used to build radiomics signature, which yielded an area under the curve (AUC) of 0.86 in the training cohort and 0.85 in the validation cohort. By incorporating the sex, maximum diameter, neutrophil count, albumin count, and radiomics score, a radiomics nomogram was developed. Radiomics nomogram (AUC: training, 0.91; validation, 0.92) had higher performance than clinical factors model (AUC: training, 0.86; validation, 0.90) or radiomics signature as a means of identifying patients at high risk for recurrence and metastasis. The radiomics nomogram had higher sensitivity than clinical factors mode (McNemar’s chi-squared = 4.1667, p = 0.04) and a little lower specificity than clinical factors model (McNemar’s chi-squared = 3.2, p = 0.07). The nomogram showed good calibration. Decision curve analysis demonstrated the superiority of the nomogram compared with the clinical factors model in terms of clinical usefulness. Conclusion The CT-based radiomics nomogram could help in predicting recurrence and metastasis risk in T1 ccRCC, which might provide assistance for clinicians in tailoring precise therapy.
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Affiliation(s)
- Bing Kang
- School of Medicine, Shandong University, Jinan, China.,Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Cong Sun
- Department of Radiology, Shandong Medical Imaging Research Institute, Jinan, China
| | - Hui Gu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Shifeng Yang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xianshun Yuan
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Congshan Ji
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhaoqin Huang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xinxin Yu
- School of Medicine, Shandong University, Jinan, China.,Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | | | - Ximing Wang
- School of Medicine, Shandong University, Jinan, China.,Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Duan C, Li N, Niu L, Wang G, Zhao J, Liu F, Liu X, Ren Y, Zhou X. CT texture analysis for the differentiation of papillary renal cell carcinoma subtypes. Abdom Radiol (NY) 2020; 45:3860-3868. [PMID: 32444891 DOI: 10.1007/s00261-020-02588-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The objective of this study was to investigate whether computed tomography texture analysis can be used to differentiate papillary renal cell carcinoma (PRCC) subtypes. METHOD Sixty-two PRCC tumors were retrospectively evaluated, with 30 type 1 tumors and 32 type 2 tumors. Texture parameters quantified from three-phase contrast-enhanced CT images were compared with least absolute shrinkage and selection operator (LASSO) regression. Receiver operating characteristic (ROC) analysis was performed, and the area under the ROC curve (AUC) was calculated for each parameter. The selected texture parameters of each phase were used to generate support vector machine (SVM) classifiers. Decision curve analysis (DCA) of the classification was performed. RESULTS The two texture parameters with the top two AUC values were - 333-7 Correlation (AUC = 0.772) and 45-7 Entropy (AUC = 0.753) in the corticomedullary phase, 333-4 Correlation (AUC = 0.832) and 45-7 Entropy (AUC = 0.841) in the nephrographic phase, and 135-7 Entropy (AUC = 0.858) and - 333-1 InformationMeasureCorr2 (AUC = 0.849) in the excretory phase. Entropy and Correlation have a high correlation with the two types of PRCC and are increased in type 2 PRCC. A model incorporating the texture parameters with the top two AUC values in each phase produced an AUC of 0.922 with an accuracy of 84% (sensitivity = 89% and specificity = 80%). The nephrographic-phase model and the model combining the texture parameters of the three phases can differentiate the two types with the largest net benefit. CONCLUSIONS Computed tomography texture analysis can be used to distinguish type 2 PRCC from type 1 with high accuracy, which may be clinically important.
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Affiliation(s)
- Chongfeng Duan
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Nan Li
- Department of Information Management, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Niu
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Gang Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Jiping Zhao
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Fang Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Xuejun Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Yande Ren
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Xiaoming Zhou
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China.
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Nguyen K, Schieda N, James N, McInnes MDF, Wu M, Thornhill RE. Effect of phase of enhancement on texture analysis in renal masses evaluated with non-contrast-enhanced, corticomedullary, and nephrographic phase-enhanced CT images. Eur Radiol 2020; 31:1676-1686. [PMID: 32914197 DOI: 10.1007/s00330-020-07233-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/14/2020] [Accepted: 08/27/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To compare texture analysis (TA) features of solid renal masses on renal protocol (non-contrast enhanced [NECT], corticomedullary [CM], nephrographic [NG]) CT. MATERIALS AND METHODS A total of 177 consecutive solid renal masses (116 renal cell carcinoma [RCC]; 51 clear cell [cc], 40 papillary, 25 chromophobe, and 61 benign masses; 49 oncocytomas, 12 fat-poor angiomyolipomas) with three-phase CT between 2012 and 2017 were studied. Two blinded radiologists independently assessed tumor heterogeneity (5-point Likert scale) and segmented tumors. TA features (N = 25) were compared between groups and between phases. Accuracy (area under the curve [AUC]) for RCC versus benign and cc-RCC versus other masses was compared. RESULTS Subjectively, tumor heterogeneity differed between phases (p < 0.01) and between tumors within the same phase (p = 0.03 [NECT] and p < 0.01 [CM, NG]). Inter-observer agreement was moderate to substantial (intraclass correlation coefficient = 0.55-0.73). TA differed in 92.0% (23/25) features between phases (p < 0.05) except for GLNU and f6. More TA features differed significantly on CM (80.0% [20/25]) compared with NG (40.0% [10/25]) and NECT (16.0% [4/25]) (p < 0.01). For RCC versus benign, AUCs of texture features did not differ comparing CM and NG (p > 0.05), but were higher for 20% (5/25) and 28% (7/25) of features comparing CM and NG with NECT (p < 0.05). For cc-RCC versus other, 36% (9/25) and 40% (10/25) features on CM had higher AUCs compared with NECT and NG images (p < 0.05). CONCLUSION Texture analysis of renal masses differs, when evaluated subjectively and quantitatively, by phase of CT enhancement. The corticomedullary phase had the highest discriminatory value when comparing masses and for differentiating cc-RCC from other masses. KEY POINTS • Subjectively evaluated renal tumor heterogeneity on CT differs by phase of enhancement. • Quantitative CT texture analysis features in renal tumors differ by phases of enhancement with the corticomedullary phase showing the highest number and most significant differences compared with non-contrast-enhanced and nephrographic phase images. • For diagnosis of clear cell RCC, corticomedullary phase texture analysis features had improved accuracy of classification in approximately 40% of features studied compared with non-contrast-enhanced and nephrographic phase images.
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Affiliation(s)
- Kathleen Nguyen
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada.
| | - Nick James
- Software Solutions, The Ottawa Hospital, Ottawa, Canada
| | - Matthew D F McInnes
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada
| | - Mark Wu
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada
| | - Rebecca E Thornhill
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada
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Negreros-Osuna AA, Parakh A, Corcoran RB, Pourvaziri A, Kambadakone A, Ryan DP, Sahani DV. Radiomics Texture Features in Advanced Colorectal Cancer: Correlation with BRAF Mutation and 5-year Overall Survival. Radiol Imaging Cancer 2020; 2:e190084. [PMID: 33778733 PMCID: PMC7983710 DOI: 10.1148/rycan.2020190084] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/31/2020] [Accepted: 05/06/2020] [Indexed: 04/11/2023]
Abstract
PURPOSE To explore the potential of radiomics texture features as potential biomarkers to enable detection of the presence of BRAF mutation and prediction of 5-year overall survival (OS) in stage IV colorectal cancer (CRC). MATERIALS AND METHODS In this retrospective study, a total of 145 patients (mean age, 61 years ± 14 [standard deviation {SD}]; 68 female patients and 77 male patients) with stage IV CRC who underwent molecular profiling and pretreatment contrast material-enhanced CT scans between 2004 and 2018 were included. Tumor radiomics texture features, including the mean, the SD, the mean value of positive pixels (MPP), skewness, kurtosis, and entropy, were extracted from regions of interest on CT images after applying three Laplacian-of-Gaussian filters known as spatial scaling factors (SSFs) (SSF = 2, fine; SSF = 4, medium; SSF = 6, coarse) by using specialized software; values of these parameters were also obtained without filtration (SSF = 0). The Wilcoxon rank sum test was used to assess differences between mutated versus wild-type BRAF tumors. Associations between radiomics texture features and 5-year OS were determined by using Kaplan-Meier estimators using the log-rank test and multivariate Cox proportional-hazards regression analysis. RESULTS The SDs and MPPs of radiomic texture features were significantly lower in BRAF mutant tumors than in wild-type BRAF tumors at SSFs of 0, 4, and 6 (P = .006, P = .007, and P = .005, respectively). Patients with skewness less than or equal to -0.75 at an SSF of 0 and a mean of greater than or equal to 17.76 at an SSF of 2 showed better 5-year OS (hazard ratio [HR], 0.53 [95% confidence interval {CI}: 0.29, 0.94]; HR, 0.40 [95% CI: 0.22, 0.71]; log-rank P = .025 and P = .002, respectively). Tumor location (right colon vs left colon vs rectum) had no significant impact on the clinical outcome (log-rank P = .53). CONCLUSION Radiomics texture features can serve as potential biomarkers for determining BRAF mutation status and as predictors of 5-year OS in patients with advanced-stage CRC.Keywords: Abdomen/GI, CT, Comparative Studies, Large BowelSupplemental material is available for this article.© RSNA, 2020.
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MRI radiomics-based nomogram for individualised prediction of synchronous distant metastasis in patients with clear cell renal cell carcinoma. Eur Radiol 2020; 31:1029-1042. [PMID: 32856163 DOI: 10.1007/s00330-020-07184-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/30/2020] [Accepted: 08/12/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the performance of a multiparametric MRI radiomics-based nomogram for the individualised prediction of synchronous distant metastasis (SDM) in patients with clear cell renal cell carcinoma (ccRCC). METHODS Two-hundred and one patients (training cohort: n = 126; internal validation cohort: n = 39; external validation cohort: n = 36) with ccRCC were retrospectively enrolled between January 2013 and June 2019. In the training cohort, the optimal MRI radiomics features were selected and combined to calculate the radiomics score (Rad-score). Incorporating Rad-score and SDM-related clinicoradiologic characteristics, the radiomics-based nomogram was established by multivariable logistic regression analysis, then the performance of the nomogram (discrimination and clinical usefulness) was evaluated and validated subsequently. Moreover, the prediction efficacy for SDM in ccRCC subgroups of different sizes was also assessed. RESULTS Incorporating Rad-score derived from 9 optimal MR radiomics features (age, pseudocapsule and regional lymph node), the radiomics-based nomogram was capable of predicting SDM in the training cohort (area under the ROC curve (AUC) = 0.914) and validated in both the internal and external cohorts (AUC = 0.854 and 0.816, respectively) and also showed a convincing predictive power in ccRCC subgroups of different sizes (≤ 4 cm, AUC = 0.875; 4-7 cm, AUC = 0.891; 7-10 cm, 0.908; > 10 cm, AUC = 0.881). Decision curve analysis indicated that the radiomics-based nomogram is of clinical usefulness. CONCLUSIONS The multiparametric MRI radiomics-based nomogram could achieve precise individualised prediction of SDM in patients with ccRCC, potentially improving the management of ccRCC. KEY POINTS • Radiomics features derived from multiparametric magnetic resonance images showed relevant association with synchronous distant metastasis in clear cell renal cell carcinoma. • MRI radiomics-based nomogram may serve as a potential tool for the risk prediction of synchronous distant metastasis in clear cell renal cell carcinoma.
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Zhou Y, Su GY, Hu H, Ge YQ, Si Y, Shen MP, Xu XQ, Wu FY. Radiomics analysis of dual-energy CT-derived iodine maps for diagnosing metastatic cervical lymph nodes in patients with papillary thyroid cancer. Eur Radiol 2020; 30:6251-6262. [PMID: 32500193 DOI: 10.1007/s00330-020-06866-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/14/2020] [Accepted: 04/06/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the value of radiomics analysis of dual-energy computed tomography (DECT)-derived iodine maps for preoperative diagnosing cervical lymph nodes (LNs) metastasis in patients with papillary thyroid cancer (PTC). METHODS Two hundred and fifty-five LNs (143 non-metastatic and 112 metastatic) were enrolled and allocated to training and validation sets (7:3 ratio). Radiomics features were extracted from arterial and venous phase iodine maps, respectively. Radiomics signature was constructed based on reproducible features using the least absolute shrinkage and selection operator (LASSO) logistic regression algorithm with 10-fold cross-validation. Logistic regression modeling was employed to build models based on CT image features (model 1), radiomics signature (model 2), and the combined (model 3). A nomogram was plotted for the combined model and decision curve analysis was applied for clinical use. Diagnostic performance was assessed and compared. Internal validation was performed on an independent set containing 78 LNs. RESULTS Model 3 showed optimal diagnostic performance in both training (AUC = 0.933) and validation set (AUC = 0.895), followed by model 2 (training set, AUC = 0.910; validation set, AUC = 0.847). Both these two models outperformed model 1 in both training (AUC = 0.763) (p < 0.05) and validation set (AUC = 0.728) (p < 0.05). CONCLUSION Radiomics analysis of DECT-derived iodine maps showed better diagnostic performance than qualitative evaluation of CT image features in preoperative diagnosing cervical LN metastasis in PTC patients. Radiomics signature integrated with CT image features can serve as a promising imaging biomarker for the differentiation. KEY POINTS • Conventional CT image features have limited value for the diagnosis of metastatic LNs in PTC patients. • Radiomics analysis of dual-energy CT-derived iodine maps significantly outperformed qualitative CT image features in differentiating metastatic from non-metastatic LNs. • Radiomics signature integrated with qualitative CT image features can serve as a useful tool in judging LNs status, thus aiding clinical decision-making.
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Affiliation(s)
- Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, 210029, People's Republic of China
| | - Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, 210029, People's Republic of China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, 210029, People's Republic of China
| | - Ying-Qian Ge
- Siemens Healthineers, Shanghai, People's Republic of China
| | - Yan Si
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Mei-Ping Shen
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, 210029, People's Republic of China.
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, 210029, People's Republic of China.
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Wang W, Cao K, Jin S, Zhu X, Ding J, Peng W. Differentiation of renal cell carcinoma subtypes through MRI-based radiomics analysis. Eur Radiol 2020; 30:5738-5747. [PMID: 32367419 DOI: 10.1007/s00330-020-06896-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/02/2020] [Accepted: 04/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To explore whether clear cell renal cell carcinoma (ccRCC), papillary renal cell carcinoma (pRCC), and chromophobe renal cell carcinoma (cRCC) can be distinguished using radiomics features extracted from magnetic resonance (MR) images. METHODS Seventy-seven patients (ccRCC = 32, pRCC = 23, cRCC = 22) underwent MRI before surgery between May 2013 and August 2018 in this retrospective study. Thirty-nine radiomics features were extracted from tumor volumes on three sequences (T2WI, EN-T1WI CMP, and EN-T1WI NP). The Kruskal-Wallis test with Bonferonni correction and variance threshold were used for feature selection among the three RCC subtypes. ROC curves for the three subtypes were generated based on radiomics features. AUC, accuracy, sensitivity, and specificity for subtype differentiation are reported. Linear discriminant analysis (LDA) was used to assess the discriminative ability of these radiomics features. RESULTS Significant radiomics features among the three subtypes were identified, and ROC curves achieved excellent AUCs for T2WI, EN-T1WI CMP, EN-T1WI NP, and combined three MR sequences (0.631, 0.790, 0.959, and 0.959 between ccRCC and cRCC; 0.688, 0.854, 0.909, and 0.955 between pRCC and cRCC; 0.747, 0.810, 0.814, and 0.890 between ccRCC and pRCC). In addition, LDA demonstrated the three RCC subtypes were correctly classified by radiomics analysis (66.2% for EN-T1WI CMP, 71.4% for EN-T1WI NP, 55.8% for T2WI, and 71.4% for the combined three MR sequences). CONCLUSIONS Radiomics analysis can be used to differentiate among ccRCC, pRCC, and cRCC based on radiomics features extracted from multiple-sequence MRI and may help diagnose and treat RCC patients in the future, while further study is still needed. KEY POINTS • Radiomics features on multiple-sequence MRI can help differentiate the three subtypes of renal cell carcinoma (clear cell, papillary renal cell, and chromophobe renal cell carcinoma). • Radiomics features based on MRI indicate greater textural heterogeneity on ccRCCs than pRCCs and cRCCs (the highest AUCs on EN-T1WI NP are 0.814 for ccRCCs vs pRCCs and 0.959 for ccRCCs vs cRCCs, respectively). • There is a significant difference in the textural heterogeneity of radiomics features between pRCCs and cRCCs (the AUC is 0.909, 0.854, and 0.688 on EN-T1WI NP, EN-T1WI CMP, and T2WI, respectively).
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Affiliation(s)
- Wei Wang
- Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China.
| | - KaiMing Cao
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, No. 150, Jimo Rd, Shanghai, 200120, People's Republic of China
| | - ShengMing Jin
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China.,Department of Urology, Fudan University Shanghai Cancer Center (FUSCC), No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China
| | - XiaoLi Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China.,Department of Pathology, Fudan University Shanghai Cancer Center (FUSCC), No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China
| | - JianHui Ding
- Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China
| | - WeiJun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China
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Wang Z, He Y, Wang N, Zhang T, Wu H, Jiang X, Mo L. Clinical value of texture analysis in differentiation of urothelial carcinoma based on multiphase computed tomography images. Medicine (Baltimore) 2020; 99:e20093. [PMID: 32358396 PMCID: PMC7440185 DOI: 10.1097/md.0000000000020093] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Identification of histologic grading of urothelial carcinoma still depends on histopathologic examination. As an emerging and promising imaging technology, radiomic texture analysis is a noninvasive technique and has been studied to differentiate various tumors. This study explored the value of computed tomography (CT) texture analysis for the differentiation of low-grade urothelial carcinoma (LGUC), high-grade urothelial carcinoma (HGUC), and their invasive properties.Radiologic data were analyzed retrospectively for 94 patients with pathologically proven urothelial carcinomas from November 2016 to April 2019. Pathologic examination demonstrated that tumors were: high grade in 43 cases, and low grade in 51 cases; and nonmuscle invasive (NMI) in 37 cases, and muscle invasive (MI) in 37 cases. Maximum tumor diameters on CT scan were manually outlined as regions of interest and 78 texture features were extracted automatically. Three-phasic CT images were used to measure texture parameters, which were compared with postoperative pathologic grading and invasive results. The independent sample t test or Mann-Whitney U test was used to compare differences in parameters. Receiver-operating characteristic curves for statistically significant parameters were used to confirm efficacy.Of the 78 features extracted from each phase of CT images, 26 (33%), 20 (26%), and 22 (28%) texture parameters were significant (P < .05) for differentiating LGUC from HGUC, while 19 (24%), 16 (21%), and 30 (38%) were significant (P < .05) for differentiating NMI from MI urothelial carcinoma. Highest areas the under curve for differentiating grading and invasive properties were obtained by variance (0.761, P < .001) and correlation (0.798, P < .001) on venous-phase CT images.Texture analysis has the potential to distinguish LGUC and HGUC, or NMI from MI urothelial carcinoma, before surgery.
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Affiliation(s)
- Zihua Wang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yufang He
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology
| | - Nianhua Wang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology
| | - Ting Zhang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology
| | - Hongzhen Wu
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology
| | - Xinqing Jiang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lei Mo
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
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Cui E, Li Z, Ma C, Li Q, Lei Y, Lan Y, Yu J, Zhou Z, Li R, Long W, Lin F. Predicting the ISUP grade of clear cell renal cell carcinoma with multiparametric MR and multiphase CT radiomics. Eur Radiol 2020; 30:2912-2921. [PMID: 32002635 DOI: 10.1007/s00330-019-06601-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/13/2019] [Accepted: 11/26/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate externally validated magnetic resonance (MR)-based and computed tomography (CT)-based machine learning (ML) models for grading clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS Patients with pathologically proven ccRCC in 2009-2018 were retrospectively included for model development and internal validation; patients from another independent institution and The Cancer Imaging Archive dataset were included for external validation. Features were extracted from T1-weighted, T2-weighted, corticomedullary-phase (CMP), and nephrographic-phase (NP) MR as well as precontrast-phase (PCP), CMP, and NP CT. CatBoost was used for ML-model investigation. The reproducibility of texture features was assessed using intraclass correlation coefficient (ICC). Accuracy (ACC) was used for ML-model performance evaluation. RESULTS Twenty external and 440 internal cases were included. Among 368 and 276 texture features from MR and CT, 322 and 250 features with good to excellent reproducibility (ICC ≥ 0.75) were included for ML-model development. The best MR- and CT-based ML models satisfactorily distinguished high- from low-grade ccRCCs in internal (MR-ACC = 73% and CT-ACC = 79%) and external (MR-ACC = 74% and CT-ACC = 69%) validation. Compared to single-sequence or single-phase images, the classifiers based on all-sequence MR (71% to 73% in internal and 64% to 74% in external validation) and all-phase CT (77% to 79% in internal and 61% to 69% in external validation) images had significant increases in ACC. CONCLUSIONS MR- and CT-based ML models are valuable noninvasive techniques for discriminating high- from low-grade ccRCCs, and multiparameter MR- and multiphase CT-based classifiers are potentially superior to those based on single-sequence or single-phase imaging. KEY POINTS • Both the MR- and CT-based machine learning models are reliable predictors for differentiating high- from low-grade ccRCCs. • ML models based on multiparameter MR sequences and multiphase CT images potentially outperform those based on single-sequence or single-phase images in ccRCC grading.
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Affiliation(s)
- Enming Cui
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Zhuoyong Li
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Changyi Ma
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Qing Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, 518035, China
| | - Yong Lan
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Juan Yu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, 518035, China
| | - Zhipeng Zhou
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Ronggang Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China.
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, 518035, China.
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Wu G, Xie R, Li Y, Hou B, Morelli JN, Li X. Histogram analysis with computed tomography angiography for discriminating soft tissue sarcoma from benign soft tissue tumor. Medicine (Baltimore) 2020; 99:e18742. [PMID: 31914093 PMCID: PMC6959892 DOI: 10.1097/md.0000000000018742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To investigate the feasibility of histogram analysis with computed tomography angiography (CTA) in distinguishing between soft tissue sarcomas and benign soft tissue tumors. Fourty nine patients (23 men, mean age = 44.3 years, age range = 25-64) with pathologically-confirmed soft tissue sarcoma (n = 24) or benign soft tissue tumors (n = 25) in the lower extremities undergoing CTA for tumor evaluation were retrospectively analyzed. Two radiologists separately performed histogram analyses of CT density with CTA images by drawing a region of interest (ROI). The 10th (P10), 25th (P25), 50th (P50), 75th (P75), 90th percentiles (P90), mean, and standard deviations (SD) of measured tumor density were obtained along with measurements of the absolute value of kurtosis (AVK), absolute value of skewness (AVS), and inhomogeneity for each tumor. Intra-class correlation coefficients (ICC) were calculated to determine inter- and intra-reader variability in parameter measurements. The Mann-Whitney U test was used to compare histogram parameters between soft tissue sarcomas and benign soft tissue tumors. Receiver operator characteristic (ROC) curves were constructed to evaluate the accuracy of tumor discrimination. ICC was greater than 0.7 for AVS, AVK, and inhomogeneity, and >0.9 for mean, SD, and all percentile measures. There was no significant difference in P10, P25, P50, P75, P90, mean, or SD between soft tissue sarcomas and benign tumors (P > .05). AVS, AVK, and inhomogeneity were significantly higher in soft tissue sarcomas (P < .05). Areas under the curve (AUC) were 0.81, 0.83, and 0.84 for AVS, AVK, and inhomogeneity respectively. AUC were below 0.6 for mean, SD, and all percentiles.Skewness, kurtosis, and inhomogeneity measurements derived from histogram analysis from CTA distinguish between soft tissue sarcomas and benign soft tissue tumors.
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Affiliation(s)
- Gang Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruyi Xie
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yitong Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bowen Hou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Xiaoming Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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